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To avoid hypoxia, the patient must be given high-flow oxygen before suctioning. During insertion of the suction tube no negative pressure is used to avoid damaging the fragile lining of the bronchi. Suction is then applied during tubal withdrawal for 15 sec or less. The patient should be in supine position, with head elevated 30 degrees or higher, unless otherwise contradicted. Baseline vital signs and oxygen saturation are assessed, and the patient informed the procedure may initiate coughing. The health care professional performs hand hygiene and puts on clean gloves. The patient is hyperoxygenated for 1 min prior to and after suctioning by increasing the ventilator’s fraction of inspired oxygen setting (FIO2) to 1. The vacuum regulator is adjusted to the desired suction pressure. The catheter is advanced to the carina of the trachea without suctioning to avoid airway injury. The patient with an intact cough reflex will begin to cough. Suctioning begins as the catheter is pulled out of the airway. The patient is checked for desired and adverse effects (such as hypoxia or arrhythmias), and needs are met. Suctioning is repeated as needed to clear secretions (usually no more than two to three passes). When suctioning is complete, the FIO2 level is returned to the proper setting. Since ventilated patients require frequent oral hygiene, this may be a good time for that to be provided. Gloves are removed, and hand hygiene repeated, and the procedure is documented.