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Aspiration of secretions

What is it?

Refer to your healthcare team if the recommendations for your child are different from those presented here.  

How does it work?

 

Your healthcare team will make recommendations specific to your child, including recommendations for equipment, and will provide information on the correct use and maintenance of equipment for the aspiration of secretions.

Refer to your healthcare team if the equipment used for your child is different from what is described in the methods of care here.

FAQ – Aspiration of secretions

When to consult your healthcare team

Secretions

During suctioning

Equipment

General condition

Your child’s healthcare team will take the opportunity during your child’s follow-up appointments to review your child’s care and equipment. Adjustments will be made as required.

Do not hesitate to refer to your child’s healthcare team for any questions or for specific advice related to your child’s condition.

WARNING: The information in this section is meant as a general guide for parents and caregivers with certain problems related to aspiration of secretions. It is not intended to replace the recommendations of your child’s healthcare team.

Discuss your child’s unique needs with the healthcare team, including WHO and WHEN to contact when problems arise.

Resistance or impossibility to insert the aspiration catheter into the tracheal cannula

Possible cause(s)

  • Mucous plug in the tracheal cannula: may be caused by insufficient humidity, excess secretions and/or insufficient frequency of suctioning
  • Foreign body in the tracheal cannula
  • Incorrect insertion of catheter for aspiration

What to do?

  • Never force the insertion of the catheter in the tracheal cannula.
  • Gently but rapidly, attempt to suction tracheobronchial secretions.
  • Instill saline drops into the tracheal cannula, as you have been taught by your healthcare team.
  • If you are unable to suction secretions (the tracheal cannula is obstructed), then:
  • If the problem is resolved:
    • observe your child’s breathing to detect any signs of respiratory distress;
    • inform your healthcare team.
  • If you are still unable to suction secretions and your child IS in respiratory distress:
  • If you able still unable to suction secretions and your child IS NOT in respiratory distress, immediately contact your child’s healthcare team.
  • If you are able to aspirate secretions, then:
    • repeat the aspiration, using installation of saline drops, up to 2 more times, as needed;
    • review methods to prevent mucous plugs with your healthcare team.

Resistance or impossibility to insert the aspiration catheter via the nose

Possible cause(s)

  • Mucous plug or foreign body in the nostril
  • Inflammation inside the nose, causing blockage of the nostril (eg, due to infection or allergy)
  • Septum deviation of the nose
  • Incorrect insertion of the catheter into the nose

What to do?

  • Clean the nose, using saline drops, as taught to you by the healthcare team.
  • Never force the insertion of the catheter into the nose.
  • Review the method of nasal aspiration.
  • Ensure that you are using the correct equipment and materials for nasopharyngeal suctioning.
  • Rapidly contact your child’s healthcare team.

Difficulty or impossibility to aspirate secretions

Possible cause(s)

  • Equipment malfunction including any of the following:
    • suction device battery charge depleted
    • suction regulator pressure too low
    • suction device broken
    • canister containing secretion overfilled
    • canister cover incorrectly closed
    • suction tubing bent or pinched
    • suction device incorrectly assembled
    • suction catheter blocked
  • Excess or very thick secretions are obstructing the airway

What to do?

  • Quickly verify that the suction device is plugged into a working electrical outlet or that the battery is correctly charged.
  • If no power is available, use the manual mucous trap device, as instructed by your healthcare team.
  • If the power supply is adequate, quickly verify that the suction device is in working order:
    • verify that the pressure on the suction; regulator is set to the correct value
    • empty the canister if full;
    • verify that the canister cover is closed correctly;
    • verify that the suction tubing is correctly installed and not blocked, pinched, bent or damaged in any way;
    • verify that that all parts of the suction circuit are correctly installed;
    • verify that the suction valve or port is working correctly;
    • verify that the suction catheter is not blocked.
  • After these steps, if you are unable to suction secretions (obstruction of the tracheal cannula):
  • If the problem is resolved:
    • observe your child’s breathing to detect any signs of respiratory distress;
    • inform your healthcare team.
  • If you are still unable to suction secretions and your child IS in respiratory distress:
  • If you able still unable to suction secretions and your child IS NOT in respiratory distress, immediately contact your child’s healthcare team.
  • If you are able to aspirate secretions, then:
    • repeat the aspiration, using installation of saline drops, up to 2 more times, as needed;
    • review methods to prevent mucous plugs with your healthcare team.

Blood-tinged secretions

Possible cause(s)

  • Irritation of the trachea by:
    • incorrect suctioning technique (too frequent, too deep or using a suction pressure that is too high)
    • excessive cough
  • Respiratory tract infection
  • Insufficient humidification
  • Insufficient hydration

What to do?

If fresh blood in the secretions:

  • Remain calm and reassure your child;
  • If bleeding continues, immediately contact your child’s healthcare team;
  • Observe your child’s breathing to detect any signs of respiratory distress (see next problem);
  • If your child is in respiratory distress, remove the suction catheter and begin manual ventilation and CPR as instructed.

If blood streaks or pink secretions:

  • Observe your child’s breathing to detect any signs of respiratory distress.
  • Check the pressure of the suction device.
  • Review suctioning technique; verify that you are inserting the catheter to the correct depth.
  • Aspirate secretions gently.
  • Avoid excessive aspiration which can damage the delicate lining of the airways.
  • Increase the level of humidity.
  • Contact your child’s healthcare team.

