Closed or Open Suctioning? Which is Better?

Suctioning is an effective measure to clear airway secretions and maintain airway patency. For patients who need suctioning, even a single accumulation of sputum can be life-threatening. Therefore, healthcare professionals need to master the suctioning technique. Generally, the main airway suctioning ways are pen suctioning and closed suctioning. So, which method is better? Let's explore.  

What Are Open Suctioning and Closed Suctioning?  

Open suctioning involves disconnecting the patient's artificial airway (such as an endotracheal tube or tracheostomy) from the ventilator during the suctioning process. A suction catheter is then inserted into the airway to remove secretions. Typically, healthcare professionals use a single-use suction catheter and discard it after each procedure. 

Closed suctioning, on the other hand, is performed using a sealed suctioning system connected to the ventilator. This method allows suctioning without disconnecting the ventilator. This catheter operates within a closed system, ensuring continuous mechanical ventilation for the patient.  

Advantages of Closed Suctioning  

1. Reduces the Risk of Atelectasis and Hypoxia  

Closed suctioning allows for uninterrupted mechanical ventilation, preventing the loss of positive end-expiratory pressure (PEEP) that occurs during open suctioning. This design helps minimize alveolar collapse, maintain lung volume, and reduce the incidence of hypoxemia and atelectasis during the procedure. Closed suctioning is especially beneficial for patients with high oxygen demands or PEEP ≥ 10 cmH2O.  

2. Lowers Infection Risk  

The closed environment of the suctioning system minimizes direct contact between healthcare personnel and patient secretions. For patients with respiratory infections (such as tuberculosis) or multidrug-resistant organisms, closed suctioning significantly reduces the risk of cross-infection, ensuring the safety of both patients and healthcare workers.  

3. Reduces Arrhythmias and Other Adverse Reactions  

Open suctioning, which involves disconnecting the ventilator, often causes increased heart rate, elevated blood pressure, or suction-related arrhythmias in patients. Closed suctioning, by maintaining continuous ventilation and oxygenation, greatly reduces the likelihood of these adverse reactions.  

4. Faster Operation and Enhanced Nursing Efficiency  

Closed suctioning eliminates the need to replace the suction catheter for each use, and the process is relatively simple and quick. This makes it particularly suitable for patients requiring frequent suctioning (e.g., more than six times per day). Moreover, there is no need to adjust ventilator settings during the procedure, resulting in more efficient operations.  

5. Cost-Effective in the Long Term  

Although the initial cost of a closed suctioning system is higher, its reusable design can reduce overall material costs over time. For patients requiring frequent suctioning, closed suctioning proves to be more economical.  

6. Protects Healthcare Workers  

Patients may cough during suctioning due to airway irritation, potentially releasing pathogens into the air. The sealed design of closed suctioning effectively minimizes aerosol dispersion, reducing the risk of occupational exposure and ensuring the safety of healthcare workers.  

Advantages of Open Suctioning  

 PVC Soft Suction Catheter

1. Lower Initial Cost  

Open suctioning primarily uses disposable suction catheters, making it a simpler and more affordable option in terms of initial costs. For patients requiring short-term mechanical ventilation, open suctioning can be more cost-effective.  

2. Suitable for Specific Operational Needs  

Open suctioning is more flexible when it comes to clearing large amounts of secretions, particularly when the secretions are thick and prone to clogging the suction catheter. This method allows for thorough cleaning of the airway.  

Closed Suctioning Precautions 

1. Preventing Tracheal Injury  

Closed suction catheters are relatively rigid, and improper handling can cause tracheal bleeding. So it would be best to be careful when suctioning to avoid damaging the tracheal mucosa.  

2. Regular Catheter Replacement  

Although reusable, closed suction catheters should be replaced when contaminated or after seven days of use to prevent bacterial growth.  

3. Clearing Secretion Buildup  

After suctioning, clear secretions from the patient's mouth, the tracheostomy tube, or the cuff above the endotracheal tube to minimize the risk of ventilator-associated pneumonia (VAP).  

4. Avoiding Catheter Blockage  

Flush the suction catheter promptly after use to prevent clogging from mucus buildup.  

Open Suctioning Precautions 

 

1. Strict Aseptic Technique  

The open suction method involves disconnecting the ventilator, which increases the infection risk. Please adhere to strict aseptic principles during the procedure. 

2. Minimizing Ventilator Disconnection Time  

Suctioning should be performed quickly to reduce the risk of oxygen desaturation caused by ventilator disconnection.  

Which is Better? 

Both suctioning ways have their pros and cons. The closed suctioning is ideal for patients requiring high oxygen levels, frequent suctioning, or those with infectious diseases. And open suctioning is simpler and more cost-effective, and it suits patients with short-term mechanical ventilation or specific needs.

 

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