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In clinical practice, suction catheter size is often expressed in French units (Fr), where 1 Fr = 0.33 mm in diameter. The general rule is that the suction catheter’s external diameter should occupy no more than one‐half to two‐thirds of the internal diameter of the endotracheal tube (ETT) to prevent significant loss of positive airway pressure and avoid airway collapse. However, when suctioning via a non‐intubated lumen (e.g., nasopharyngeal suction), selecting the size based on patient age and airway dimensions helps balance efficacy and safety.
Below is a breakdown of recommended catheter sizes by age group:
| Age Group | Approximate Weight | Suction Catheter Size (Fr) | Internal Diameter (ID) of ETT (mm) |
|---|---|---|---|
| Preterm neonate (≤ 1 kg) | < 1 kg | 5–6 Fr | — |
| Term neonate (1–3 kg) | 1–3 kg | 6–8 Fr | 3.0–3.5 |
| Infant (3–10 kg) | 3–10 kg | 8–10 Fr | 3.5–4.5 |
| Toddler (1–3 years) | 10–14 kg | 10–12 Fr | 4.5–5.0 |
| Child (4–8 years) | 14–25 kg | 12–14 Fr | 5.0–6.0 |
| Older child (9–12 years) | 25–40 kg | 14–16 Fr | 6.0–7.0 |
| Adolescent (13–17 years) | 40–60 kg | 16–18 Fr | 7.0–8.0 |
| Adult | > 60 kg | 14–18 Fr | 7.0–9.0 |
When suctioning through an ETT, always check that the catheter size does not exceed two‐thirds of the tube's ID.
Key considerations:
Avoid excessive suction pressure. Use pressures of 80–100 mmHg in neonates and up to 150 mmHg in adults to minimize mucosal injury.
Limit duration. Each suction pass should last no longer than 10–15 seconds to prevent hypoxemia and vagal stimulation.
Preoxygenation. Briefly preoxygenate (e.g., 100% O₂ for 30 seconds) before suctioning, especially in ventilated or critically ill patients.
Sterility and technique. Maintain aseptic technique; advance the catheter only until slight resistance is met, then withdraw ~1 cm before applying suction.
Humidification and saline. Routine saline instillation is not recommended but may be considered if thick secretions persist; always weigh benefits against risk of desaturation.
By following age‐based catheter sizing and adhering to safe suctioning protocols, clinicians can ensure effective airway clearance with minimal complications.
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