Clearing the Airway

Rapidly clearing the airway to improve ventilation or facilitate breathing is a critical element of airway management.

Rapidly clearing the airway to improve ventilation or facilitate breathing is a critical element of airway management. Suctioning in the prehospital environment involves mechanical aspiration of blood, vomitus and pulmonary secretions from the patient's airway. Safe suctioning requires a core knowledge of equipment, techniques, patient preparation and the complications that may occur during the procedure.

Role of Suction in Airway Management

A patent airway is crucial to patient survival. Removal of accumulated secretions, blood and vomit increases respiratory efficiency, decreases the risk of complete airway obstruction and improves visualization of the trachea for intubation.1

Awareness of the risks involved is the first step toward developing a plan for prehospital suction of the critically ill patient. Together with appropriate use of equipment, this enables provision of the best possible patient care during suctioning.2

Working under local policies and procedures, the EMS provider must determine the most appropriate method for suction, taking into consideration issues of patient safety, time requirements, the suction source and patient comfort. Suctioning is not a benign technique. Providers must also have plans for resolving problems that may occur during suctioning. Tracheal trauma, suctioning-induced hypoxemia, hypertension, cardiac dysrhythmias and raised intracranial pressure have all been associated with suctioning. Several studies also note the need for psychological support for the conscious patient.3

Suction Equipment Check

Today's suction units offer easy-to-use testing to quickly confirm that all functions are in working order: occlusion check, vacuum buildup efficiency, maximum achievable vacuum level and air leakage status. Large dials and single-control units are easier to operate with gloves and in the often-constrained environments of EMS operations. Check all of your unit's suction equipment at the beginning of each shift and after each use, following the manufacturer's recommendations. Portable and wall-mounted suction devices within the ambulance commonly have variable vacuum settings of 0 mmHg-

500 mmHg. Suction pressure in mechanical, battery-operated units and Venturi systems can be regulated with adjustment of a control knob or valve.

Suction systems incorporate some form of check valve to prevent liquid or particulate matter entering the suction line to the pump. Never connect the suction tubing directly to the suction source. Bypassing the trap could result in contamination of the pump and associated tubing, degradation of pump performance or complete pump failure.

Suctioning Equipment

Suction can be delivered pneumatically by oxygen, manually by hand or foot, or through an electric pump powered by the vehicle's power supply or a battery. Increasing the rate of aspiration significantly makes it possible to remove large foreign material from the airway. This suction technique requires large suction tips. Ensure all connections are secure during the vehicle check-out at the beginning of each shift. The tubing must be connected to the proper suction tip for optimal suctioning.

Battery-Driven Suction Devices

Battery-powered suction devices are ideal for emergency and field situations. When properly maintained, the devices deliver consistent and reliable suction for EMS operations. These devices do not require a gas source, manual operation or close proximity to the ambulance. The battery-driven portable suction unit must be small, lightweight, have a high-capacity battery and provide for the easy, safe and rapid removal of any contaminated supplies.

Ambulance-Mounted Suction Units

The ambulance pump servicing the suction system should include a controllable suction regulator, system alarms, if needed, a vacuum gauge and a suction outlet. Particle traps, or some system to collect an overflow of suctioned material, should be placed between the collection reservoir and the suction pump. The trap should be visible to the operator.

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