Suction Machine (Pump) (E 1)

This equipment is mainly important for airway problems as in Resuscitation of the Young Infant

Subsection of this chapter:

1. Clinical Problem
2. Assessment
3. Management
4. Infection Prevention
5. Complications
6. Care & Maintenance
7. Troubleshooting & Repair

NEST360°. Newborn Essential Solutions and Technologies-Education – Clinical Modules: Suction Pump. (June 2020). License: CC BY-NC-SA 4.0.

Clinical Problem

Obstruction of the nostrils, mouth or upper airway with secretions or blood will cause respiratory compromise and potential hypoxia.

Suction pumps can be used in patients to clear secretions, vomitus, and blood from the mouth, nostrils, or upper airway.

LABOUR & OBSTETRIC NOTE

If meconium stained liquor is present at delivery and the baby is not vigorous or has not taken a breath, inspect the nose and mouth for obstruction. If meconium is present, gentle suctioning is recommended¹. Routine suctioning is not recommended.

Assessment

Suction Pumps

A suction pump (2.1) uses a negative vacuum created by an internal pump to remove blood or secretions from oral and nasopharyngeal cavities.

A bacterial filter is used in circuit with the suction pump to filter out any aerosolised particles or bacteria from the blood and secretions suctioned from a patient.

A suction pump may be tailored to adults (2.2) or paediatric (2.3) patients.

Although an adult suction pump can be used on paediatric or neonatal patients, the vacuum range is much higher which makes it more difficult to control for the low ranges required for neonatal patients. Use of an adult pump to treat neonatal patients is not encouraged.

Penguin suckers

Penguin suckers are reusable devices made of a flexible silicone, which can be used to provide low pressure suctioning.(2.4) Penguin suckers are autoclavable. Although suction bulbs may also be used, they are not autoclavable, sare difficult to clean, and are not recommended due to greater infection risk between patients.

Neonatal patients should be suctioned gently, no deeper than the eye can see and only within a range of 60 to 100 mmHg of negative pressure and for a period less than 10 seconds. (Alert 2.1)

Management

Management covers how to use the suction pump, including set up for a patient, patient preparation & commencement, care whilst on the device & removal of the patient from the device.

SETTING UP FOR A PATIENT

1. Collect: (3.1)
• Suction pump with collection reservoir
• Suction pump filter (if not already attached to pump)
• Short suction tubing
• Long suction tubing
• Suction catheter or Yankauer sucker
• Water in a suitable container (e.g., kidney dish, bowl)

2. Visually inspect the suction pump’s collection reservoir. If it is full or there are secretions present (3.2), dispose of the secretions appropriately, clean the reservoir and place it back in place with the lid firmly closed.
3. If a filter is not attached to the collection reservoir, place the filter in the lid of the collection reservoir at the port labelled Vacuum. Using the short suction tubing, connect the inlet of the suction filter on the suction pump collection reservoir to the suction pump outlet port.
(3.3)
4. Connect long suction tubing to the collection reservoir outlet port labelled Patient. (3.4)
5. Plug the power cable in the device. (3.5) Plug the power cable into the wall and turn on suction pump.

6. Connect the suction catheter or Yankauer sucker to the long suction tubing. (3.6)
7. Using the suction regulator, adjust the suction vacuum to the desired level within safe neonatal levels (60 to 100 mm Hg). Test the suction functionality with some water. (3.7)

