Mechanical Aspiration: A Reappraisal of Its Hazards

Abstract

The complications of tracheal suctioning occur frequently, although they often escape immediate detection. Mechanical aspiration should be performed only when indicated. Mechanisms resulting in damage are discussed and measures that may be taken to avoid such damage are listed. These include diligent observ- ance of aseptic technique, preoxygenation before suctioning, choice of appropriate catheter size and design, avoidance of active suction during endobronchial impac- tion, limiting the degree and duration of subatmospheric pressure, and manual hyperinflation after suctioning. The relative efficacy of saline and mucolytic instil- lation is discussed, along with modes of administration. A technique for pharyn- geal suctioning is offered and a sequence to be followed during extubation is out- lined.