Any one or more of these respiratory distress symptoms following aspiration of nasopharyngeal or tracheal secretions: labored breathing; more comfortable in a sitting position or with head elevated than in a lying down position; rapid, noisy or wheezy breathing; shallow breathing; weak cough; indrawing (retraction of the skin over, under and in between the ribs), use of accessory muscles to help with breathing; nasal flaring (enlargement of the nostrils during breathing); extension of the neck backwards to try to breathe in air; continuously crying; agitation; anxiety; scared look on your child’s face; pale skin; blue color of lips and nail beds

Possible cause(s)

  • Mucous plug moved further down the airways towards the lungs
  • Bronchospasm: narrowing or constriction of the airways (eg, due to irritation, inflammation and/or secretions in the airways)
  • Pneumothorax (a puncture in the lining of the lungs)

What to do?

  • Remain calm and reassure your child.
  • Stop suctioning.
  • Remove the suction catheter.
  • Give prescribed medication, such as a bronchodilator (eg, Ventolin®) and/or oxygen if available and recommended by the healthcare team.
  • If your child IS NO LONGER in respiratory distress, contact your child’s healthcare team.
  • If your child REMAINS in respiratory distress:

Vomiting during the aspiration of secretions

Possible cause(s)

  • Aspiration too soon after the last meal
  • Incorrect aspiration technique (eg, insertion of the suction device such as Yankauer suction tip too far back in the throat)
  • Stimulation of the gag reflex during oral or nasopharyngeal suctioning
  • Incorrect insertion of the catheter

What to do?

  • Turn your child’s head to the side to avoid choking or passage of vomit into the lungs.
  • If the secretions were aspirated during a meal, pause your child’s feeding.
  • Clean your child’s mouth.
  • Closely observe your child’s breathing to detect any signs of respiratory distress (see previous problem).
  • Rapidly contact your child’s healthcare team.

To avoid vomiting:

  • Minimize aspiration of secretions immediately after meals.
  • Review the correct technique for aspiration of secretions.
  • Gently insert the suction catheter to avoid stimulating the gag reflex.

Nosebleeds after nasopharyngeal aspiration

Possible cause(s)

  • Agitated child, moving a lot during the aspiration procedure
  • Incorrect insertion of the suction catheter
  • Irritation of the nostril
  • Excessive suctioning of the nose
  • Suction pressure too high

What to do?

  • Reassure your child.
  • Apply direct pressure to the bridge of your child’s nose for a few minutes to stop bleeding; if possible put your child in the upright or sitting position.
  • If the bleeding persists, rapidly contact your child’s healthcare team.

To avoid nosebleeds:

  • Review the correct technique for nasopharyngeal aspiration of secretions.
  • Verify that the suction pressure regulator is correctly set, as recommended by the healthcare team.
  • Verify that the catheter is well lubricated prior to insertion.
  • Gently insert the catheter into the nose.

Prolonged cough or spasms of cough during aspiration of nasopharygeal or tracheobronchial secretions

Possible cause(s)

  • Incorrect insertion of the suction catheter
  • Bronchospasm: narrowing or constriction of the airways
  • Respiratory tract infection

What to do?

  • Stop suctioning.
  • Remove the suction catheter.
  • Reassure your child.
  • Assess your child’s breathing and colour.
  • If your child calms and stops coughing, gently re-insert the catheter to aspirate secretions.
  • If the cough persists, consider administration of a bronchodilator such as Ventolin® and/or oxygen if available and recommended by the healthcare team.
  • If your child shows signs of respiratory distress:
  • If the cough persists, rapidly contact your child’s healthcare team.

To prevent this problem: Review the correct technique for aspiration of secretions.

Pallor (paleness), blue lips or blue nails; oxygen desaturation, as indicated by a monitor

Possible cause(s)

Low level of oxygen in the blood (desaturation or hypoxia)

What to do?

  • Stop aspiration of secretions.
  • Remove the suction catheter.
  • Administer oxygen, if available.
  • Closely observe your child.
  • If your child is mechanically ventilated, reconnect your child to the ventilator.
  • If your child remains in respiratory distress:
  • If your child improves, immediately contact your child’s healthcare team.

Weakness, fainting or loss of consciousness

Possible cause(s)

Vagal stimulation

What to do?

  • Stop aspiration of secretions.
  • Verify the general and respiratory status of your child, following the training provided by your healthcare team.
  • If your child is in respiratory distress, call 911 immediately and begin manual ventilation and CPR as instructed.

Suction device noisy

Possible cause(s)

  • Break or leak in the suction device system (eg, cover not secured, catheter or filter incorrectly connected)
  • Defective suction device

What to do?

  • Verify that the suction device is correctly installed and connections are secured.
  • If necessary, use the manual mucous trap device to aspirate secretions from the tracheal cannula
  • If the problem persists, rapidly contact your healthcare team.

Suction device not working

Possible cause(s)

  • Canister is overfilled
  • Battery depleted
  • Defective suction device

What to do?

  • Verify that the suction device is plugged into a working electrical outlet or that the battery is correctly charged.
  • Empty the canister if full.
  • If the problem persists, rapidly contact your child’s healthcare team.

Do not hesitate to contact your child’s healthcare team for any questions or for specific advice related to your child’s condition.

Everyday tips

Clothing

If your child has a tracheostomy, refer to the appropriate section.

Bathing and swimming

If your child has a tracheostomy, refer to the appropriate section.

