This procedure allows patients to breathe more easily and reduces the chances of oxygen deprivation due to blockage caused by mucus.
 

Mucus suction may be recommended in the following situations:

1. Patient breathes noisily.
2. Patient seems fidgety and/or restless.
3. Patient’s pulse and respiration rates are elevated.
4. Patient is beginning to turn blue due to lack of oxygen (cyanosis).

1. Suctioning mucus through the nose and mouth

• A nasopharyngeal airway or nasal airway is a flexible tube with a flared end that is designed to be inserted into the nasal passageway, allowing convenient access to the nasopharynx, which connects the back of the nose to the back of the mouth. Suctioning mucus through the nasopharyngeal airway is often done in the cases where a patient often bites down on the oropharyngeal airway.
• An oropharyngeal airway or oral airway is a tube inserted through the mouth and into the oropharynx, the part of the throat at the back of the mouth.

2. Suctioning mucus through an endotracheal or tracheostomy tube

Suctioning through an endotracheal or tracheostomy tube allows removal of mucus from the lower respiratory tract, especially in patients who are not conscious and are unable to expel the mucus on their own. An endotracheal tube may be inserted through the mouth (orotracheal) or nose (nasotracheal) and will be passed through the epiglottis and vocal cords into the trachea. An endotracheal tube is usually only placed for three to four weeks, after which a tracheostomy tube will be used for direct access to the trachea.
 

1. The nurse will assess the patient’s condition before suctioning mucus. The nurse will observe the patient’s breathing and respiration rate, the color of their skin, nails and lips (for signs of cyanosis), whether the patient is listless, the characteristic of the mucus (the amount and texture), and if the patient has vomited or regurgitated any food that is still remaining in the patient’s mouth.
2. The patient should not eat for at least two hours before mucus suctioning to prevent aspiration.

1. Patient will be placed to lie on the back. Staff will be wrapping patient’s body and held down while turning patient’s face to the side.
2. The suctioning tube will be attached to the suction machine and pressure will be adjusted as appropriate. The pressure will be checked by the nurse placing a finger over the tip of the tube.
3. Nasal secretion is sucked by gently inserting finger tip or MU-Tip (Mahidol University-Tip) into patient’s nostril until MU-Tip/finger tip is placed against the inner wall but not scratch the inner part of the nose.
4. While suctioning, MU-tip/finger tip will be gently moved back and forth to make sure secretion is sucked as much as possible. When MU-Tip/finger tip is moved, the nurse will be careful not to let the tip hit the inner part of the nose. When nasal suction is done, another tube for oral suction will be connected.
5. If mucus is found too sticky, 0.9% normal saline solution will be dropped into the nostril before suction or 0.9% normal saline solution will be dropped into other nostril while suctioning the other side with MU-Tip/finger tip.
6. Each session of oral suction should not be longer than 10 seconds to prevent larynx constriction and oxygen deficiency (if patient is on tracheostomy tube, suction through the tube first.)
7. The patient should deeply inhale oxygen three to four times and the nurse will observe the breathing patterns and notice the sound as well as the appearance of any mucus to decide whether or not suction must be repeated.

1. Mucus that can cause blockage of the respiratory tract.
2. Lack of oxygen, slowed pulse, collapsed lung.
3. Body does not receive enough oxygen.
4. Irritation to the lining of the respiratory tract.
5. Respiratory infection.
6. Injury or redness of the skin around the tube inserted into the airway.
7. Impact to the airway, such as perforation or necrosis.
8. High pressure in the skull.
9. Vomiting, aspiration.

 
Caution

1. To prevent irritation of the lining of the respiratory tract, when inserting the tube, be sure to open one side of the connector to prevent too much air from being sucked out and until the tube is placed in the appropriate location, then close it. When suctioning turn move the tube all around and slowly move it back out.
2. If the mucus is very thick, drop three to five milliliters of normal saline solution into the endotracheal tube to dissolve the mucus, making it easier to suction out.
3. To prevent oxygen deprivation, make sure that the patient is given oxygen for 30 seconds to 2 minutes or use an ambu bag attached to oxygen and squeeze 3 to 6 times before suctioning. Then provide oxygen after mucus is suctioned as well to help expand the lungs and prevent collapse.
4. To prevent lung atelectasis from repeated suctioning, only suction when there is mucus or when absolutely necessary and don’t suction for longer than 5 to 10 seconds each time, and wait 3 minutes between sessions.

Mucus is successfully removed from the respiratory tract.
 
What If This Procedure is Not Performed?
The respiratory tract is blocked causing oxygen insufficiency.
 
 

Nasal rinsing and suctioning mucus with bulb syringe.