Suctioning may cause direct stimulation of vagal nerve fibers, especially in an infant.
Sputum is produced by cells lining the respiratory tract. Although production is minimal in the healthy state, disease states can increase the amount or change the character of sputum. Examination of sputum may aid with diagnosing and treating various conditions.
In many cases, suctioning is indicated to collect sputum from a young pediatric patient. Suctioning may also be necessary for pediatric patients with developmental delays, regardless of age. A cough can possibly be elicited by tickling the back of the patient’s throat with the suction catheter. In addition to direct stimulation of vagal nerve fibers, suctioning may provoke coughing, vomiting, and aspiration of stomach contents and induce pharyngeal, laryngeal, and bronchial muscle constriction. In pediatric patients with endotracheal (ET) or tracheostomy tubes, sputum is easily aspirated from the trachea. Adolescents and older pediatric patients are usually able to produce a sputum specimen by coughing if they are given very clear instructions.
Sputum for cytology, culture and sensitivity, and acid-fast bacilli (AFB) are the three major types of sputum specimens. Cytologic or cellular examination of sputum may identify aberrant cells or cancer. The most common types of diagnostic tests performed on sputum specimens include respiratory syncytial virus, influenza A and B, parainfluenza, rhinovirus, and enterovirus. Sputum collected for culture and sensitivity testing can be used to identify specific microorganisms to determine which antibiotics are the most sensitive. The AFB smear is used to support a diagnosis of tuberculosis (TB). A definitive diagnosis of TB also requires a sputum culture and sensitivity test. Regardless of the test ordered, a sputum specimen should be collected first thing in the morning due to a greater accumulation of bronchial secretions overnight.
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Stress the importance of deep coughing and of not clearing the throat if the patient is expectorating sputum. Have a health care team member secure the patient’s head and hands as needed if suctioning will be used to obtain a specimen.
Ensure that the patient does not use mouthwash or toothpaste because they may decrease the viability of the microorganisms and alter the culture results.
Rationale: The semi-Fowler position promotes full lung expansion and aids the ability to cough.
Rationale: Expectorant must come from the lungs. Saliva is not sputum.undefined#ref3">3
Ensure that the container is tightly closed before wiping to prevent contamination of the specimen.
Rationale: Connecting the suction tubing to the sputum trap establishes suction that passes through the sputum trap to aspirate a specimen.
Rationale: The tracheobronchial tree is a sterile body cavity. Sterile gloves allow for manipulating the suction catheter without contaminating it.
Sterile gloves are not required if a sleeved suction catheter is used.
Rationale: Connecting the sterile suction catheter or the sleeved suction catheter to the rubber tubing on the sputum trap allows aspirated sputum to go directly to the trap instead of to the suction tubing.
Rationale: Having the patient cough allows secretions to gather and loosen before they are suctioned with the catheter.
Rationale: Inserting the catheter without applying suction decreases the chances of trauma to the mucosa.
Advance the suction catheter only to the point of resistance in the naris.
Rationale: Entering the larynx and trachea triggers the cough reflex.
Rationale: Rotating the catheter during withdrawal minimizes mucosal damage.
Limit the duration of each suction pass to less than 5 seconds and limit the number of passes to a maximum of three to help minimize hypoxemia, airway trauma, and cardiac arrhythmias.1
If the patient becomes hypoxic during the procedure, discontinue the procedure immediately and provide supplemental oxygen, tactile stimulation, and positive pressure ventilation.
Rationale: Suction can damage mucosa if it is applied during withdrawal.
If another suction pass is needed, give the patient 30 to 60 seconds to recover.1
Ensure that the sputum trap is tightly sealed before wiping to prevent contaminating the specimen.
Rationale: Excessive coughing or prolonged suctioning can alter the respiratory pattern and cause hypoxemia.
Rationale: The procedure may be uncomfortable and scary for a patient.
Rationale: Abnormal sputum characteristics may indicate disease entities.
Report unusual sputum characteristics or changes in the characteristics of the sputum to the practitioner.
Rationale: An AFB culture indicates whether abnormal cells or microorganisms are in sputum.
Booth, L.D. and others (2021). Culture ordering for patients with new-onset fever: A survey of pediatric intensive care unit clinician practices. Pediatric Quality and Safety, 6(5), e463. doi:10.1097/pq9.0000000000000463
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