During tracheal suctioning, which sequence is recommended?

• A. Endotracheal tube, mouth, nose
• B. Endotracheal tube, nose, mouth
• C. Mouth, nose, endotracheal tube
• D. Nose, mouth, endotracheal tube

Answer: (A)

The sequence prioritizes clearing the airway from the bottom up. You first pass the suction catheter through the endotracheal tube to directly suction the trachea and lower airway, removing secretions that are most likely to cause hypoxia or aspiration if left there. After the trachea has been cleared, you suction the mouth to remove oropharyngeal secretions that could be aspirated or spill into the airway during manipulation or extubation. Finally, you suction the nose to clear nasal secretions, which helps prevent additional secretions from running into the oropharynx and ultimately the lower airway. Suctioning the nose or mouth before addressing the endotracheal tube could leave secretions in the lower airway or move them there later during the procedure.