Mouth care:

  • Your child’s mouth should be cleaned at least twice a day.
  • If your child has no teeth, use a small face cloth or a gauze dampened with water and rolled around your index finger, to gently rub your child’s gums front to back.
  • Once teeth start to appear, brush your child’s teeth after each meal and at bedtime. Since young children have a tendency to swallow toothpaste instead of spitting it out, use only the size of a small grain of rice in children under 2 years old and the size of a small pea in children up to 6 years old. Use this time to also gently massage their gums with the toothbrush.
  • As your child matures, teach and supervise brushing of the teeth.
  • Apply, if required, a hydrating lip balm.

Nasal hygiene:

  • In all children, secretions, along with bacteria and viruses collect in the nose. Keeping your child’s nose clean helps prevent lung infections.
  • In infants and children who are unable to blow their noses, saline drops are often used to clean the nose.
  • Refer to your child’s healthcare team for the technique and the frequency of nasal care recommended for your child, including the procedure for the preparation of homemade saline solution and safe storage.
  • The use of saline nasal drops is especially important if your child requires nasopharyngeal suctioning.

Sleeping

If your child has a tracheostomy, refer to the appropriate section.

Nutrition and hydration

  • Ensure that your child is well hydrated, especially during hot weather or if your child is unwell and has a fever, vomiting or diarrhea. These conditions cause thicker secretions. Adequate hydration will allow for easier aspiration of secretions and a more effective cough.
  • Verify with your healthcare team the quantity of liquids necessary for your child according to the state of health.
  • If your child has a tracheostomy, refer to the appropriate section.

Activities

  • Your child may participate in daily activities according to ability, endurance and underlying conditions.
  • Position your child in the most comfortable position possible to facilitate breathing and aspiration of secretions. If your child has a tracheostomy, refer to the appropriate section.

Travel and transportation

  • Always check to see if your child requires suctioning prior to leaving home or starting activities.
  • Always have on hand a “travel kit” when leaving your home containing:
    • suction catheters
    • a portable suction device
    • suction tubing
    • a canister to collect secretions
    • connecting tubing (if pertinent)
    • solutions to lubricate and clean the suction catheter (sterile water or cooled boiled water)
    • solutions to rinse the suction catheter (hydrogen peroxide 3%), if needed
    • containers for the solutions
    • alcohol swabs
    • non steriles gauze compresses
    • paper tissues (to wipe away excess secretions)
    • a manual mucus trap device (that can be used without battery or electrical power).
  • Have a list on hand of the contents of this kit so it can be easily restocked. Confirm with your healthcare team how often you should verify supply and status, including expiry dates of equipment and materials.
  • Keep a resource list close at hand with the names and telephone numbers of hospital, doctors, other members of your child’s healthcare team and equipment providers. Make sure you know how to contact these resources outside of regular hours and during vacations.
  • Before leaving on a trip:
    • make sure you have a document from the healthcare team describing your child’s condition and your child’s needs regarding aspiration of secretions and a complete list of medications;
    • bring enough supplies to last for the duration of the trip and add a bit extra as a reserve;
    • make sure to ask if equipment providers and other resources are available at your destination in the event of equipment failure or other healthcare need;
    • take the climate of your destination into consideration because the relative humidity of the ambient air could modify the quantity and the consistency of your child’s secretions.
  • For travel by airplane:
    • contact the airline company to inquire about their policy concerning the transport of medical equipment;
    • keep all medical equipment and supplies with you in the cabin.
  • If your child has a tracheostomy, refer to the appropriate section.

Others

Emergencies:

  • Always have a telephone nearby in case of an emergency. Make sure your cell phone is charged at all times. When you go out, bring what you need to charge the phone, when necessary (cable with charger and portable Power Bank charger).
  • Discuss with your child’s healthcare team whether your child requires monitoring by a trained and competent individual capable of intervening, as needed; during the day, night or at all times.
  • If your child has a tracheostomy, refer to the appropriate section.

Humidity:

  • Your child needs to live in an environment with adequate humidity so that secretions are easier to clear.
  • Unless there is a medical restriction, keep your child well hydrated, increasing your child’s intake as needed.
  • Avoid overheating the house in winter and use an air conditioner in the summer to maintain humidity in your home.
  • The recommended relative humidity in the home, measured with a hygrometer, should be between 40 to 50%.
  • If your home air is too humid (55% and more), install a dehumidifier and clean it every week in order to prevent the presence of mold in the air that your child breathes.
  • If your home air is too dry (less than 40%), the following daily habits can help increase the moisture in your home:
    • do not activate the exhaust fan when you cook or boil water;
    • avoid using an air conditioner in the summer;
    • keep the bathroom door open when you shower;
    • minimize the use of electric heaters, wood burning stoves and fireplaces during the winter;
    • eliminate carpeting and rugs in the home.
  • With your child’s healthcare team, discuss ways in which the level of humidity can be optimised in the air your child breathes for comfort and to aid in secretion mobilisation and clearance (eg, use of a portable humidifier filled with tap water, increasing humidity through other methods, etc).

Air quality:

  • Clean air, with reduced dust, dirt and pollens can reduce the need for aspiration of secretions.
  • Avoid all exposure to traditional or electronic cigarette smoke or vapor, especially at home.
  • Clean and regularly change filters on the air conditioners.
  • In your child’s proximity, avoid:
    • accumulation of dust, presence of rugs, upholstered furniture and home accessories that are difficult to clean (eg, heavy drapery);
    • dust from renovations;
    • wood burning heating systems (stove or fireplace);
    • excessive pollution (eg, smog, heavy traffic, strong winds).
  • In your child’s room:
    • use pillows cases, sheets, and blankets made of washable synthetic material (hypo-allergenic);
    • sheets that are very soft and fluffy with fibers (eg, flannel sheets) are not recommended: they attract dust;
    • wash bedding in hot water every week in order to destroy dust mites;
    • dry bedding in a dryer if your child is allergic to pollen.
  • If your child has a tracheostomy, refer to the appropriate section.

