In a patient without a tracheostomy, airway secretions are easily handled by the mucociliary transport system and by coughing or swallowing secretions. Any interruption to these mechanisms can increase retention of secretions, which causes increased airway resistance and work of breathing. Suctioning may become necessary in patients with an artificial airway, as their natural mechanisms are impaired or completely bypassed.
Suctioning should only done when it is clinically indicated by an accumulation of secretions, and should not be scheduled on a routine basis in the patient with a tracheostomy. When you are applying suction, you are applying subatmospheric pressure through a catheter inserted in the airway. Secretions may be visualized or there may be adventitious lung or airway sounds and an ineffective cough. At these times, you can consider suction. Additionally, if there is evidence of airway occlusion, you should suction.
Within the healthcare setting (skilled nursing, long-term care, ICU / Hospital), most available suction systems are currently “closed” suction systems, which allow suctioning without disconnecting the patient from the ventilator. These systems reduce the opportunity for environmental contamination, and maintain positive pressure ventilation and PEEP, reducing hypoxemic episodes. Additionally, in patients who must be frequently suctioned, closed suction systems are cost effective. A closed suctioning system decreases the risk of nosocomial (hospital acquired) pneumonia. (19)
