Nursing care
Suctioning: the nurse's role, start to finish
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
Suctioning clears secretions the patient cannot clear alone, protecting the airway and improving oxygenation. Each pass must be no longer than 10–15 seconds, with suction applied only as the catheter is withdrawn, never on insertion. Pre- and post-oxygenate with 100% oxygen to offset the hypoxia the procedure itself causes.
What the procedure achieves
Suctioning removes secretions from the airway when a patient cannot cough them up effectively: post-stroke patients with a weak swallow, sedated or ventilated patients, anyone with a tracheostomy, or a patient too fatigued to clear their own chest. Left in place, those secretions obstruct airflow, collapse alveoli, and seed infection. The goal is a clear airway and adequate gas exchange, not a scheduled task performed on a fixed clock.
Suctioning is not benign. The catheter removes air along with secretions, so every pass drops the patient's oxygen saturation, and the mechanical stimulation can trigger vagal bradycardia, laryngospasm, or a rise in intracranial pressure. Nursing judgement about when suctioning is genuinely needed, rather than routine, is part of the skill. Assess first: coarse or gurgling breath sounds, visible secretions in the airway, a saw-tooth pattern on the ventilator waveform, or a sudden drop in saturation with restlessness. Suction because the assessment says so, not because a shift has passed.
Pre-procedure nursing responsibilities
Confirm the order and indication, then explain the procedure to the patient even if sedated; hearing matters even when the ability to respond does not. Check the suction equipment is functioning and set the wall or portable unit to an appropriate negative pressure: roughly 100–120 mmHg for an adult, lower for children and infants, since excessive pressure damages the tracheal mucosa. Select a catheter no larger than half the internal diameter of the tracheostomy or endotracheal tube to avoid a near-total airway occlusion during the pass.
Pre-oxygenate with 100% oxygen for 30 seconds to a few minutes before the first pass. This is the step most often rushed, and it is the one that buys the patient tolerance for the hypoxia the procedure will cause. Position the patient semi-Fowler's if conscious, or with the head slightly hyperextended if unconscious, to align the airway. Don personal protective equipment, since secretions are a splash and droplet risk, and use sterile technique for tracheal suctioning, clean technique for oral or nasal suctioning.
Equipment and positioning
A complete suction setup includes a suction source with a calibrated regulator, a sterile catheter kit, sterile water or saline for rinsing the line, sterile gloves, and a resuscitation bag with mask connected to 100% oxygen at the bedside in case of a vagal event or desaturation that does not recover. For tracheal suctioning, add a manual resuscitation bag fitted to the artificial airway.
Insert the catheter without suction applied, advancing gently until resistance is met or the patient coughs, then withdraw it slightly before applying suction. This detail is the one most frequently tested: suction is applied on withdrawal only, using a twisting motion, and never during insertion. Applying suction on the way in strips the mucosa and removes oxygen the patient has not yet been given a chance to use. Limit each pass to 10–15 seconds from insertion to removal, and allow the patient to recover, with reoxygenation between passes, before repeating if still indicated.
Complications and early signs
Hypoxia is the most immediate risk, and continuous pulse oximetry during the procedure is not optional. A saturation that fails to recover after oxygenation, or that continues to fall, means stop and ventilate before attempting another pass. Bradycardia from vagal stimulation is the next concern, particularly in infants and in patients with underlying cardiac disease; watch the monitor, not just the clock.
Mucosal trauma and bleeding follow from excessive pressure, an oversized catheter, or suction applied on insertion, and appear as blood-tinged secretions or frank bleeding in the catheter tubing. Laryngospasm presents as stridor or a sudden inability to pass the catheter and requires immediate withdrawal and oxygen. In patients with head injury, suctioning transiently raises intracranial pressure, so limit passes to the minimum needed and pre-oxygenate generously. Any of these findings changes the plan: stop, oxygenate, reassess, and escalate if the patient does not stabilise.
Post-procedure care
Reoxygenate immediately after the final pass and reassess breath sounds, respiratory rate, and oxygen saturation to confirm the intervention worked. Document the amount, colour, consistency, and odour of secretions, the patient's tolerance, and any complications; a change from thin and clear to thick and yellow-green over a shift is a clinically meaningful finding, not paperwork.
Reposition the patient comfortably and offer oral care, since secretions and the procedure itself leave the mouth dry and irritated. Rinse the catheter and tubing between passes with sterile water, and discard and replace the catheter kit rather than reusing it for a second suctioning episode. Continue to monitor for delayed desaturation or bronchospasm for several minutes after the procedure ends, since some reactions are not immediate.
What to teach before discharge
A patient or caregiver going home with a tracheostomy needs hands-on competency in suctioning, not just a verbal explanation: how to recognise when suctioning is needed, how to maintain clean technique at home, and how to limit each pass to the same 10–15 seconds taught in hospital. Teach the caregiver to watch the patient's colour and breathing rather than watching the clock alone.
Cover equipment care: cleaning and air-drying reusable catheters, storing supplies away from moisture, and knowing when a catheter must be replaced rather than reused. Teach the signs that mean call for help rather than continue suctioning at home: bleeding that does not stop, persistent desaturation, or an inability to clear the airway despite repeated attempts. Confirm the caregiver has a working suction unit, backup power or a manual option, and a clear plan for emergency contact before the patient leaves the unit.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our respiratory practice questions are the closest set to what this page covers.
Common questions
How long should each suction pass last?
No more than 10 to 15 seconds from insertion to withdrawal. Longer passes cause more hypoxia and more mucosal trauma without clearing more secretions.
Should suction be applied while inserting the catheter?
No. Suction is applied only while withdrawing the catheter. Applying suction on insertion removes oxygen the patient has not been given a chance to use and increases mucosal injury.
How many suction passes can be done in a row?
Reoxygenate fully between passes and reassess whether suctioning is still needed. Repeated passes without recovery time compound hypoxia and can trigger bradycardia.
What suction pressure is used for an adult?
Roughly 100 to 120 mmHg for adults, with lower settings for children and infants. Excessive negative pressure damages the tracheal mucosa without improving secretion clearance.
What should a nurse do if the patient's oxygen saturation does not recover after suctioning?
Stop suctioning, ventilate with 100% oxygen via resuscitation bag, and reassess before attempting another pass. A saturation that fails to recover is a reason to escalate, not to continue.