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Suction Depth
Question# 968
As a PCP, we have the Emergency Tracheostomy and ETT Suctioning Protocol. Under this protocol, suctioning is included.
My confusion is regarding what is considered appropriate suctioning. As PCPs, are we certified to perform deep tracheostomy/ETT suctioning or in-line suctioning? If not, how deep are we permitted to suction for tracheostomy and ETT tubes?
My confusion is regarding what is considered appropriate suctioning. As PCPs, are we certified to perform deep tracheostomy/ETT suctioning or in-line suctioning? If not, how deep are we permitted to suction for tracheostomy and ETT tubes?
Answer:
In airway suctioning, the terms shallow and deep suctioning describe the intended depth of catheter insertion relative to the airway device.
Shallow suctioning refers to suctioning that is limited to the measured length of the endotracheal tube (ETT) or tracheostomy tube only. The suction catheter is measured to the known or estimated length of the tube, clearly marked, and advanced no further than the distal end of the tube. Depth of suctioning for shallow suctioning would include the length of the airway device in place. Note that the length of a tracheostomy is MUCH shorter than that of an ETT and caution needs to be taken when considering the depth of suction. This is the recommended and appropriate practice for both ACP and PCPs
Suction is applied only while withdrawing the catheter, reducing the risk of hypoxia, mucosal injury, and vagal stimulation.
Deep suctioning, by contrast, involves advancing the suction catheter until definitive resistance is encountered, typically at the level of the carina (however, can proceed down the mainstem bronchi [right more common given anatomy]), and then withdrawing approximately 1 cm prior to applying suction. This technique intentionally advances the catheter beyond the distal end of the tube into the lower trachea.
This depth has associated adverse events including vagal response (syncope, bradycardia), lung trauma causing hemorrhage or edema, bronchospasm and incidence of increased ICP. Therefore, deep suctioning is not recommended routinely and therefore caution should be taken to ensure we perform shallow suctioning within the airway device in the prehospital setting.
It is acknowledged that coughing or a sensation of resistance may occur during tube‑limited suctioning, particularly with shorter tracheostomy tubes. However, the defining factor is intentional depth. PCPs are authorized to suction to the end of the tube only, using a pre‑measured and marked catheter. Any technique that deliberately advances beyond the tube in order to contact the carina represents deep suctioning and is not permitted within PCP practice.
Shallow suctioning refers to suctioning that is limited to the measured length of the endotracheal tube (ETT) or tracheostomy tube only. The suction catheter is measured to the known or estimated length of the tube, clearly marked, and advanced no further than the distal end of the tube. Depth of suctioning for shallow suctioning would include the length of the airway device in place. Note that the length of a tracheostomy is MUCH shorter than that of an ETT and caution needs to be taken when considering the depth of suction. This is the recommended and appropriate practice for both ACP and PCPs
Suction is applied only while withdrawing the catheter, reducing the risk of hypoxia, mucosal injury, and vagal stimulation.
Deep suctioning, by contrast, involves advancing the suction catheter until definitive resistance is encountered, typically at the level of the carina (however, can proceed down the mainstem bronchi [right more common given anatomy]), and then withdrawing approximately 1 cm prior to applying suction. This technique intentionally advances the catheter beyond the distal end of the tube into the lower trachea.
This depth has associated adverse events including vagal response (syncope, bradycardia), lung trauma causing hemorrhage or edema, bronchospasm and incidence of increased ICP. Therefore, deep suctioning is not recommended routinely and therefore caution should be taken to ensure we perform shallow suctioning within the airway device in the prehospital setting.
It is acknowledged that coughing or a sensation of resistance may occur during tube‑limited suctioning, particularly with shorter tracheostomy tubes. However, the defining factor is intentional depth. PCPs are authorized to suction to the end of the tube only, using a pre‑measured and marked catheter. Any technique that deliberately advances beyond the tube in order to contact the carina represents deep suctioning and is not permitted within PCP practice.