Suction Devices and Techniques

Why Suctioning Matters

Airway obstruction from vomit, blood, mucus, or foreign material is a leading cause of preventable death in emergency patients. Your ability to quickly clear the airway with a suction device can be the single action that saves a life. Every EMT and paramedic must be able to assemble, check, and operate suction equipment without hesitation and must perform the technique safely within established time limits.

Types of Suction Units

Portable battery-powered units are lightweight and designed for field use. They run on rechargeable batteries and must be maintained in a fully charged state at all times. Portable units are used on scene, during patient movement, and in the ambulance when the vehicle's power is unavailable.

Fixed wall-mounted (vehicle or facility) units are powered by the ambulance's electrical system or a facility's vacuum line. They typically deliver higher and more consistent negative pressure than portable units. You will find them mounted in the patient compartment of the ambulance.

Both types consist of the same core components: a collection canister, connecting tubing, a suction catheter, and a power or vacuum source. Always confirm that all connections are tight and that suction is present at the catheter tip before patient contact.

Suction Catheters

Rigid (hard) catheters — Yankauer: The Yankauer catheter has a large-bore, rigid tip designed for the oropharynx. Its shape lets you sweep the mouth efficiently. It is the preferred tool for suctioning thick secretions, vomit, and blood from an unresponsive patient's mouth and throat.

Flexible (soft) catheters: Flexible catheters are used when you need to suction through a nasal passage, through an advanced airway device, or in situations where the rigid catheter cannot be safely placed. They are measured and inserted to a premeasured depth to avoid trauma to delicate tissues.

Setting Negative Pressure

Negative pressure that is too low will not clear secretions effectively. Pressure that is too high can damage mucous membranes and cause hypoxia by pulling air out of the lungs. Follow your local protocols and device manufacturer guidelines. As a general principle, suction pressure for adults is typically set in the range that is sufficient to clear secretions without causing tissue trauma — commonly referenced as approximately 80–120 mmHg for most adult patients, though you should confirm the specific range in your local protocol. Pediatric patients require lower pressures. Always check your unit's pressure after assembly.

Assembling the Suction Unit

1. Connect the collection canister to the power source or wall port.

2. Attach the connecting tubing from the canister to the catheter.

3. Turn the unit on and occlude the tubing or catheter tip with your thumb.

4. Confirm suction is present and the pressure gauge reads within the acceptable range.

5. Release the catheter, keeping it clean and ready for use.

Use an assembly checklist every time in training so the steps become automatic.

Oropharyngeal Suctioning Technique

Step 1 — Pre-oxygenate. Before suctioning, provide supplemental oxygen or ventilate the patient for at least 30 seconds when possible. Suctioning removes oxygen along with secretions.

Step 2 — Measure and position. For a Yankauer catheter, no formal measurement is needed, but visualize the area you intend to reach. Position the patient — supine with the head turned to the side if there is no suspected spinal injury, to allow gravity to assist drainage.

Step 3 — Insert without suction active. Turn off suction or occlude the tubing vent before inserting the catheter. Insert the Yankauer along the roof of the mouth to the back of the oropharynx under direct visualization. This prevents suction trauma during insertion.

Step 4 — Apply suction while withdrawing. Uncover the vent or activate suction. Withdraw the catheter in a rotating motion while suctioning. Each suction pass must be completed within 15 seconds from insertion to removal. This 15-second limit minimizes hypoxia.

Step 5 — Re-oxygenate. Immediately after each pass, provide supplemental oxygen or ventilations for at least 30 seconds before repeating suctioning if needed.

Step 6 — Reassess. Confirm breath sounds, skin color, and oxygen saturation after suctioning. Repeat as needed while staying within time limits.

Safety Points

• Never exceed 15 seconds per suction pass in an adult. Use a stopwatch in practice until timing is instinctive.
• Always pre-oxygenate and post-oxygenate around each suction attempt.
• Maintain standard precautions — gloves, eye protection, and mask when suctioning.
• Do not force a rigid catheter past the visible oropharynx; this can cause laryngospasm or vomiting.
• If the patient vomits during suctioning, turn the patient to the side immediately and continue suctioning.
• Keep the suction unit powered and ready on every call — check it at the start of each shift.
• For pediatric patients, reduce suction pressure and limit pass duration even further.

The Seizing Patient with Vomiting — Key Sequence

When you arrive at a scene where a patient has seized and vomited, your sequence is: confirm scene safety → don personal protective equipment → position the patient → suction the oropharynx (Yankauer, within 15 seconds per pass, with pre- and post-oxygenation) → insert an oropharyngeal airway adjunct if the patient is unresponsive and has no gag reflex → provide ventilations or supplemental oxygen → reassess continuously. Verbalizing this sequence in training builds the automatic response needed in real emergencies.