Prevention of infections:

  • Always wash your hands before providing care to your child and have your child wash his hands before and after all meals and frequently during the day.
  • If you have a cold, the flu or another respiratory infection, use non sterile gloves and wear a mask when providing care to your child.
  • If your child has a tracheostomy, refer to the appropriate section.

Suction catheter replacement frequency:

  • If used regularly and well maintained (see Maintenance and cleaning of medical supplies and equipment, below):
    • a flexible suction catheter may be used for up to 24 hours; change every day or according to the frequency recommended by your healthcare team;
    • a suction device such as Yankauer suction tip or Little Sucker® should be replaced every 2-4 weeks or according to the frequency recommended by your healthcare team;
    • a BBG nasal aspirator should be replaced every 7 days.
  • All catheters should be replaced if secretions remain visible inside the catheter, despite proper cleaning or if the catheter is damaged in any way.
  • If your child has a respiratory infection, the catheters may require more frequent replacement; follow the recommendations of your child’s healthcare team.

Maintenance and cleaning of medical supplies and equipment:

  • Always refer to the manufacturer’s recommendations and those provided by your healthcare team; the healthcare team will consider the specific characteristics of your child to make the most appropriate recommendations. In general, these are the most commonly recommended practices:
  • Suction device:
    • each week or more often, if necessary: clean the outer surfaces of the device with a soft cloth or a damp cloth; use a small amount of dish washing soap. Dry the surfaces using a clean cloth.
  • Suction catheter:
    • after each aspiration:
      • suction sterile water or cooled boiled water to thoroughly rinse and clean the inside of the catheter so that no visible secretions remain;
      • if secretions are difficult to remove from inside the catheter, suction a small amount of hydrogen peroxide 3% followed by cooled boiled water or sterile water;
      • once well rinsed, dry the interior of the catheter by aspirating air; this prevents the growth of bacteria;
      • clean the outside of the catheter using an alcohol swab and let it air dry;
      • store the cleaned and dried catheter in the envelope that it came in, with a cap (if applicable) or in a clean, dry container;
      • if you are using a container for storage, clean it using the high heat setting on the dishwasher, at least once daily.
    • each week (suction device such as Yankauer suction tip or Little Sucker®):
      • aspirate soapy water, then rinse using sterile or boiled water;
      • once well rinsed, dry by aspirating air; obstruct the suction valve if present;
      • let air dry and then store as usual.
  • Canister to collect secretions:
    • daily or when the canister is 3/4 full:
      • empty contents into the toilet;
      • wash the canister with warm soapy water;
      • rinse with warm water and let air dry;
      • reattach to the suction device.
    • each week:
      • disassemble the canister parts, if applicable;
      • rinse the canister and parts under warm running water;
      • soak the canister and parts in warm soapy water; use mild dish washing soap;
      • clean the inside of the canister using a soft cloth or a soft bottle brush to remove any adherent secretions;
      • rinse with warm water and let air dry;
      • reattach to the suction device.
    • if needed (for persistent odours even after appropriate cleaning): soak the canister in a 50% vinegar, 50% water solution for 20 to 30 minutes and then rinse well or replace the canister.
  • Suction tubing:
    • after each aspiration:
      • ensure that there are no retained secretions inside the tubing; if secretions are present, rinse the tubing by suctioning sterile water or cooled boiled water;
      • if secretions in the tubing persist, suction hydrogen peroxide 3% followed by cooled boiled water or sterile water;
      • if you are unable to remove the secretions, replace the tubing.
    • each week:
      • aspirate soapy water followed by rinsing with cooled boiled water or sterile water;
      • dry the tubing by aspirating air;
      • let the tubing air dry and then store as usual.
    • each month or at the frequency recommended by your healthcare team: replace the tubing.
  • Containers for cleaning and rinsing solutions (boiled water or sterile water and hydrogen peroxide 3%):
    • after each use: rinse containers with water and let air dry.
    • daily: clean containers with warm soapy water, rinse well with water and let air dry.
  • Daycare and school:
    • Your child’s healthcare team will evaluate your child’s needs and will support you in the planning of integration to daycare or to school.
    • Advise school staff of the treatment and care that your child requires.

Methods of care

Methods of care : Aspiration of oral secretions

Indications

Considerations:

Frequency

Required materials

If needed:

The methods of care below are illustrated using a LSU suction device, a Yankauer® rigid stem catheter and/or a Little Sucker® type catheter.

Refer to your child’s healthcare team if the material or the sequence of steps you have been taught is different than those described here.

Step 1: Anticipation

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

  • Create the right moment: integrate the care in a routine.
  • Alert your child to the needed care and communicate together.
  • Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

Step 2: Preparation

See the full description here

Summary:

  • Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
  • Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
  • Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

Step 3: Procedure

See the full description here

Summary 3 key concepts:

  • Safety: Carefully follow the care practice steps as you have been taught.
  • Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
  • Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

Step 4: Prepare the materials

  • Use a flat work surface that has been properly cleaned.
  • Gather the material required.
  • Leave the catheter in its envelope or with the cap on. Open one end of the envelope if using a new catheter.
  • Pour cooled boiled water or sterile water into a clean container.
  • Check that the canister for collecting secretions is correctly installed on the suction device and that it is less than ¾ full.
  • Connect the suction tubing to the suction device.
Why ?

