Is Suctioning Painful? Understanding the Discomfort and Ensuring Patient Comfort

October 2, 2025 •

5 min read

Studies indicate that for critically ill patients, endotracheal suctioning is often reported as one of the most painful procedures performed in the intensive care unit. The question, "Is suctioning painful?" is complex, as the experience of discomfort or pain depends heavily on the type of procedure, the patient's individual condition, and the technique used.

Quick Summary

The sensation of suctioning can range from mild discomfort to moderate pain, especially during deep airway procedures. Factors influencing the experience include the technique, catheter size, and patient anxiety. Healthcare providers can use proper techniques and medication to reduce patient distress.

Key Points

Pain is Possible: Suctioning can be painful, particularly deeper procedures like endotracheal suctioning, with studies showing moderate-to-severe pain levels in some patients.
Discomfort Varies: The degree of discomfort depends on the type of suctioning, patient health, and the technique used.
Technique Matters: Proper technique is key to minimizing pain, including using the correct catheter size, pressure, and brief suction duration.
Anxiety is a Factor: Psychological distress and anxiety can significantly worsen the perception of pain during the procedure.
Management Strategies Exist: Pain can be managed with medication, pre-oxygenation, and non-pharmacological interventions like clear communication.
Technological Improvements: Closed suctioning systems have been shown to cause less pain compared to open systems, especially for mechanically ventilated patients.
Individualized Care: Patient-centered, individualized care is necessary to effectively manage pain and discomfort during suctioning procedures.

Understanding Suctioning: What Is It and Why Is It Performed?

Suctioning is a medical procedure used to remove secretions, such as mucus or saliva, from a patient's airway when they cannot clear them on their own through coughing. This is crucial for maintaining a patent (open) airway and ensuring adequate oxygenation. It is a common procedure in many clinical settings, from hospital intensive care units to home care, and is vital for patients with conditions that affect their ability to manage airway secretions.

There are several types of suctioning, categorized by the area of the airway being cleared:

Oropharyngeal: Suctioning from the mouth and throat.
Nasopharyngeal: Suctioning through the nose to the back of the throat.
Tracheal: Deeper suctioning directly into the trachea (windpipe), often via an endotracheal or tracheostomy tube.

How Suctioning Can Cause Pain or Discomfort

While the goal of suctioning is to help a patient breathe, it is an invasive procedure that can cause distress. The sensation can be unpleasant for a variety of reasons:

Mechanical Stimulation

The most direct cause of pain is the physical movement of the suction catheter inside the airway. The delicate mucosal tissue lining the airways can be irritated or traumatized by the catheter, especially if the technique is not gentle or the catheter is too large. Patients who are awake and can verbalize their pain have described the sensation using terms like "tender," "sharp," and "aching". In some cases, over-aggressive or poorly controlled suction can cause bleeding.

Airway Irritation and Reflexive Coughing

Inserting a foreign object like a suction catheter into the airway can trigger a strong, uncontrolled cough. While coughing can help bring secretions forward, a forceful cough can be painful, particularly for surgical patients with abdominal or chest incisions. The sustained irritation of the trachea can also lead to lingering discomfort after the procedure is complete.

Negative Pressure

The suctioning mechanism itself creates negative pressure, which can feel distressing. For a brief moment, the patient may feel as if their breath is being taken away. If the pressure is set too high or the duration of suction is too long, it can be particularly traumatic to the lung tissue and contribute to a feeling of suffocation.

Psychological Distress and Anxiety

Knowing that a procedure is about to happen, especially one that has caused discomfort before, can cause significant fear and anxiety. For critically ill patients who may have little control over their situation, the anticipation of suctioning can be very stressful. The psychological aspect can amplify the physical sensation of pain, making the experience more difficult for the patient.

Factors Influencing the Pain Experience

Several factors contribute to the level of pain and discomfort a patient experiences during suctioning:

Procedure Type and Depth

Deep Tracheal Suctioning (via ETT/Trach): This is consistently reported as the most painful type of suctioning for awake patients in intensive care. The depth and invasiveness of the procedure cause greater irritation.
Nasopharyngeal Suctioning: Often more uncomfortable than oropharyngeal due to irritation of the nasal passages, but generally less severe than deep tracheal suctioning.
Tracheostomy Suctioning: While not typically described as acutely painful, it can cause discomfort and provoke coughing.

Patient's Medical Condition

Patients' overall health and specific medical conditions play a large role. Critically ill patients may have heightened sensitivities, while surgical patients may experience increased pain due to pressure on incisions from coughing. Young children or infants may be especially distressed and react to suctioning as a painful stimulus.

