Direct suction to ET tube on extubation

Nurses Safety

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Here is my concern...I recently encountered a CRNA who placed the suction tube directly to the ET tube on extubation of the patient. I do not feel comfortable with this method and expressed concern with it. The patient began gasping for air, but recovered ok with hyperoxygenation and O2 on transport. This gentleman was in his mid-70's with a history of smoking and COPD, and there were visible secretions in the ET tube. Two other OR nurses in the room said nothing, however when I voiced concern, it was made clear to me that there is no reason for concern.

Most of my experience is with critically ill patient's in the Main OR, and I have NEVER seen an anesthesiologist extubate a patient this way. This occurred in the ambulatory setting.

I would love to hear opinions from my more experienced RN's.

Any thoughts?

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Specializes in Critical Care.

There are various ways to deal with the mucous that can build up around the ETT when extubating, that mucous can potentially completely occlude the airway so making sure it comes out along with tube is critical. One way is to use the ETT as the suction device once the cuff has been deflated.

Maybe you could clarify your concerns with doing it this way?

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The ETT was not used like that. The mucous was inside the tube.

The patient was still intubated. Then the circuit was disconnected from the ETT and suction tubing attached to the end. This was followed by deflating the balloon and then extubating the patient with the ETT connected to the suction.

It just seemed a little harsh for someone with lung issues. His O2 sat dropped significantly, but he was hyperventilated and came back to 97% pretty quickly (this was where he lived at).

Anyway, I really appreciate the input.

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Specializes in Critical Care.

I am not totally sure what you are describing, but are you talking about ETT that have an extra port to attach to suction? Sometimes it is referred to as a "high-low" (spelling? lol im tired and its late...). basically "above cuff suctioning" at a low, continuous rate.

Or are you talking about actively suctioning somebody while they are being extubated?

Using "high lows" are usually not harsh, but I can imagine some places using other or "multiple suction methods" during extubation with the purpose of preventing VAP or some other complication/ adverse effects, re-intubation, etc. Lots of things practiced in medicine do not "look very nice" but are aimed for the benefit of the patient.

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Specializes in Critical Care.
20 hours ago, ORRNJJ3 said:

The ETT was not used like that. The mucous was inside the tube.

The patient was still intubated. Then the circuit was disconnected from the ETT and suction tubing attached to the end. This was followed by deflating the balloon and then extubating the patient with the ETT connected to the suction.

It just seemed a little harsh for someone with lung issues. His O2 sat dropped significantly, but he was hyperventilated and came back to 97% pretty quickly (this was where he lived at).

Anyway, I really appreciate the input.

The purpose was to clear the patient's airway of mucous, not the ETT. Airway suctioning isn't pleasant, but it's far more pleasant that choking on a mucous plug.

As far as tracheal suctioning goes, this is one of the more kind ways of doing it, typically we insert a suction tube down nose, sometimes through the mouth, down to the trachea to suction the airway, at least in this case a tube that was already in place was used for the suctioning.

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Yes, I’ve just usually seen anesthesia use a suction cannula, especially in these fragile little old guys.

thanks so much for your comments!

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Specializes in CRNA, Finally retired.

Yes, hell yes. CRNA did something proactive on a COPD'er who would suffer the consequences of inhaling any secretions more than a healthy patient who can cough them out. Acute airway management is our little area of expertise. I rarely suctioned healthy patients but ALWAYS with patients who produce excess sputum.

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Awesome! Thanks so much for the input. Totally new experience for me and something I could suggest in the future as safe care then!

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Also, there was no suction port. This was directly connected to a suction tube that usually connects to yankauer or suction cath. The CRNA I saw do this is very experienced and patient did well after. It was just something I’d never seen. Wanted to get some other opinions. ?? Thanks everyone

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Specializes in ICU, CVICU, E.R..

The only thing I would be concerned about is did he use a new suction tubing to stuff down the ETT? Or was it one that has been in use for a few days? Usually the in-line suction catheter connected to the ETT is a closed circuit to reduce possibility of introducing foreign bacteria.

A 14fr suction catheter would have been more appropriate as it can access the airway better than a wide ended suction tubing.

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No, there was no suction cath or other tip on the suction tube. He hooked it directly to the end of the ETT where the circuit would connect, turned on the suction full blast and yanked it out.

I’ve seen secretions in the ETT before, but most anesthesiologists will pull the tube and suction with a yankauer in the mouth, to remove any of those secretions. Not remove the yankauer tip and hook the suction to the tube. It is not one with indwelling suction cath. This was for an outpatient surgery.

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Specializes in CRNA, Finally retired.

You can't get a Yankauer down a tube and people with normal lungs don't usually need tube suctjon. 14 French catheters are usually only used once during a case. All tubing is fresh for each case.

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