Management of Airway Secretions in Acute Care 
 
Why Secretion Management Matters 
– Prevents airway obstruction, hypoxia, atelectasis, and Ventilator Associated Pneumonia (VAP). 

Assessment of Secretions 
– Respiratory status, secretion characteristics, patient ability to clear secretions. 
– Suction only when clinically indicated. 
 
Non-Ventilated Patients 

First-line measures: 
– Coughing, positioning, hydration, physiotherapy, nebulisers, oral care. 

Oropharyngeal suction: 
– Use Yankauer suction catheter 
– Suction only what you can see (do not push the catheter to the back of the mouth as this can initiate the gag reflux  
– Limit to 10–15 seconds on each pass 
 
Ventilated Patients 

Indications: 
– Visible/audible secretions, rising pressures, falling oxygenation 

Suction Catheter Selection 
– Catheter should not exceed 50% of airway lumen 
– Size ≈ ETT internal diameter x 2 
 
Suction Pressures (Adults) 
– ETT/tracheostomy: 80–120 mmHg 
– Oral suction: 100–150 mmHg 
 
Ventilated Suction Procedure 
– Pre-oxygenate 
– Closed (in line) suction preferred 
– insert catheter, illicit cough, withdraw 2cm then apply suction and withdraw smoothly to the full length 
– Limit passes and reassess 
 
Subglottic Suctioning 

– Removes secretions above cuff – note: only applies to ET tubes with a subglottic port 
– Pressure: 20–30 mmHg (use a 10ml syringe) 
– Part of VAP prevention 

Complications 
– Hypoxia, mucosal trauma, arrhythmias 
 
Documentation 
– Indication, method, pressures, secretion type, response 
 
*Always refer to local hospital policy