1. Indications for Suctioning:

• Respiratory distress associated with thick secretions.

• Meconium-stained amniotic fluid at birth (per NRP guidelines).

• Blood-stained amniotic fluid at birth (per NRP guidelines).

• Sputum.

• Emesis (vomiting).

• Attempts to clear secretions with bulb syringe or blunt-tip suctioning have been unsuccessful.

• Suspected nasal obstruction.

• Choanal atresia.

• Stenosis.

  2. Indications for Gastric Decompression:

• Infants receiving positive pressure ventilation (PPV) via bag/mask for an extended period.

• Infants who are endotracheally intubated.

• Removal of gastric contents to prevent aspiration of emesis. The gastric tube should be left open to air to vent PPV.

  3. Complications:

  • Vagal response with symptoms such as apnea, bradycardia, cyanosis, and loss of muscle tone.

  • Hypoxia.

  • Laryngeal spasm.

  • Trauma to mucosal lining.

  • Esophageal tears.

  4. Pre-procedure:

  • Must obtain physician order, except in emergency situations following NRP guidelines or in compromised infants. Follow hospital protocols if in place.

  • Deep pharyngeal suctioning should not be routine; notify the physician if suctioning with a bulb syringe or blunt-tip suction is insufficient.

  • Have a second RN or RT present to assist in case of complications.

  • Nasopharyngeal: Sterile catheter appropriate for infant size.

  • Premature infant: 5-6 Fr.

  • Term infant: 6-8 Fr.

  • Oropharyngeal: 5/6 Fr to 10 Fr.

  • Gastric: Feeding/gastric tube appropriate for infant size (5 Fr to 8 Fr).

    • Equipment needed:

      • Gloves

      • Catheter

      • Wall suction device with suction tubing

      • Water-soluble lubricant (as needed)

      • Sputum trap (if collecting specimen)

      • Oxygen flowmeter

      • Resuscitation equipment (readily available)

  6. Prepare Equipment:

  • Check wall suction for proper function and pressure.

  • Suction pressures should be no greater than –60 to –80 mmHg when tubing is occluded.

  • Prepare suction catheter, lubricant, and normal saline using sterile technique.

  • Designate one hand as "sterile" for handling the catheter and the other as "dirty" for handling equipment.

    Measure depth for catheter insertion:

    • Nasopharyngeal: From the tip of the nose to the earlobe (Fig 1).

    • Gastric: From the bridge of the nose to the earlobe

      and from the earlobe to halfway between the xiphoid

      process and umbilicus. (Fig 2).

7. Suctioning Procedure:

a. Nasopharyngeal catheter insertion: Gently insert catheter along the floor of the nasal cavity, avoiding force against obstructions. If one side is blocked, try the other.

b. Oropharyngeal catheter insertion: Gently insert the catheter into the mouth without suction, guiding it along the side of the mouth to prevent gagging. Never force against obstructions.

• • Apply suction and gently rotate as the catheter is withdrawn.

  • Do not apply suction for longer than 5 seconds.

  • Observe for complications such as color change, apnea, poor muscle tone, and bradycardia.

    If complications occur:

    • Stop suctioning immediately.

    • Stimulate the infant.

    • Provide oxygen.

    • Administer neonatal resuscitation, including PPV if indicated.

• Post-procedure:

  • Use a new sterile suction catheter if the catheter becomes obstructed or with each new suctioning session.

  • Dispose of the catheter and gloves in a waste container.

  • Document in Electronic Health Record:

    • Secretions: Amount, consistency, and color.

    • Toleration of the procedure.

    • Notify RN/MD of any abnormal findings, bleeding, emesis, or complications.

    • Keeping the team informed ensures better patient outcomes.