In patients with elevated intracranial pressure, suctioning should be performed how?

• A. Only when necessary
• B. Routinely every hour
• C. Preemptively after every meal
• D. Continuously without pause

Answer: (A)

When intracranial pressure is elevated, suctioning must be used sparingly because the procedure can transiently raise ICP. The act of suctioning can trigger coughing, gagging, and a Valsalva-like response from increased intrathoracic pressure, which reduces cerebral venous outflow and momentarily increases cerebral blood volume. That spike in pressure can worsen brain edema or reduce cerebral perfusion, so suctioning is reserved for situations where secretions threaten airway patency or ventilation. If you need to suction, do it in the shortest possible bursts (ideally under 10 seconds), preoxygenate with 100% oxygen to prevent hypoxemia, and use techniques that minimize ICP rise (such as a closed suction system when available). Position the patient with the head midline and the bed elevated around 30 degrees to promote venous drainage, and avoid routine or continuous suctioning.