When should suctioning be performed in ventilator patients?

When to Perform Suctioning in Ventilator Patients

Suctioning should be performed only when clinically indicated based on patient assessment, not according to a routine schedule. 1, 2, 3

Primary Indications for Suctioning

Suction ventilated patients when any of the following clinical indicators are present:

• Visible or audible secretions in the artificial airway 1, 3
• Abnormal breath sounds on auscultation (coarse crackles, rhonchi) 3
• Sawtooth pattern on the ventilator flow-volume waveform 3
• Acute increase in peak airway pressure or airway resistance 3
• Oxygen desaturation not explained by other causes 2, 4
• Patient distress or difficulty triggering the ventilator 4

Assessment-Based vs. Routine Suctioning

The evidence strongly supports assessment-based suctioning over scheduled routine suctioning. 1, 2, 3 Research demonstrates that patients suctioned only when clinically indicated have significantly better outcomes, including:

• Less hemodynamic instability (smaller changes in heart rate and mean arterial pressure) 5
• Reduced peak airway pressure fluctuations 5
• Fewer complications overall 5, 2
• More effective secretion removal 5

The American Association for Respiratory Care explicitly recommends against routine scheduled suctioning (e.g., every 2 hours), as this practice increases the risk of airway trauma, infection, hypoxemia, and cardiovascular instability without clinical benefit. 2, 4, 3

Minimum Suctioning Frequency

For stable patients without evidence of secretions, perform suctioning at minimum twice daily (morning and bedtime) solely to assess tube patency. 1 This is critical because artificial airways can become obstructed without obvious clinical symptoms. 1

Special Populations

Neonatal Patients

• Use breath sounds and acute increases in airway resistance as primary indicators 3
• As-needed suctioning is sufficient; avoid scheduled routines 3

Pediatric Patients

• Suctioning frequency varies based on age, neurological status, cough effectiveness, and secretion viscosity 1
• As-needed suctioning is sufficient 3

High-Risk Adult Patients

• Patients on high FiO₂ or PEEP require particular attention to avoid disconnection and lung derecruitment 2, 3
• Consider closed suction systems for these patients 2, 3

Common Pitfalls to Avoid

Do not suction routinely "every 2 hours" or on a fixed schedule. 1, 2 Despite decades of evidence against this practice, routine scheduled suctioning remains common and increases patient harm. 1

Do not delay suctioning when clinical indicators are present. 1 Waiting too long can lead to tube obstruction, atelectasis, and respiratory compromise. 4

Always clear visible secretions first before delivering hyperinflation breaths. 1 Delivering manual breaths when secretions are present in the tube forces them deeper into the airways. 1

Avoid deep suctioning as routine practice. 1, 3 Use premeasured shallow suctioning to just beyond the tube tip, as deep suctioning causes epithelial damage and inflammation. 1, 2, 3 Reserve deep suctioning only for special circumstances when shallow suctioning proves ineffective. 1, 3