This step ensures the safety and the continuity of the procedure.

Step 5: Set the pressure regulator of the suction device

  • Switch on the suction device.
  • Adjust the pressure setting, following the directions of the healthcare team.
Why ?

This step ensures that the correct pressure setting is used.

An excessively high pressure may damage the fragile lining of the mouth.

A pressure that is too low may be ineffective in suctioning secretions.

Step 6: Connect the suction catheter to the suction tubing

  • Take the free end of the suction tubing with one hand.
  • With the other hand, connect the end of the suction catheter to the tubing, taking care to keep the tip of the catheter (the part that goes into the mouth) inside the envelope or with the cap on.
Why ?

By connecting the catheter in this way, the tip stays clean, reducing contamination with bacteria.

Step 7: Position your child

  • Place your child in a comfortable position that easily allows you to perform this care.
  • If your child is in a sitting or semi-sitting, gently turn your child’s head to one side, facing you.
  • The procedure can also be done with your child in the lying position.
Why ?

The sitting or semi-reclining position is preferred to optimally remove oral secretions.

Step 8: Check the pressure level of the suction device and lubricate the catheter

  • Remove the suction catheter from the protective envelope or remove the cap, if applicable.
  • Dip the tip of the catheter into the lubrication solution (either cooled boiled water or sterile water) in order to aspirate a small amount of water.
  • If the catheter has a suction valve: then at the same time as you dip the catheter into the solution, close the valve with your thumb to create a vacuum effect and then remove your thumb to release the suction.
  • If the catheter does not have a suction valve: the aspiration of the water will be continuous.
  • Check that the water has been sucked into the catheter.
  • Confirm that the pressure level indicated on the device is matched to the values recommended by the healthcare team.
  • Remove the tip of the catheter from the water container.
Why ?

This step ensures that the device works and that the catheter is lubricated.

This also verifies that there is no air leak in the aspiration device and that the pressure is correctly set.

Dipping the catheter in water ensures that it is lubricated; this minimizes irritation of the lining of the mouth.

Step 9: Insert the catheter

  • Carefully insert the catheter into your child’s mouth.
  • Continue inserting the catheter, aiming towards your child’s cheeks (not blocking the suction valve, if present).
Why ?

This method avoids injury to the lining of the mouth.

Step 10: Aspirate the secretions

  • Gently move the tip of the catheter inside the mouth, around the gums, under the tongue and towards the back of the throat.
  • Gently remove the catheter from the mouth (intermittently closing the suction valve with your thumb, if present).
  • Each session of aspiration should not last more than 15 seconds.
  • Pause suctioning if your child starts to cough; once the coughing stops, resume the steps here.
  • Wipe excess secretions from the mouth using a paper tissue, if necessary.
Why ?

Aspiration of oral secretions should be brief as it removes air from the lungs at the same time. Excess suctioning can dry out your child’s mouth.

Step 11: Rinse the catheter

  • Wipe the outside of the catheter using a non sterile gauze or compress to remove secretions.
  • Dip the tip of the catheter into the cooled boiled water or sterile water container and aspirate a small quantity of water to clean the inside of the catheter (closing the suction valve of the catheter with your thumb, if present).
  • Remove the catheter from the water container.
Why ?

By wiping clean the outside of the catheter first, you avoid contaminating the water solution before rinsing the inside of the catheter.

Aspirating water into the catheter helps to remove and residual secretions from the inside the catheter.

Step 12: Repeat the aspiration, as needed

  • Let your child rest for at least 30 seconds between each episode of aspiration.
  • Repeat the procedure 2 to 3 times if secretions are still present in the mouth.
  • Between each episode of aspiration, rinse the catheter with water (boiled or sterile).
  • Notify your healthcare team if there is a change in the colour, consistency or amount of secretions.
Why ?

This step helps remove saliva and secretions more effectively from your child’s mouth.

A rest period between each episode of aspiration gives your child a chance to catch his breath.

A change in the colour, consistency or amount of secretions may indicate a change in your child’s healthcare status (eg, beginning of a respiratory tract infection).

Step 13: Clean the catheter

Keeping the suction valve closed with your thumb, if present:

  • Thoroughly rinse the catheter one last time by aspirating water (boiled or sterile) until no more secretions are visible inside the catheter and the suction tubing.
  • If secretions remain inside the catheter, aspirate a small amount of 3% hydrogen peroxide (previously poured into a small clean container) until the secretions are removed.
  • Aspirate water (boiled or sterile) and air into the catheter to rinse and dry the inside of the catheter.
  • Wipe the outside of the catheter with an alcohol swab.
  • Let the catheter air dry.
  • Disconnect the catheter from the suction tubing.
Why ?

This step is needed to keep the catheter clean and ready for next use and to limit contamination that might cause infections.

Step 14: Store the equipment

  • Turn off the suction device.
  • Replace the cap on the catheter, if applicable; or place the catheter back into the envelope or a clean, sealed container.
  • If necessary, empty the secretions from the canister into the toilet.
  • Discard the rinsing and lubricating solutions used during the aspiration procedure.
  • Rinse the containers used to hold the solutions with water and let air dry.
  • Store the containers with the rest of the aspiration equipment.
Why ?

This step ensures that the equipment is clean, in good condition and ready to use for the next episode of aspiration.

Step 15: Recovery

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

  • Listen to what your child says about the parts of the procedure that were difficult or painful.
  • Comfort your child and recognize your child’s collaboration with positive feedback.
  • Highlight your child’s  specific strengths that helped make the procedure positive.
  • Discuss with your child what might be done the same or differently the next time the care is needed.
  • Keep your promises if you have promised a reward, follow through.
  • Reward yourself too.

