Suctioning an adult ICU patient: governance

Recommendations for practice





Each local health district (LHD) should use this guideline to develop site-specific procedures to address suction practice.



To ensure optimal patient outcomes, hospitals should periodically evaluate practice against this guideline.



Hospitals should ensure that clinicians who perform this procedure are competent or are directly supervised by a competent clinician.



Individual feedback should be provided to improve development of competency in tracheal suction.



Where possible, tailored performance in a simulated setting could be useful in teaching and assessing practice of this skill.


The evidence review for these recommendations was current to December 2012. Clinicians are advised to check the literature as research may have been published that change these recommendations.

There is limited evidence on effective strategies to improve clinical suctioning practices. Current research evidence suggests that there is variation between nursing and physiotherapy knowledge and the practice of endotracheal suctioning. To reduce variability in practice, site-specific procedures and auditing of practice need to be developed.

The following should be included within an education program:

  • use of individualised feedback in the context of a simulation setting to achieve the greatest effect (1)
  • increased awareness of complications related to suction (1, 2)
  • analysis for need to suction, clinical indicators, reassessing the patient post procedure and reinforcement of infection guidelines (1-4).

Grading of recommendation taxonomy

Grade of recommendation



Body of evidence can be trusted to guide evidence


Body of evidence can be trusted to guide practice in most situations


Body of evidence provides some support for recommendation/s but care should be taken in its application


Body of evidence is weak and recommendation must be applied with caution


Consensus was set as a median of ≥ 7

Grades A–D are based on NHMRC grades (5)


  1. Kelleher S, Andrews T. An observational study on the open-system endotracheal suctioning practices of critical care nurses. Journal of Clinical Nursing. 2008;17(3):360-9.
  2. Day T, Iles N, Griffiths P. Effect of performance feedback on tracheal suctioning knowledge and skills: randomised control trial. Journal of Advanced Nursing. 2009;65(7):1423-9.
  3. Pederson CM, Rosendahl-Nielsen M, Hjermind J, Egerod I. Endotracheal suctioning of the adult intubated patient - What is the evidence? Intensive and Critical Care Nursing. 2009;25:21-30.
  4. (AARC) AAfRC. AARC Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways. Respiratory Care. 2010;Jun; 55(6):758-64.
  5. NHMRC. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. 2009.


The information on this page is general in nature and cannot reflect individual patient variation. It reflects Australian intensive care practice, which may differ from that in other countries. It is intended as a supplement to the more specific information provided by the doctors and nurses caring for your loved one. ICNSW attests to the accuracy of the information contained here but takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.