Question :
Posted On : 31 Jan 2016
What is the recommended time in seconds to pass a suction catheter when deep suctioning an infant, child_?
Thank-you!
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Expert Answer :
The time interval for an efficacious and safe suction cannot be defined “a priori” because it is strictly related to the clinical conditions and the age of children. The duration of suctioning maneuver should be as shorter as possible in order to avoid bronchiolar and alveolar collapse {negative pressure applied to the airways favoring collapse!}.

Easy secretion’s removal from main bronchi and trachea must be obtained by:
1. Adequate humidification and warming of ventilated gases {completely vapor saturated and 35-37 °C} in order to maintain fluid secretions`
2. Reducing deep sedation and avoiding muscle paralysis {it must be applied only to effectuate special maneuvers, e.g. intubation, and not to treat the child “fighting to the ventilator”} in order to maintain efficacious cough and physiological mobilization of the secretions`
3. Using suitable PEEP level in order to maintain terminal bronchiole continuously open`
4. Mobilization of the child and application of chest physiotherapy to drain secretions towards main bronchi and trachea from which will be easily suctioned.

Suction’s catheter could be introduced into the endotracheal tube no more than half centimeter of the tube’s tip. The secretions must be convoy towards main bronchi and trachea using suitable humidification and warming of ventilated gases and applying prone positioning and chest physiotherapy. Secretions could be suctioned in 4-5 sec. Deep and prolonged suction is contraindicated in infants and small children, in asthma, bronchiolite, obstructive lung syndrome and in presence of high volume closure of airway {e.g. infants and children Less than 2 years of age} because increases the risks of alveolar and smaller airway collapse.

Collapse of small airway and alveoli connected with suctioning can be reduced by:
1. Use of suction’s catheter that does not occlude totally the lumen’s tube {1, 3 of internal diameter of the tube must remain patent}`
2. Use of negative suctioning pressure less than 25-30 cm H2O.

In summary:
Suction’s efficacy and secretion’s removal are strictly connected to
- humidification and warming of ventilated gases`
- postural drainage of secretions {appropriate use of prone positioning and chest physiotherapy}.

Deeper introduction of suctioning catheter and, or prolonging the time of negative pressure application doesn’t improve the efficacy of secretion’s removal but favor collapse of the airways.

Dr Giuseppe Marraro
Answer Discussion :
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