Methods of care : Aspiration of nasopharyngeal secretions

Indications

Considerations:

Frequency

Required materials

If needed:

The methods of care below are illustrated with a LSU suction device.

Refer to your child’s healthcare team if the material or the sequence of steps you have been taught is different than those described.

Step 1: Anticipation

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

  • Create the right moment: integrate the care in a routine.
  • Alert your child to the needed care and communicate together.
  • Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

Step 2: Preparation

See the full description here

Summary:

  • Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
  • Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
  • Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

Step 3: Procedure

See the full description here

Summary 3 key concepts:

  • Safety: Carefully follow the care practice steps as you have been taught.
  • Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
  • Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

Step 4: Prepare the materials

  • Use a flat work surface that has been properly cleaned.
  • Gather the material required.
  • Leave the catheter in its envelope. Open one end of the envelope if using a new catheter.
  • Pour cooled boiled water or sterile water into a clean container.
  • Check that the canister for collecting secretions is correctly installed on the suction device and that it is less than ¾ full.
  • Connect the suction tubing to the suction device.
  • If you are using a water-soluble lubricant, then open the pouch and squeeze a small amount onto a non-sterile compress, as recommended by your healthcare team.
Why ?

This step ensures the safety and the continuity of the procedure.

Step 5: Set the pressure regulator of the suction device

  • Switch on the suction device.
  • Adjust the pressure setting, following the directions of the healthcare team.
Why ?

This step ensures that the correct pressure setting is used.

An excessively high pressure may damage the fragile lining of the mouth.

A pressure that is too low may be ineffective in suctioning secretions.

Step 6: Connect the catheter to the suction tubing

  • Take the free end of the suction tubing in one hand.
  • With the other hand, connect the tip of the catheter to the suction tubing, taking care to keep the catheter in its protective envelope.
Why ?

By connecting the catheter in this way, the tip stays clean, reducing contamination with bacteria.

Step 7: Position your child

  • Place your child in a comfortable position that easily allows you to perform this care.
  • If your child is in a sitting or semi-sitting, gently extend your child’s head, with the chin in a slightly raised position.
  • The procedure can also be done with your child in the lying position.
Why ?

The semi-seated position is preferred, if possible.

With the head slightly extended, the catheter can be more easily inserted.

Step 8: Check the pressure level of the suction device and lubricate the catheter

  • Remove the suction catheter from the protective envelope without touching the tip of the catheter (the portion of the catheter that will go in the nose).
  • Holding the catheter in the middle, dip the tip of the catheter into the lubrication solution (either cooled boiled water or sterile water) in order to aspirate a small amount of water.
  • At the same time as you dip the catheter into the solution, close the valve with your thumb to create a vacuum effect and then remove your thumb to release the suction.

 

  • Check that the water has been sucked into the catheter.
  • Confirm that the pressure level indicated on the device is matched to the values recommended by the healthcare team.
  • Remove the tip of the catheter from the water container.
  • If you are using a water-soluble lubricant: dip the tip of the catheter in the lubricant that you squeezed out onto a compress; follow the recommendations of your healthcare team.
  • Keep the catheter in your hand, taking care that the tip does not touch anything.
Why ?

This step ensures that the catheter works and is lubricated.

This also verifies that there is no air leak in the aspiration device and that the pressure is correctly set.

Avoid contamination of the catheter by not touching the tip of the catheter with your hands.

Lubricating the catheter facilitates insertion in the nose and reduces irritation.

Step 9: Insert the catheter

  • Identify the maximal insertion length point on the catheter, using your previous measurements for the reference point.
  • Ask your child to take slow deep breaths, if possible.
  • Without blocking the suction valve, quickly but gently insert the catheter into one of your child’s nostrils, ideally when your child takes a breath in.
  • Continue to gently insert the catheter, following the inside wall of the nose.
  • Without blocking the suction valve, insert the catheter to the reference point as previously determined; this number on the catheter should align with the outside edge of the nostril.
  • Ask your child to cough, if possible.
  • If you experience resistance while attempting to insert the catheter:
    • Do not force insertion; remove the catheter and gently re-insert either in the same nostril or the other one.
    • Make sure that the catheter does not go into the mouth; if this happens, remove the catheter and re-insert it, directing it towards the back of the throat.
Why ?

This method minimizes the risk of injury to the lining of the nose and pharynx.

Taking a deep breath during the insertion of the catheter can help your child stay calm, facilitate insertion of the catheter and the passage of air into the lungs.

Coughing helps secretions move upwards in the airways towards the pharynx, facilitating removal.

Step 10: Aspirate the secretions

  • While withdrawing the catheter gently but quickly with one hand, intermittently close the suction valve with the thumb of your other hand.
  • Rotating the catheter during withdrawal (by rolling it between your thumb and index finger) can be helpful in aspirating secretions; check with your healthcare team to see if this recommended for your child.
  • Each aspiration session should not last more than 15 seconds or as tolerated by your child.
  • After the aspiration, ask your child to take regular breaths to recover from the procedure.
  • Wipe excess secretions from the mouth and nose with a paper tissue, if required.
Why ?

Intermittent suction avoids injury to the lining of the pharynx and nose.

Aspiration of secretions from the nasopharynx should be brief as it removes air from the airways at the same time.

