An Endotracheal Suctioning Guideline for Adults with an Artificial Airway

Saturday, 26 July 2014

Chanya Thanomlikhit, RN, MNS
Suthada Kanha, RN, MNS
Pavadee Likitwong, RN, MS
Department of Nursing, King Chulalongkorn Memorial Hospital (KCMH), Thailand, Bangkok, Thailand


Endotracheal suctioning is particularly important for patients that may not adequately cough out secretions by themselves. The suction procedure is associated with complications and risks of atelectasis. The purpose of this study was to make available the literature regarding endotracheal suctioning for adult intubated patients and to provide evidence-based recommendations for endotracheal suctioning and the prevention of atelectasis.


The process for this guideline consists of 4 stage was as follows: 1) The PICO format was used to find questions; P (Populations) - endotracheal suction in adult ; I (Interventions) - interventions endotracheal suction, suction, endotracheal   suction, guideline, close suction, open suction, tracheal suction ; O (Outcomes) - ventilator associated pneumonia (VAP), mucosa damage, hypoxia. ; 2) a computer literature search was conducted for ascertaining the best evidence and syntheses for the guideline. ; 3) the next strategies for an appropriate guideline were public hearings at the hospital. ; 4) Last, all processes of this guideline were proved by expert nurses.


An electronic literature search for articles published between  2008 – 2012 was conducted using the CINAHL, Cochrane, Proquest, and Pubmed databases. From the 18 citations found, 10 studies were selected. The guideline came from the process of synthesizing 10 studies.

This guideline has three parts: 1) patient preparation, especially close suction, 2) the suction procedure using the shallow suctioning technique, and 3) follow-up care.


This study revealed strong evidence to support endotracheal suctioning, which requires further evaluation and needs to keep up with the changes in technology.