Healthcare Provider Technique

The skill and care of the healthcare provider are paramount. Proper technique can drastically reduce patient discomfort. This includes using the correct equipment, appropriate pressure, and minimizing the duration of each suction pass.

Types of Suctioning and Associated Discomfort: A Comparison


Type of Suctioning	Common Routes	Likelihood of Discomfort	Potential Causes of Pain/Distress
Oropharyngeal Suctioning	Mouth and throat	Low to Moderate	Gag reflex, mechanical irritation of the throat.
Nasopharyngeal Suctioning	Nose and throat	Moderate	Nasal irritation, slight bleeding, gagging, feelings of distress.
Tracheostomy Suctioning	Tracheostomy tube	Low to Moderate	Mechanical irritation, coughing reflex, psychological distress.
Deep Endotracheal Suctioning	Endotracheal tube in ICU	High	Deep airway irritation, severe coughing, feeling of breath being taken away.

How Healthcare Providers Minimize Pain and Ensure Comfort

Preparation and Communication

Pre-Procedure Communication: For conscious patients, clearly explaining the procedure and its purpose can reduce anxiety and build trust.
Non-Pharmacological Techniques: Distraction techniques, hand massage, or ensuring a calm environment can help reduce patient stress and perception of pain.

Optimized Procedure Technique

Gentle Insertion: Inserting the catheter gently, and not advancing it past the point of resistance, prevents airway trauma.
Controlled Pressure and Duration: Using the lowest effective suction pressure and limiting each pass to 10-15 seconds reduces the risk of tissue damage and hypoxia.
Intermittent Suction: Applying suction only while withdrawing the catheter, rather than continuously, is a recommended practice to reduce trauma.
Pre-Oxygenation: Providing supplemental oxygen before the procedure helps prevent hypoxemia, a common side effect that can cause distress.

Advanced Systems and Medical Support

Closed Suctioning Systems: In mechanically ventilated patients, closed suctioning has been shown to be less painful and disruptive than open systems.
Analgesia and Sedation: For patients in intensive care or those highly sensitive to pain, appropriate analgesics or sedatives may be administered prior to the procedure.

Conclusion

While suctioning is a critical and potentially life-saving procedure, it is not without discomfort, and can be painful for many patients, especially during deeper airway clearance. However, the level of discomfort is not fixed and is heavily influenced by the type of procedure, the technique employed, and the patient's individual circumstances. Healthcare providers play a crucial role in mitigating pain by using optimized techniques, providing clear communication, and employing a range of pain and anxiety management strategies. Ultimately, prioritizing patient comfort through careful, individualized care can transform a potentially traumatic experience into a manageable one, ensuring the best possible outcome for the patient.

For more detailed guidance on proper suctioning techniques for different patient populations, refer to resources like the National Center for Biotechnology Information (NCBI) on nursing skills and tracheal suctioning.

Frequently Asked Questions

Suctioning can cause a range of sensations from mild discomfort to moderate pain, depending on the procedure's depth and type. Patients may feel the urge to cough, a sense of having their breath taken away, or mechanical irritation.

Tracheostomy suctioning is generally not considered acutely painful but can cause discomfort, especially triggering a cough. The catheter can irritate the airway, but a careful technique helps minimize distress.

Endotracheal or deep tracheal suctioning is often painful because it involves inserting a catheter deep into the sensitive trachea, stimulating a strong cough reflex and irritating the mucosa. Critically ill patients may be particularly sensitive to this procedure.

Healthcare providers look for behavioral cues like grimacing, clenched fists, or body rigidity. They also monitor physiological signs such as changes in heart rate, blood pressure, and oxygen saturation.

Yes, if the suction catheter causes trauma to the delicate airway tissues, it can cause bleeding. Using an appropriate catheter size and gentle technique is important to prevent this complication.

Pain can be reduced by using proper suctioning technique, administering analgesics or sedatives, pre-oxygenating the patient, and providing reassurance and clear communication. Non-pharmacological methods like distraction may also help.

Research suggests that closed suctioning systems, where the catheter is housed in a sterile sleeve, may cause less pain than open systems for mechanically ventilated patients. This is likely due to a gentler technique and fewer physiological disruptions.

The most intense discomfort from suctioning typically lasts only a few seconds while the catheter is in place. It may take the patient a few minutes to settle afterward, and proper post-procedure care helps reduce any lingering irritation.