Sterile Technique

Techniques for sterile suctioning

Suctioning is a method of removing mucous from the lungs. People with a spinal cord and/or a brain injury may have problems breathing due to congestion. The muscles that help with breathing and coughing may not work well. Suctioning will help keep the airway clear.

A person should be suctioned when any of the following happens:

  • Rattling breathing sounds are heard.
  • Mucous bubbles up in the throat or airway tube (trach tube).
  • When a hand placed on the chest can feel a vibration or rattling from congestion.
  • When the person tells you it is needed (when it is hard to breathe).

Try having the person cough first (or perform an assist cough). Sometimes the person may not need to be suctioned if he/she is able to remove the mucous with a good cough.

Dos and Don’ts of Suctioning

Step 1: Gather the supplies.

  • Portable suction machine
  • Clean suction catheter
  • Sterile normal saline (recipe below)
  • Resuscitator bag (also known as the Ambu Bag)
  • One helper

For a full list of supplies, visit the Suctioning Techniques page.

Step 2: Wash your hands.

Wash your hands with soap and water. Dry them with a clean towel.

Step 3: Check portable suction equipment.

Make sure all tubing connections and collection jar have a tight seal.

Step 4: Place portable suction unit on a flat, dry and safe surface.

Plug suction unit to an electrical outlet. Turn unit on.

Step 5: Set the suction pressure.

  • The portable suction pressure should not be set higher than 15 mm/Hg.
  • Check pressure by turning the machine on and covering the open end of the suction line with one hand.
  • Look at the pressure dial. It should rise but not go any higher than the 15 marker on the dial.
  • If the pressure does not go up, re-check all tubing connections or adjust to the correct pressure.

Step 6: Open the suction catheter kit.

Each sterile solution will have:

  • 1 or 2 sterile gloves
  • 1 sterile catheter slipped into a paper bag
  • 1 cardboard container to use for rinsing the portable suction tubing when you are done

Step 7: Put on gloves.

  • If your kit only contains one sterile glove, slip it onto your dominant hand. Make sure to use sterile technique as you learned during rehabilitation. Only touch the folded over part of the glove that would be near your wrist…do not touch the glove near the fingers or palm.
  • If your kit has 2 gloves, slip on each glove using sterile technique as shown below.

Step 8: Connect the tubing to the suction catheter.

  • With the non-dominant hand, pick up the long connecting tubing that comes from the suction machine and attach it to the suction catheter.
  • Be careful not to touch the catheter tip on the other “sterile” hand.

Step 9: Turn on the suction machine.

  • Use the non-sterile hand to turn on the machine.

Step 10: “Bag” the person.

  • The person must receive extra breaths during suctioning. This is done by using the Ambu Bag.
  • Attach the bag to the person’s airway (trach tube) and squeeze the bag to give extra breaths.
  • Each person will be different in respect to how many times he/she needs to be “bagged.” Follow the directions you were given from your doctor or therapist.
  • A person will need to be bagged before, during and after each suctioning.

Step 11: Place the catheter into the trach tube.

  • Holding the catheter with the sterile dominant hand, place the catheter into the opening of the trach.
  • Be careful not to let it touch anything before entering the opening. Please remember that the inner cannula must always be in place when a person is suctioned.
  • The inner cannula is the tube that fits into the trach at the neckplate. It can be re-usable or disposable depending on your specific situation.
  • Never suction without the inner cannula in place.
  • Slowly move the catheter down into the trach until resistance is felt. Do not force the catheter down.

Step 12: Cover the suction port.

  • Cover the suction port with your thumb. Slowly pull the suction catheter up and out. Do not leave the suction catheter in the trach tube for more than 10 seconds.
  • Suction Off (port open)
  • Suction On (port closed)

Step 13: Bag the person.

  • Repeat steps 10, 11 and 12 until the mucous is gone.
  • If you notice that the mucous is thick, you can use normal saline to make it thinner. Squirt a small amount into the trach tube and then bag the person with the Ambu Bag. This will help loosen up the mucous and make it easier to suction. Now you may insert the suction catheter and repeat Step 11.

Step 14: Disconnect the catheter from the suction tubing.

  • Throw away the suction catheter.

Step 15: Rinse the suction tubing.

  • Once suctioning is complete, the canister tubing must be rinsed. This can be done with tap water or normal saline.
  • With the suction machine still on, put the tubing in a container of water or squirt some normal saline into the tubing. Allow it to rinse through the tubing until it is cleared of mucous.

Step 16: Shut off suction unit.

Step 17: Remove all gloves.

Step 18: Throw away all suction kit materials.

Step 19: Wash your hands.

Sterile normal saline

  • Prepare a mixture of 1 quart of water with 2 teaspoons of table salt.
  • Heat until it comes to a boil.
  • Store normal saline in a clean, sterile jar. The jar and lid should be cleaned and sterilized as if for canning or preparing baby milk bottles.
  • Make normal saline fresh every day.

Sterile water

  • Boil 1 quart of tap water for 10 minutes.
  • Let it cool.
  • Store sterile water in a clean, sterile jar. Jar and lid should be cleaned and sterilized as if for canning or preparing baby milk bottles.
  • Make sterile water fresh every day.
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