Evidence-based suction management in Accident and Emergency: a vital component of airway care

Abstract

Effective airway management aims to establish and maintain a patent airway to ensure adequate alveolar ventilation and patient survival. Suction therapy must be regarded as a vital component of airway care, with all staff who are required to perform this procedure being aware of the principles of safe, effective suctioning. This paper provides an outline of the types of suction catheters available for use in the emergency care setting, and describes the safe procedures to be followed for both endotracheal and oro-pharyngeal suctioning. Potential complications are discussed under the headings of respiratory, cardiovascular, immunological and traumatic, all of which are relevant to safe patient care whatever the setting, and all of which should be recognizable by any staff undertaking this procedure. The final section looks at the ways in which some of the complications can be minimized or detected by relating some of the more important theoretical points discussed throughout the paper to the practical situation. Suction therapy is not without risk for the patient and, although the frequency of suction therapy is far less in Accident and Emergency (A & E) than in the Intensive Care Unit, the potential dangers remain the same. In order to minimize some of the dangers and reduce confusion amongst staff, this paper concludes with a recommendation for a degree of standardization in such catheter use.