PREPARING A PATIENT

1. Collect: (3.1)
• Suction pump with collection reservoir
• Suction pump filter (if not already attached to pump)
• Short suction tubing
• Long suction tubing
• Suction catheter or Yankauer sucker
• Water in a suitable container (e.g., kidney dish, bowl)
2. Always explain the purpose, risks, and benefits of a procedure to guardians BEFORE performing the procedure. Follow handwashing protocol and put on gloves.
3. Suctioning is only required when there is airway obstruction. Visually inspect the patient’s oral and nasopharyngeal cavities for secretions or blood.
4. Assess whether to use a suction catheter or Yankauer sucker.
   • For thicker secretions it may be necessary to use a Yankauer sucker but do not use in the nares of a newborn.
   • For thinner secretions, use an appropriately sized suction catheter (typically Fr sizes 6, 8 or 10). A correctly sized suction catheter should be the approximate size of the nostril. Nasogastric tubes are not recommended as a substitute for a suction catheter.
5. If secretions, blood, or meconium are visible, collect:
   • Clean suction catheter or Yankauer sucker
   • Tape
6. If using a suction catheter: determine suction depth by measuring from the nose to the ear and halfway back. Mark this distance with a small piece of tape. (3.8)
7. If using a Yankauer sucker, no measurement is required. Suctioning should only be conducted as far as can be visually assessed.
8. Place the infant in a neutral position to ensure effective suctioning. (3.9)

STARTING A PATIENT

1. Collect: (3.1)
• Suction catheter marked with appropriate suction depth or Yankauer sucker
• Suction pump with collection reservoir and tubing in place
• Water in a container
2. Always explain the purpose, risks, and benefits of a procedure to guardians BEFORE performing the procedure.
3. Follow handwashing protocol.
4. Plug suction machine into power outlet and turn on.
5. Connect suction catheter marked with appropriate suction depth or Yankauer sucker to long suction tubing. (3.11)
6. Using the suction regulator, adjust the suction vacuum to the desired level, maintaining safe vacuum levels for neonates. Test the suction functionality by suctioning the water.
7. When using a suction catheter: pinch the catheter and insert gently into the patient’s mouth or nostril to the point marked by the tape. When introducing catheter into the nose do so following the floor of the nose. Release the pinch on the catheter slowly as you withdraw the catheter from the mouth or nostril, gently rotating until it is completely removed. (3.12)
8. If using a Yankauer sucker: for thicker secretions or meconium, it may be necessary to use a Yankauer sucker.
• Suctioning should only be conducted as far as can be visually assessed when using a Yankauer sucker. If secretions are thick, application of 1-2 drops of normal saline to both nostrils may assist suctioning and reduce nasal trauma.
• Some Yankauer suckers may require a hole at the hub of the sucker to be occluded for suctioning pressure.
9. Allow the patient to visibly recover from the procedure. While waiting, rinse the catheter with water. Repeat this process on the other side of the mouth or nostril.
10. Repeat steps 5 through 7 until all secretions are removed. Remember: suctioning should be a gentle procedure. Do not suction too vigorously and do not suction too long. Suction only until the reservoir is ¾ full; if it reaches this point, remove collection jar, dispose of contents and reattach to complete suctioning.

CARING FOR A PATIENT

Observe suctioned contents carefully whilst suctioning procedure is taking place:

• If fresh blood starts to be suctioned, trauma may have been caused to the oral or nasopharyngeal cavities. Decrease the force with which the suction catheter is being inserted into the patient’s nose or mouth.
• If stomach contents are being suctioned, the patient’s suction catheter is being inserted into the oesophagus. Recheck the suction depth measurement.

REMOVING A PATIENT

Gently withdraw the suction catheter from the patient’s passageway.

Infection Prevention

Routine and adequate cleaning of medical devices is critical to prevent hospitalacquired infections in newborn care units. If devices & equipment are not disinfected promptly & adequately between patients, they pose a significant infection risk.

GENERAL INFECTION PREVENTION

1. Clean hands with soap and water or alcohol before and after initiating treatment using a suction pump or handling any tubing that will be used on a patient.
2. Ensure that all patient-related tubing and consumables (including suction catheters and collection reservoirs) are new or have been cleaned thoroughly before use (if following re-use guidelines). Any patient-related tubing must be cleaned (following the ward protocol) before it is used to suction another patient. Tubing should be hung to dry after disinfection and should not touch the floor or other unsanitary surfaces whilst drying.
3. When re-using suction tubing there is a risk of infection if inadequately cleaned. If the machine is not cleaned after each use, it can become a source of infection for patients in the ward. Suction catheters should never be reused.
4. All patient-related consumables should be stored in a clean, dry location. Tubing should be stored in loose rolls, preventing sharp bends and kinks, which will decrease its lifetime.

