Table 2.
Recommendations for endotracheal suctioning in intubated newborns
| Clinical issue | Recommendation | Articles in agreement (%) | Evidence level |
|---|---|---|---|
| Hyperoxygenation | Hyperoxygenation should not be incorporated into the suctioning routine. If there is a drop in SpO2 with suctioning, hyperoxygenation should be established by increasing the FIO2 value 10 to 20% above that prior to suctioning 30 to 60 seconds before, during and 1 minute after the procedure | 50 | 2B |
| Suctioning probe diameter | Probe diameter must not exceed 50% of ETT diameter | 50 | 2C |
| Suctioning duration | Must not exceed 15 seconds | 100 | 2C |
| Negative suction pressure | Must be between 50 and 100mmHg | 75 | 3C |
| Saline instillation | Must not be performed routinely | 75 | 2C |
| Number of repetitions | Must not exceed 3 repetitions. The NB should be connected to the ventilator between suctions | 25 | - |
| Suctioning time | Suctioning must not be performed routinely and should only be performed where clinically indicated. Clinical indications primarily include lung auscultation (coughing, coarse or reduced breathing) or visible secretions in the ETT, audible secretions, drop in SpO2 decreased chest excursion, changes in blood gas values, changes in respiratory rate and/or breathing pattern, bradycardia/tachycardia and/or agitation without other cause, and increased peak pressure on the ventilator | 100 | 1C |
| Biosafety standards | CDC guidelines should be respected, including the following: protection of the professional's eye, nose and mouth protection with the use of face mask and goggles, use of apron and sterile gloves, and performance of hand hygiene before and after performing the procedure. To increase safety, the procedure must be performed by at least two people | 50 | - |
| Monitoring | The following variables should be monitored before, during and after the procedure: SpO2 skin coloring, respiratory frequency; respiratory pattern; hemodynamic variables (if monitored), such as heart rate, blood pressure, heart rhythm and ICP; suctioned secretion characteristics, such as color, volume, consistency and odor; cough characteristics; ventilatory parameters, such as peak inspiratory pressure and plateau pressure; current volume; flow; exhaled volume; and FiO2 | 100 | - |
SpO2 - peripheral capillary oxygen saturation; FiO2 - inspired oxygenation fraction; NB - newborn; ETT - endotracheal tube; CDC - Center for Disease Control and Prevention; ICP - intracranial pressure.