Mucus suctioning is a procedure to remove the mucus and to aid breathing in children. The suction is performed with special types of equipment designed for clinical use. There are different equipment for different areas like the nose, mouth, and trachea.
Mucus is secreted by a lining called mucosa which lines the tube-like structures and cavities of the body, for example, the trachea, esophagus, oral cavity, stomach, intestine, etc. Sometimes the secretion of mucus increases and thickens due to some pathology (disease), and the person may find it difficult to expel the mucus with a normal cough reflex. This may be accompanied by lung dysfunction which further adds to the secretion of mucus.
1. Suctioning mucus through the nose and mouth
1.1 The nasopharynx is the tubular area where the nose ends and goes downwards towards the back of the oral cavity. Suction is done through this passage when oral suction is not possible because kids may bite the inserted tube. This is also indicated if the collection of secretions is deep in the trachea, and it is difficult to approach it through the mouth.
1.2 When the suction tube is inserted through the mouth to the pharynx and sometimes into the trachea, it is called oropharyngeal suction.
2. Suctioning mucus through an endotracheal or tracheostomy tube
When the patient is unconscious and cannot put effort into breathing, then to support the patient a tube called an endotracheal tube is inserted either through the oral cavity or nasal cavity which then passes through the epiglottis and the vocal cords into the trachea. Suctioning is done through this tube to clear the secretions from the lower respiratory tract. When there is a requirement of keeping the patient on airway support even after three to four weeks, then tracheostomy is indicated and suction is done through the tracheostomy tube.
General indications of endotracheal suction:
With the help of the nursing staff, the patient is placed in a supine (lying on the back) position with the head turned towards the side.
The suction apparatus is arranged which has a suction head and a suction tube that connects the head with the suction machine. Pressure in the machine is adjustable and set according to medical guidelines. Before starting the procedure, the assigned nurse checks the pressure.
The suction of nasal secretions is done by inserting a suction tip in the nose, which is advanced into the inner wall without causing any trauma.
While suctioning, it is required to change the position of the suction tip by moving it in or out. This is done to suck out the maximum quantity of secretions. Nurses are trained to do the procedure without causing any harm to the surrounding tissue. After performing nasal suction, the suction tip is changed for oral suction.
If the secretion seems to be viscous and it is difficult to suck it out, then a 0.9% saline solution can be used to dilute it. Saline can be placed in the same nostril or the adjacent one while doing suction.
A suctioning session longer than 10 seconds may cause larynx constriction which will lead to oxygen deficiency. Also, if a tracheostomy tube is present then suction should first be performed through that.
After the suction is complete, a stethoscope is used to verify whether the chest is clear or not and the nurse will do this by asking the patient to take a deep breath. If the nurse finds any abnormality, then the suction can be repeated.
The patient will be examined before the procedure to ensure if there are any changes of color in the nails and the skin (cyanosis), or any other respiration-related changes. The nurse will make sure that there is nothing in the mouth in case the patient has vomited.
It is advised not to eat at least two hours before the procedure to prevent aspiration.
The patient will be seated in a comfortable position after the procedure and is observed for some time. The doctor will re-examine the patient to check for improvements in oxygen saturation levels and chest sounds. If the doctor suspects anything out of the usual, then treatment will be suggested accordingly. Usually, patients show an improvement after this procedure.
Why does my child need to be suctioned?
When your child cannot clear the respiratory tract with normal body reflexes in response to hypersecretion of mucus, then suction is done. Secretion of mucus is the immune response of our body, it may be against the disease-causing microorganism example common cold, Respiratory Syncytial Virus (RSV), Pneumonia, Influenza, etc, or any allergen as in allergic bronchitis.
When our cough reflexes are not strong enough?
What if this procedure is not performed?
Our body is made up of cells and they need a continuous oxygen supply for their survival. If suction is not performed, then the airway will remain blocked the child’s body will not get sufficient oxygen. It may be fatal if the brain doesn’t get oxygen.
When should I suction my child’s nose or mouth?
What are the alternatives to mucus suction for children?
You can consult your doctor for alternatives. Your doctor may suggest you irrigation of nose with saline water which is done with the help of a bulb syringe. This dilutes the mucus and makes it of a flowable consistency, which then becomes easier to expel. The technique will be explained by the nurse or doctor.
This can be used at home but only with proper caution.
When should nasopharyngeal (NP) suctioning be performed?
A nurse, doctor, or respiratory therapist may decide to use NP suctioning when,