DISINFECTION AFTER USE

1. Gently disconnect the suction catheter from the suction tubing and dispose of catheter appropriately. If reusing, immediately begin hospital protocol for disinfection of tubing. Delay in initiating cleaning of reused medical devices can lead to the need for more intensive cleaning procedures to remove pathogens. If not reusing, discard safely.
2. Turn off and unplug the suction pump, if not using with another patient. Check filter. If filter is obviously dirty, replace. (4.1) Refer to user manual for specific instructions on when to change the filter.
3. Disinfect the suction pump pressure gauge controls using gauze and 70% alcohol.
4. The housing of the suction pump should be cleaned according to ward guidelines for disinfecting surfaces.
5. All tubing and collection reservoir should be cleaned after each patient.

• Remove the collection reservoir from suction pump. (4.2) Dispose of contents and disinfect reservoir appropriately, wearing gloves, a mask and apron to ensure staff safety. Return collection reservoir to suction pump and store in secure location until next use.
• Remove short and long suction tubing pieces. Follow hospital protocol for disinfection of tubing.

Complications

Introduction of equipment in newborn care units poses clinical and device complications for patients. Awareness of potential complications is critical to maximise patient safety.

CLINICAL COMPLICATIONS

• Hypoxia: if a patient is on oxygen, it may be necessary to remove oxygen treatment during suctioning, especially when suctioning the oropharynx. This interruption in treatment may worsen patient’s hypoxia. Place the patient back on oxygen as soon as oral and nasopharyngeal cavities are clear.
• Trauma: incorrect or excessive suctioning of the nose and mouth may cause trauma to mucosal surfaces. (This is more likely to happen when the pressures on the machine is above the safety range for neonates 60-100mmHg.) If bleeding occurs, stop suctioning, assess severity, and restart when safe.
• Vomiting: incorrect measurement of the suction catheter or suctioning too far may stimulate the gag reflex and induce vomiting. This also risks potential aspiration.
• Vagal stimulation: inappropriately deep suctioning can cause vagal stimulation resulting in apnoea or bradycardia.

DEVICE COMPLICATIONS

Positioning:suction pumps are not heavy devices but are frequently positioned on walls / shelves. This is appropriate if well secured during use. If improperly secured, suction pumps may fall, causing potential permanent or fatal injury, particularly to neonatal patients.

Care & Maintenance

Users are responsible for basic first-line care and maintenance to ensure equipment lasts to their potential lifetime.

POWER SOURCE

Suction pumps may be powered by mains or battery power (6.1) or manually via a foot or hand pump. (6.2) If a suction pump is battery powered, it should be taken off its charger only as necessary to ensure that it is charged for use in the event of a power blackout.

WARD LOCATION

Suction pumps should be secured in an accessible location where nursing staff can regulate and view vacuum easily, but where the pump is not at risk of falling. Suction consumables should be kept nearby for easy access in case of emergency.

USER PREVENTIVE MAINTENANCE

The suction pump should be turned on and allowed to run for 15 minutes every week.

Troubleshooting & Repair

Although users are not responsible for repairing their devices, there are steps that may be taken to troubleshoot first-line errors that may occur before contacting maintenance or engineering support.

References

1. Helping babies breathe provider guide. (American Academy of Pediatrics, 2016).
2. WHO technical specifications for neonatal resuscitation devices. (World Health Organization, 2016).
3. Curless MS, Ruparelia CS, Thompson E, and Trexler PA, eds. 2018. Infection Prevention and Control: Reference Manual for Health Care Facilities with Limited Resources. Jhpiego: Baltimore, MD.