Paediatric Suction:

Paediatric Suction:
Nasopharyngeal/ ETT/
Tracheostomy
By Andrea Wood
Clinical Specialist Physiotherapist
RHSC

Indications
Audible secretions, unable to clear themselves.
Inspiratiroy Crackles on Auscultation.
Increased signs of Respiratory Distress.
Palpable secretions.
Reduced O2O
Saturations
Ventilated – Raised PIP, ETCO2 or reduced volumes.
Audible secretion on Manual ventilation in a ventilated
child.

CONTRAINDICATION/CAUTIONS
Coagulpathy.
Patient expectorating independently.
Stridor (if not intubated)
Cardiovascular instability.
Nasal suction in patients with CSF Leak
Nasal Suction in patients with facial fractures/trauma.
Patients with raised ICP.

COMPLICATIONS OF
SUCTIONING
Complications
• Hypoxia
• Vaso-vagal – bradycardia, arrythmia, hypoxia,
cardiorespiratory arrest.
• Actelectasis
• Pneumothorax
• Altered intracranial pressure
• Introduction of infection
• Mucosal trauma
Reduced Risk
• Pre and Post Oxygenation. Careful monitoring
throughout.
• Pre and Post Oxygenation. Monitoring throughout.
Shallow suction.
• Pre and Post Oxygenation. Check vacuum
pressures. Maximum of 5 seconds of suction applied.
Correct catheter size used.
• Correct technique.
• Pre and Post Oxygenation. Correct vacuum pressure
applied.
• Avoid contamination of the catheter or site of suction.
• Correct catheter size used. Correct vacuum pressure
applied. Correct technique (e.g. shallow suction)
used.

CATHETER SIZE
Endotracheal/Tracheostomy
Size of tube x 2 = size of catheter (Fg(
Fg)
e.g. ETT size 4 x 2 = 6 Fg catheter to be
used
Naso/oropharyngeal
Newborn = 6 Fg
6 months – 10years = 6 – 8 Fg
>10 years = 10 Fg

RECOMMENDED PRESSURES
Neonate = 50-80 mmHg or 6-10KPa6
Infant -55 yrs = 60 -100 mmHg or 8-138
KPa
5 -15 yrs = 60 – 100 mmHg or 8 -13
KPa
> 15yrs = 120 mmHg or 16 -20
KPa

Technique
Deep Suction – Catheter passed down ETT to
resistance felt then withdrawn slightly before
applying suction.
Shallow Suction – Catheter is only passed 0.5
– 1.0 cms beyond ETT/ Tracheostomy.
Cochrane Review (2006) found no evidence
from RCT comparing the risk and benefits
between the 2 though recognise anecdotal
evidence.

NP SUCTION
Measuring Depth – Nose to ear.
Technique – In babies and small children
angle catheter backwards and towards
opposite ear. In older children catheter
angled up and towards opposite eye you
may need lubrication.

SALINE INSTILLATION
Adequate fluid balance/ Hydration
Adequate Humidification.
If instilling saline:
- 0.5 mls in babies and infants
-1.0
mls – 2.0 mls in older children

OUTCOMES
Auscultation
SpO2
Respiratory Pattern
Ventilatory Requirements

REFERENCES
Glass, C & Grap, , M (1995) Ten tips for Safer Suctioning. American Journal
of Nursing, , pp52-53.
53.
Know, A (1993) Performing endotracheal suction on children: a literature
review and implications for nursing practice. Int. and Crit. Care Nursing,
9,pp48-54.
Pritchard, M et al (2006) Preoxygenation for tracheal suctioning in
intubated, , ventilated newborn infants (review). The Cochrane Library, , no.2.
Runton, , N (1992) Suctioning artificial Airways in Children: Appropriate
technique. Paediatric Nursing, , 18(2) pp115-118.
118.
Raymond, S (1995) Normal saline instillation before suctioning: Helpful or
harmful? Am. J. of Critical Care,4(4), pp267-271.
271.
Spence, K et al (2006) Deep versus shallow suction of endotracheal tubes
in ventilated neonates and young infants. The Cochrane Library, , no.1,
(CD003309).
Wilson, M (2005) Tracheostomy management, Paediatric Nursing. . 17,3, 38-
44.