Bradycardia or dysrhythmias during suctioning (vagal stimulation/hypoxia): stop, oxygenate, and report.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client with increased ICP is intubated. The nurse must suction the airway. Which technique minimizes a spike in ICP during suctioning?
Answer: A. To limit ICP rise during suctioning, the nurse hyperoxygenates before and after, limits each suction pass to no more than 10 to 15 seconds, and limits the number of passes. Prolonged repeated suctioning, instilling saline routinely, and bagging vigorously raise ICP and cause hypoxia.
Question 2 of 3
A nurse is suctioning a vigorous term newborn at birth. What is the correct sequence and technique?
Answer: B. Suction the mouth before the nose. Stimulating the nares can trigger a gasp that aspirates oropharyngeal secretions, so the mouth is cleared first. For a vigorous newborn, gentle bulb suctioning of the mouth then nose is sufficient; routine deep suctioning is avoided because it can cause vagal bradycardia and mucosal trauma.
Question 3 of 3
A nurse assesses a newborn at 1 minute of life: heart rate 110, slow irregular respirations with a weak cry, some flexion of extremities, grimace with suctioning, and a pink body with blue hands and feet. What is this newborn's Apgar score?
Answer: B. Apgar scores each of 5 signs 0-2. HR over 100 = 2; slow irregular weak cry = 1; some flexion = 1; grimace = 1; acrocyanosis (blue extremities, pink body) = 1, for a total of 6. A score of 4-6 is moderately depressed and warrants continued support; 7-10 is reassuring.
Keep the streak going with more questions like these, each with a full rationale.
What is suctioning?
It is done only when clinically indicated, not on a routine schedule, because it causes hypoxia and trauma. Key principle: hyperoxygenate first, suction only on withdrawal, and limit each pass to 10 to 15 seconds.
Key points to remember
- Suction when assessment shows a need: audible/visible secretions, coarse crackles, decreased SpO2, restlessness.
- Hyperoxygenate with 100% oxygen before and between suction passes to prevent hypoxia.
- Apply suction only while withdrawing the catheter, using intermittent suction and a rotating motion.
- Limit each suction pass to 10 to 15 seconds and allow recovery between passes.
- Tracheal/ET suctioning is sterile; oropharyngeal (Yankauer) suctioning is clean.
- Recommended suction pressures: roughly 100 to 120 mmHg for adults (lower for children).
Nursing priorities
- Assess breath sounds, SpO2, and secretions to confirm suctioning is indicated.
- Hyperoxygenate before and after suctioning.
- Insert the catheter without suction; apply intermittent suction only on withdrawal.
- Limit passes to 10 to 15 seconds and monitor for hypoxia, dysrhythmias, and bradycardia.
- Document amount, color, and consistency of secretions and the client's tolerance.
Labs & values
Patient teaching
- Tell staff if you feel short of breath or your secretions become thick or bloody.
- Deep breathing and coughing between suctioning helps clear the airway.
- Staying hydrated keeps secretions thinner and easier to clear.
Red flags: report now
- Bradycardia or dysrhythmias during suctioning (vagal stimulation/hypoxia): stop, oxygenate, and report.
- Sustained drop in SpO2, cyanosis, or distress means stop and re-oxygenate before continuing.
- Never apply suction while inserting the catheter and never exceed 10 to 15 seconds per pass.
References
Clinical references for this topic
