Can nasal suctioning cause injury?

Nasal Suctioning: Potential Injuries and Safety Considerations

Nasal suctioning should be used with extreme caution in patients with anticoagulation, bony or soft tissue injuries, or after recent surgery of the upper airways, as it can cause injury to the nasal mucosa. 1

Potential Injuries from Nasal Suctioning

Nasal suctioning, while sometimes necessary for airway clearance, can lead to several types of injuries:

1. Mucosal Damage:

   • Excessive negative pressure can cause invagination and injury to the respiratory mucosa
   • Can lead to bleeding, especially in patients on anticoagulants
   • May result in ulceration of the epithelium 1

2. Granulation Tissue Formation:

   • Repeated mucosal injury from suction catheters can lead to granulation tissue formation
   • Most commonly occurs in the distal trachea and right-sided bronchi
   • Can progress to airway narrowing or occlusion 1

3. Tracheal/Bronchial Stenosis:

   • Vigorous suctioning techniques may contribute to stenosis development
   • Particularly concerning in infants and children with smaller airways 1

4. Traumatic Injury:

   • Can cause epistaxis (nosebleeds)
   • Risk of trauma increases with improper technique or inappropriate catheter size
   • May exacerbate existing nasal injuries 1

5. Physiological Responses:

   • Can trigger bradycardia, especially in neonates 1
   • May cause drops in oxygen saturation 2
   • Can induce pain responses, particularly in neonates 2

Safety Guidelines for Nasal Suctioning

To minimize the risk of injury during nasal suctioning:

Catheter Selection and Technique

• Use appropriately sized catheters that do not occlude more than 70% of the airway lumen in neonates and 50% in pediatric and adult patients 3
• Choose catheters with multiple side holes on several planes rather than single side or end holes 1
• For non-intubated patients, restrict passage of the suction catheter to avoid deep suctioning 1

Pressure Settings

• Use negative pressure below -120 mm Hg in neonatal and pediatric patients 3
• Use negative pressure below -200 mm Hg in adult patients 3
• Avoid pressures above 50-80 cm H2O as they increase likelihood of mucosal damage 1

Duration and Frequency

• Apply suction for a maximum of 15 seconds per procedure 3
• Use as-needed suctioning rather than scheduled suctioning, especially for neonatal and pediatric patients 3
• Only perform suctioning when clinically indicated (visible secretions, abnormal breath sounds, increased airway resistance) 3

Special Populations Requiring Extra Caution

Nasal suctioning should be used with particular caution in:

1. Patients on anticoagulation therapy due to increased bleeding risk 1
2. Patients with bony or soft tissue injuries of the face or nose 1
3. Patients who have had recent surgery of the upper airways 1
4. Neonates, who are particularly sensitive to physiological changes during suctioning 1
5. Patients with nasal fractures or trauma 4, 5

When to Avoid or Use Alternative Methods

• For non-intubated patients: Use oro-nasal suctioning only when other methods fail to clear secretions 1
• For patients with retained secretions: Consider alternative airway clearance techniques first, such as:
  • Interventions to increase inspiratory volume
  • Manually assisted cough techniques
  • Positioning and mobilization 1

Conclusion

While nasal suctioning is sometimes necessary for airway management, it should be performed judiciously with proper technique to minimize the risk of injury. The procedure should be reserved for situations where other methods of airway clearance have failed, and extreme caution should be exercised in high-risk patients.