What is the proper technique for suctioning a distressed baby with no nasal flaring or grunting?

Proper Technique for Suctioning a Distressed Baby

Suctioning should only be performed when secretions are present and visible, not routinely, using a bulb syringe or suction catheter with appropriate technique to avoid complications. 1

Assessment Before Suctioning

Before proceeding with suctioning, assess the baby for:

• Presence of visible secretions in the mouth or nose
• Signs of respiratory distress (though the baby has no nasal flaring or grunting)
• Red face from crying (not cyanosis, which would indicate more severe distress)

Suctioning Technique for a Distressed Baby

Equipment Needed:

• Bulb syringe (preferred for initial clearing in non-intubated infants)
• Appropriate-sized suction catheter if bulb syringe is insufficient
• Clean gloves

Proper Technique:

1. Position the baby properly:

   • Place the baby in a "sniffing" position to open the airway 1
   • For infants under 2 years, maintain a neutral position 1

2. Use bulb syringe first:

   • Compress the bulb before insertion
   • Gently insert the tip into the mouth first (then nose if needed)
   • Release the bulb slowly to create suction
   • Remove and expel secretions
   • Repeat as necessary until secretions are cleared

3. If using a suction catheter:

   • Select appropriate size (should occlude less than 70% of the airway for infants) 2
   • Set suction pressure below -120 mmHg for infants 2
   • Insert the catheter only until resistance is met or the child coughs
   • Apply suction only during withdrawal (not during insertion)
   • Limit suctioning to less than 15 seconds per attempt 2
   • Allow recovery time between attempts

4. Sequence of suctioning:

   • Mouth first, then nose if needed
   • This prevents aspiration if the baby vomits during oral suctioning

Important Cautions

• Avoid routine suctioning when secretions are not present 1, 2
• Avoid deep suctioning unless shallow suctioning is ineffective 2
• Never suction for longer than 15 seconds to prevent hypoxia 2
• Do not use saline instillation prior to suctioning 3, 2
• Monitor the baby's response throughout the procedure
• Stop immediately if the baby develops bradycardia, increased distress, or color changes

Special Considerations

• If the baby was born through meconium-stained fluid but is vigorous (as indicated by crying), routine suctioning of the trachea is not recommended 1
• For babies with a tracheostomy, use clean technique with non-sterile gloves and maintain cleanliness of the catheter portion that will be inserted 1
• If the baby shows signs of deterioration during suctioning, stop immediately and provide appropriate respiratory support

After Suctioning

• Reassess the baby's respiratory status
• Position the baby to maintain a patent airway
• Document the procedure, including the amount and character of secretions obtained and the baby's tolerance of the procedure

Suctioning is a simple but critical procedure that, when done correctly, can effectively clear secretions while minimizing risks of complications such as hypoxia, bradycardia, and trauma to the airway mucosa.