Airway suction, oxygen devices and nebuliser technique: Viva

Branch 1: Clearing the airway — suction technique

The candidate should lead with the principle that an obligate nose-breather with bronchiolitis often obstructs behind nasal secretions, so gentle suction alone may transform the child. They suction what they can see first: mouth and oropharynx with a rigid Yankauer, and the nose gently, pre-oxygenating before and between passes and limiting each pass to about 5 to 10 seconds with continuous heart-rate and SpO2 monitoring. ^[3]

The examiner should probe the physiology and the complications. The candidate explains that suctioning provokes a vagal bradycardia and desaturation within seconds, which is why pre-oxygenation, short passes and monitoring are non-negotiable. They state that a suction catheter is sized to about half the airway lumen, advanced gently and never forced, and that deep, blind pharyngeal suction in infants has caused iatrogenic mediastinitis, so the safe rule is to suction only what can be seen. ^[4]

If the examiner pivots to the tracheostomy-dependent child, the candidate switches to sterile technique with an appropriately-sized catheter, follows the child's own airway plan, and involves the family, who are usually the most expert people at the bedside. ^[3]