Suctioning osce

Reading File

Finding Sources

Reading File

I now have comprehensive content. Let me compile a full OSCE-focused suctioning guide.

Suctioning - OSCE Guide

Source: Roberts and Hedges' Clinical Procedures in Emergency Medicine

Overview

Suctioning removes secretions, blood, vomitus, or particulate debris from the airway when patient positioning and maneuvers alone are insufficient. It can be performed via the oropharynx, nasopharynx, endotracheal (ET) tube, tracheostomy, or minitracheostomy.

Types of Suction Devices (Upper Airway)

Device	Best Use
Large-bore dental tip (e.g., HI-D Big Stick)	Vomitus - least likely to clog with particulate matter
Tonsil tip (Yankauer)	Blood and secretions - rounded tip is less traumatic
Standard catheter	NOT suitable for vomitus (too narrow - clogs easily)

Tube diameter matters: standard 1/4-inch catheters obstruct with viscous material; 5/16-inch inner diameter tubing significantly reduces suction time for thick/particulate material.
Keep suction equipment connected and ready at all times during emergency airway management.
A suction trap close to the device prevents tubing clog.

Indications

Upper airway (oropharyngeal) suctioning:

Vomitus, hemorrhage, or secretions obstructing the airway
During emergency airway management (always have ready)

Tracheal suctioning (ET tube / tracheostomy):

Remove secretions, enhance oxygenation, or obtain lower respiratory tract samples
Coarse rales, rhonchi, or tubular breath sounds
Acute or worsening dyspnea
Arterial oxygen desaturation
Respiratory distress in tracheostomy patients

Important: Tracheal suctioning should only be performed when clinically indicated. Frequent, routine suctioning is NOT recommended.

Contraindications

Absolute: None

Relative:

Severe bronchospasm (may worsen with suctioning)
Persistently elevated intracranial pressure (ICP) - suctioning exacerbates ICP
Cardiovascular instability (increased risk of dysrhythmias)

Catheter Size Formula (Tracheal)

Size (French) = 2 × (Tracheostomy/ET tube size - 2)

Example: 7.0 tube → 2 × (7-2) = 10 Fr
Catheter must be no larger than half the inner diameter of the tube
Too large: obstructs airflow during insertion → alveolar collapse → hypoxaemia
Too small: inadequate secretion removal

Vacuum pressure limits:

Infants: ≤80 mmHg
Adults: ≤150 mmHg (use lowest effective pressure)

Procedure - Step by Step (Tracheal/Tracheostomy)

Before Suctioning

Monitor: Attach continuous pulse oximetry, cardiac monitor, and capnography if available.
Position patient: Awake patients sit upright, head neutral. Ventilated patients: head of bed at 30 degrees.
Pre-oxygenate: Administer 100% O2 for 30-60 seconds before suctioning. This is the most important step to prevent hypoxia.
Prepare equipment: Select correct catheter size. Use aseptic technique throughout. Have backup airway equipment ready.
Gloves and PPE: Sterile gloves for open suctioning.

During Suctioning

Insert catheter: Insert without applying suction. Advance to target depth:
- Shallow: just beyond the hub of the tracheostomy tube
- Premeasured: beyond the caudal end of the tracheostomy tube
- Deep: until resistance met (not recommended routinely - can cause mucosal injury)
Apply suction while withdrawing: Apply thumb over suction port and withdraw in a gentle rotating motion.
Time limit: Do NOT exceed 15 seconds per suction pass.
Closed system: If ventilated, use a closed-system catheter (sterile sheath) to avoid interrupting ventilation and prevent contamination.

After Suctioning

Re-oxygenate: Give supplemental O2 immediately after.
Reassess: Check SpO2, breath sounds, and respiratory status.
Repeat only if clinically indicated.

Upper Airway Suctioning - Key Points

Perform under direct vision or with laryngoscope whenever feasible.
Do NOT blindly force a suction tip into the posterior pharynx - can injure tissue or convert partial to complete obstruction.
Nasal suction is rarely needed in adults (most obstruction is in mouth/oropharynx). Used mainly in infants.

Complications

Complication	Mechanism
Hypoxaemia	Removal of O2 along with secretions; limit to 15 sec, pre-oxygenate
Increased ICP	Stimulation causes reflex ICP rise; avoid in raised ICP
Dysrhythmias	Vagal stimulation; monitor cardiac rhythm
Atelectasis	Excessive negative pressure collapses alveoli
Mucosal injury / bleeding	Trauma from catheter tip; use side-port catheters, avoid deep suctioning routinely
Infection / tracheitis	Break in asepsis; use sterile technique
Patient agitation	Stimulation; consider sedation if needed

Special Technique Tips

Closed-system suctioning (preferred for ventilated patients):

Catheter enclosed in a sterile sheath attached to ventilator tubing
Allows suctioning without disconnecting from ventilator
Reduces hypoxia and nosocomial infection risk

Directional/Coudé tip catheters:

Curved tip allows selective suctioning of left or right main stem bronchus

Deep vs. shallow suctioning:

Deep suctioning (to carina) is NOT more effective than shallow/premeasured suctioning and carries greater risk of mucosal damage and granulation tissue - do not perform routinely.

OSCE Checklist Summary

Wash hands / don PPE (sterile gloves for open suction)
Explain procedure to patient
Attach monitoring (SpO2, cardiac, capnography)
Pre-oxygenate with 100% O2
Select correct catheter size (Fr = 2 × [tube size - 2])
Set vacuum to lowest effective pressure (≤150 mmHg adult)
Insert catheter without suction applied
Suction on withdrawal, rotating gently
Each pass ≤15 seconds
Re-oxygenate after each pass
Reassess breath sounds and SpO2
Dispose of catheter safely
Document

Roberts and Hedges' Clinical Procedures in Emergency Medicine, Chapters 3 & 7

This is a shared conversation. Sign in to Orris to start your own chat.