Step 11: Rinse the catheter

  • Wipe the outside of the catheter using a non sterile gauze or compress to remove secretions.
  • Dip the tip of the catheter into the cooled boiled water or sterile water container and aspirate a small quantity of water to clean the inside of the catheter (closing the suction valve of the catheter with your thumb).
  • Remove the catheter from the water container.
Why ?

By wiping clean the outside of the catheter first, you avoid contaminating the water solution before rinsing the inside of the catheter.

Aspirating water into the catheter helps to remove and residual secretions from the inside the catheter.

Step 12: Repeat the aspiration, if needed

  • Let your child rest for at least 30 seconds between each aspiration.
  • Repeat the process 2 to 3 times if secretions are still present in the throat, alternating nostrils.
  • Between each aspiration, rinse the catheter with water (cooled boiled water or sterile water).
  • At the end of the procedure, have your child breath deeply.
  • Advise your healthcare team if you notice a change in the colour, quantity or consistency of secretions.
Why ?

This step optimizes removal of secretions from the nose and throat.

A rest period between each aspiration allows your child to catch his breath.

Breathing deeply at the end allows your child to relax and recover.

A change in the secretions may indicate a change in the health status of your child (eg, beginning of a respiratory tract infection).

Step 13: Clean the catheter

Keeping the suction valve closed with your thumb:

  • Thoroughly rinse the catheter one last time by aspirating water (boiled or sterile) until no more secretions are visible inside the catheter and the suction tubing.
  • If secretions remain inside the catheter, aspirate a small amount of 3% hydrogen peroxide (previously poured into a small clean container) until the secretions are removed.
  • Aspirate water (boiled or sterile) and air into the catheter to rinse and dry the inside of the catheter.
  • Wipe the outside of the catheter with an alcohol swab.
  • Let the catheter air dry.
  • Disconnect the catheter from the suction tubing.
Why ?

This step is needed to keep the catheter clean and ready for next use and to limit contamination that might cause infections.

Step 14: Store the equipment

  • Turn off the suction device.
  • Place the catheter back into the envelope or a clean, sealed container.
  • If necessary, empty the secretions from the canister into the toilet.
  • Discard the rinsing and lubricating solutions used during the aspiration procedure.
  • Rinse the containers used to hold the solutions with water and let air dry.
  • Store the containers with the rest of the aspiration equipment.
Why ?

This step ensures that the equipment is clean, in good condition and ready to use for the next episode of aspiration.

Step 15: Recovery

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

  • Listen to what your child says about the parts of the procedure that were difficult or painful.
  • Comfort your child and recognize your child’s collaboration with positive feedback.
  • Highlight your child’s  specific strengths that helped make the procedure positive.
  • Discuss with your child what might be done the same or differently the next time the care is needed.
  • Keep your promises if you have promised a reward, follow through.
  • Reward yourself too.
.Reviser : Ross .Version : 1.0

Methods of care : Suctioning a tracheostomy tube

Indications

Considerations:

Frequency

Required materials

If needed:

Always have on hand all equipment required in case of emergency.

The methods of care below are illustrated with a LSU suction device. 

Refer to your child’s healthcare team if the material, sequence and steps taught to you are different than those described.

Step 1: Anticipation

See the full description here

Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

  • Create the right moment: integrate the care in a routine.
  • Alert your child to the needed care and communicate together.
  • Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

Step 2: Preparation

See the full description here

Summary:

  • Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
  • Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
  • Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

Step 3: Procedure

See the full description here

Summary 3 key concepts:

  • Safety: Carefully follow the care practice steps as you have been taught.
  • Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
  • Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

Step 4: Prepare the materials

  • Use a flat work surface that has been properly cleaned.
  • Gather the material required.
  • Leave the catheter in its envelope. Open one end of the envelope if using a new catheter.
  • Pour cooled boiled water or sterile water into a clean container.
  • Check that the canister for collecting secretions is correctly installed on the suction device and that it is less than ¾ full.
  • Connect the suction tubing to the suction device.
Why ?

This step ensures the safety and the continuity of the procedure.

Step 5: Set the pressure regulator of the suction device

  • Switch on the suction device.
  • Adjust the pressure setting, following the directions of the healthcare team.
Why ?

This step ensures that the correct pressure setting is used.

An excessively high pressure may damage the fragile lining of the airways.

A pressure that is too low may be ineffective in suctioning secretions.

Step 6: Connect the catheter to the suction tubing

  • Take the free end of the suction tubing in one hand.
  • With the other hand, connect the tip of the catheter to the suction tubing, taking care to keep the catheter in its protective envelope.
Why ?

By connecting the catheter in this way, the tip stays clean, reducing contamination with bacteria.

Step 7: Position your child

  • Place your child in a comfortable position that easily allows you to perform this care.
  • If your child is lying on his back, place a rolled towel underneath the shoulders (not underneath the neck) in order to extend your child’s head backwards so that the neck and the tracheostomy site is easily visible.
  • If your child is in the semi-sitting position, gently extend your child’s head backwards so that the tracheostomy site is easily visible.
Why ?

The preferred position is one that facilitates the procedure and optimizes the comfort of your child.

Step 8: Check the pressure level of the suction device and lubricate the catheter

  • Remove the suction catheter from the protective envelope without touching the tip of the catheter (the portion of the catheter that will go in the nose).
  • Holding the catheter in the middle, dip the tip of the catheter into the lubrication solution (either cooled boiled water or sterile water) in order to aspirate a small amount of water.
  • At the same time as you dip the catheter into the solution, close the valve with your thumb to create a vacuum effect and then remove your thumb to release the suction.
  • Check that the water has been sucked into the catheter.
  • Confirm that the pressure level indicated on the device is matched to the values recommended by the healthcare team.
  • Remove the tip of the catheter from the water container.
  • Keep the catheter in your hand, taking care that the tip does not touch anything.
  • Ensure that excess drops of moisture do not fall into the trachea.
Why ?

