What are the guidelines for a suction evacuation procedure?

Guidelines for Suction Evacuation Procedure

Suction evacuation procedures should be performed using sterile technique with appropriate equipment including a high-volume, low-pressure suction system to minimize complications and ensure effective evacuation.

Equipment Requirements

• Suction apparatus with adequate vacuum and flow for effective evacuation 1
• Large-bore, non-kinking suction tubing and appropriate suction catheters (sizes #5, #8, #10, #14, tonsil) 1
• Sterile collection container and sterile water for cleaning tubes and catheters 1
• Installed suction units should provide airflow of >40 L/min at the end of delivery tube and vacuum of >300 mm Hg when tube is clamped 1
• Adjustable suction pressure settings to accommodate different patient populations 1
• Sterile gloves and appropriate personal protective equipment 1

Procedural Guidelines

Pre-procedure Preparation

• Ensure all equipment is properly sterilized or high-level disinfected before use 1
• Use aseptic technique throughout the procedure 1
• Position the patient appropriately to facilitate drainage 2
• For pleural effusion drainage, position the drainage system below the level of the patient's chest at all times 2

During the Procedure

• Use sterile technique when performing suction procedures 3
• For airway suctioning, suction catheters should occlude <50% of the tube lumen in adults and <70% in neonates 3
• Apply suction for a maximum of 15 seconds per suctioning procedure to prevent complications 3
• For pleural drainage, limit initial drainage to 10 ml/kg or no more than 1-1.5 liters at one time to prevent re-expansion pulmonary edema 1, 2
• If draining large volumes, slow the drainage rate to about 500 ml/hour 1, 2
• For traumatic hemothoraces, initial suction evacuation before chest tube placement may reduce chest tube duration and complications 4

Suction Pressure Guidelines

• For airway suctioning, maintain suction pressure below -120 mm Hg in neonatal/pediatric patients and below -200 mm Hg in adult patients 3
• For pleural drainage, if suction is required, use a high-volume, low-pressure system at 5-10 cm H₂O 1, 2
• Excessive vacuum pressure increases risk of mucosal damage; recommended clinical suction pressures are 80-100 mmHg for most procedures 5

Post-procedure Management

• Monitor for complications including bleeding, infection, or respiratory distress 1
• For chest drainage systems, ensure proper water seal function and maintain the system below the level of the patient's chest 2
• Document the amount and characteristics of evacuated material 2

Special Considerations

For Pleural Drainage

• Confirm radiographically that complete lung re-expansion has occurred 1
• Once effusion drainage and lung re-expansion are confirmed, do not delay pleurodesis while waiting for cessation of pleural fluid drainage 1
• Never clamp a bubbling chest drain due to risk of tension pneumothorax 2
• Immediately unclamp a drain if patient complains of breathlessness or chest pain 2

For Obstetric Procedures

• In cases of suction and evacuation for retained products of conception or molar pregnancies, be prepared for potential intractable hemorrhage 6
• If bleeding occurs, uterine-preserving techniques such as bilateral uterine artery ligation (via laparotomy or laparoscopic coagulation) may be effective alternatives to hysterectomy 6

For Airway Management

• Use as-needed suctioning rather than scheduled suctioning for neonatal and pediatric patients 3
• Preoxygenate patients before airway suctioning to prevent desaturation 3
• Avoid routine use of normal saline instillation during airway suctioning 3
• Use deep suctioning only when shallow suctioning is ineffective 3

Potential Complications and Prevention

• Re-expansion pulmonary edema from rapid drainage of large effusions - prevent by limiting initial drainage volume and rate 1, 2
• Tension pneumothorax if bubbling drain is clamped - never clamp a bubbling chest drain 2
• Mucosal damage from excessive suction pressure - use appropriate pressure settings 5
• Infection - maintain sterile technique throughout procedure 1, 3
• Bleeding - have appropriate equipment ready for hemostasis 6

By following these guidelines, clinicians can perform suction evacuation procedures safely and effectively while minimizing potential complications.