This step ensures that the catheter works and is lubricated.

This also verifies that there is no air leak in the aspiration device and that the pressure is correctly set.

Avoid contamination of the catheter by not touching the tip of the catheter with your hands.

Lubricating the catheter facilitates insertion in the tracheal cannula and reduces irritation to the trachea.

Excess drops of moisture on the catheter from the lubricating solutions can cause severe coughing in your child and may promote the development of a respiratory infection.

Step 9: Insert the catheter

  • Identify the maximal insertion length point on the catheter, using your previous measurements for the reference point.
  • Ask your child to take slow deep breaths, if possible.
  • Disconnect your child from the ventilator, if applicable.
  • If there are many secretions visible in the tracheal cannula, block the suction valve as you quickly but gently insert the catheter into the tracheal cannula, preferably when your child takes a breath in.
  • If there are no visible secretions in the tracheal cannula, then quickly but gently insert the catheter into the tracheal cannula, preferably when your child takes a breath in, without blocking the suction valve.
  • Continue to insert the catheter to the reference point as previously determined; this number on the catheter should be aligned to the exterior rim entrance of the cannula connector.
  • Ask your child to cough, if possible.
Why ?

This method minimizes irritation to the trachea.

Taking deep breaths helps to minimize the lower airflow that takes place during aspiration of secretions.

Coughing can help dislodge secretions, allowing for easier removal.

Step 10: Aspirate the secretions

  • Withdraw the catheter gently but quickly with one hand by rolling the catheter between your fingers as you continuously close the suction valve with the thumb of your other hand.
  • The aspiration session should not last more than 5 seconds.
  • Completely withdraw the catheter, slowly retracting the catheter by gently rolling it between your fingers. Avoid making large circular movements with the catheter to prevent injury to the tracheal walls. Do not move the catheter up and down.
  • Reconnect your child to the ventilator, if applicable.
  • Wipe excess secretions from the tracheal cannula with a non sterile gauze compress, if required.
  • Encourage your child to take breaths to recuperate from the session.
Why ?

Aspiration of tracheobronchial secretions should be less than 5 seconds short in duration as it blocks the passage of air into the lungs.

Rolling the catheter between your fingers keeps it from sticking to the wall of the cannula.

Continuous aspiration (by blocking the suction valve) optimizes removal of secretions.

Avoid moving the tracheal cannula during aspiration to minimize irritation to the trachea.

Step 11: Rinse the catheter

  • Wipe the outside of the catheter using a non sterile gauze or compress to remove secretions.
  • Dip the tip of the catheter into the cooled boiled water or sterile water container and aspirate a small quantity of water to clean the inside of the catheter (closing the suction valve of the catheter with your thumb).
  • Remove the catheter from the water container.
Why ?

By wiping clean the outside of the catheter first, you avoid contaminating the water solution before rinsing the inside of the catheter.

Aspirating water into the catheter helps to remove and residual secretions from the inside the catheter.

Step 12: Repeat the aspiration, if needed

  • Allow your child to rest for at least 30 seconds between each aspiration.
  • Repeat the procedure 2 to 3 times as needed if secretions are still present.
  • Rinse the catheter with water (boiled or sterile) between each aspiration.
  • At the end of the procedure, encourage your child to take deep breaths, if able.
  • Advise your healthcare team if there is a change in the colour, consistency and/or amount of secretions.
Why ?

This step allows for effective removal of secretions from the trachea.

A short rest between each aspiration allows your child to breathe.

Breathing deeply at the end allows your child to relax and recover.

A change in the secretions may indicate a change in your child’s health (eg, beginning of a respiratory tract infection).

Step 13: Clean the catheter

Keeping the suction valve closed with your thumb:

  • Thoroughly rinse the catheter one last time by aspirating water (boiled or sterile) until no more secretions are visible inside the catheter and the suction tubing.
  • If secretions remain inside the catheter, aspirate a small amount of 3% hydrogen peroxide (previously poured into a small clean container) until the secretions are removed.
  • Aspirate water (boiled or sterile) and air into the catheter to rinse and dry the inside of the catheter.
  • Wipe the outside of the catheter with an alcohol swab.
  • Let the catheter air dry.
  • Disconnect the catheter from the suction tubing.
Why ?

This step is needed to keep the catheter clean and ready for next use and to limit contamination that might cause infections.

Step 14: Store the equipment

  • Turn off the suction device.
  • Place the catheter back into the envelope or a clean, sealed container.
  • If necessary, empty the secretions from the canister into the toilet.
  • Discard the rinsing and lubricating solutions used during the aspiration procedure.
  • Rinse the containers used to hold the solutions with water and let air dry.
  • Store the containers with the rest of the aspiration equipment.
Why ?

This step ensures that the equipment is clean, in good condition and ready to use for the next episode of aspiration.

Step 15: Recovery

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

  • Listen to what your child says about the parts of the procedure that were difficult or painful.
  • Comfort your child and recognize your child’s collaboration with positive feedback.
  • Highlight your child’s  specific strengths that helped make the procedure positive.
  • Discuss with your child what might be done the same or differently the next time the care is needed.
  • Keep your promises if you have promised a reward, follow through.
  • Reward yourself too.
.Reviser : NR .Version : 1.0

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