Sunday, March 1, 2020

Wagensteen Suction - Elegantly Simple Without Electricity

Wangensteen suction in action during the 1930s. The water level in the top bottle
drains by gravity into the lower bottle to the left generating negative pressure. 
A glass drinking straw inserted to the top of the top bottle conducts suction to the patient.

Whippersnapperns  don't give a second thought to the equipment  needed  to suction a patient. Intermittent Gomco, straight tracheal suction, or low pressure Wangensteen, just plug that suction  regulator into the handy dandy wall socket and go to town. Like everything else in today's high technology world, handy dandy wall suction is a convoluted, complex system masquerading as something  simple. Hospital  centralized suctions are anything but simple. Bright  young whippersnappern are  tapping into an over-engineered, overpriced  pipeline connected to hidden pumps, vacuum reservoirs, traps, filters, regulators, sensors, and alarms. I shudder to think of the resources required to maintain this complex hodge-podge of exorbitant  components.

There is an easier way to maintain GI  suction on  a post - op patient suffering from a paralytic ileus. I'm not talking about those plug in "portable" machines that weigh 1/2 as much as your patient. There are few pieces of medical equipment that generate a more annoying buzz saw  noise than portable suction machines. A bone saw in action might sound worse, but at least the patient does not hear it.

Electrified  suction machines in action remind  me of the time a yellow jacket flew inside my full coverage motorcycle helmet while cruising on Lake shore Drive. You can't turn off a buzzing suction machine when suction is necessary and you can't remove  a helmet in heavy traffic. Meanwhile that persistent  buzzing is driving  you  nuts.

In old diploma nursing schools, instructors like Miss Bruiser, my all time favorite, frequently said that we should learn how to do something "just in case."  Students were required to "learn" how to smoke cigarettes so we could better relate to psych patients. Other various hacks were part of the "just in case" curriculum like using sterile finger cots to perform procedures in the event we ran out of gloves.

We were also taught how to construct a do-it-yourself Wagensteen suction using 3 large glass bottles, rubber tubing and a glass drinking straw "just in case" of a power failure. Old hospitals had no backup power supplies.  The  principle underlying manual Wangensteen suction was Boyle's gas law which stated there was an inverse relationship between pressure and volume. As the water flowed out of the glass bottle on top, a negative pressure was created by the increase in size of the void within the bottle. A glass drinking straw inserted through a hole in the stopper served to harvest the vacuum created by the falling water

The clothesline pulley on top of 
the stand facilitated bottle exchange
There were a couple of ways to suspend one large glass water filled  bottle above another. The easiest way was to hang it  with a canvas sling suspended on the rail for the bedside curtain, but this required lifting the bottle on the floor when it had filled upon completion of a cycle. A big glass bottle filled with water requires the arm strength of Magilla Gorilla to heft back into position.

 A more elegant system involved a pole outfitted  with an ordinary clothesline pulley which according to my notes could be obtained at any hardware store. A length of rope about 7 feet long was attached to each bottle and threaded through the clothesline pulley  assembled at the top of the pole.When the bottles needed exchanged after draining, a nurse could swap their position  with a  not so gentle tug on the connecting rope. As the bottles made their up and down journey continuous suction was maintained as water continually drained from top to bottom. Dr. Owen Wangensteen, the inventor would have been most proud.

There is something to be said for simple devices cobbled together with a nurse's two hands. Wangensteen suction was a breakthrough discovery in the 1930s that reduced operative mortality from 44% to less than 20%. Owen Wagensteen should have received the Nobel Prize for medicine in 1931, but they gave it to someone who discovered an esoteric enzyme. Simple, silent devices like this suction engender those immersive, visceral feelings old nurses experienced from directly helping someone feel better even if the nurse  was too busy yanking on the clothesline to take a break for a Coke and a smoke.


  1. A true classic OFRN. The last episode of the MASH television series had a scene where Hawkeye and Radar O'Reilly rigged up a suction apparatus just how you described. Not so sure about the inclusion of the clothesline pulley to rotate the bottles back and forth. A true stroke of genius.

  2. When I was a young nurse ( long ago) I sometimes thought that nurses much older than me were not the sharpest straight Mayos in the instrument tray-so to speak- but just because they lacked the latest technology did not mean they weren't very smart. Old nurses were experts at maximizing the limited resources and knowledge at their disposal.

  3. The wife of a friend of mine volunteers as an RN on the Mercy Ships that offer desperately needed surgery to poor people in various African countries. She's the same age as me. Her husband tells me she is considered very valuable on the Mercy Ships as they are often without the latest technology in areas and the young nurses don't know what to do - she is used to improvising and reusing equipment and he says the young whippersnippers would be lost without her old-time RN expertise.
    So you see OFRN we do have our uses even today! Cheers, Sue

  4. I enjoyed haring about your resourceful friend. With all the regulatory busybodies in healthcare today, I suspect lots of our hand made items like Montgomery straps or scultetus binders would not pass muster.

  5. I thought I'd say Hi and I hope you're OK OFRN - we certainly are living in interesting times, as the saying goes. This virus business is a mess. I hope you are staying OK. Best wishes from Sue in Australia.

    1. Thanks for thinking of me Sue. There are so many unknowns about the corona virus. I really admire all those courageous whippersnapperns out there caring for patients. Nursing can be tough sledding, but I cannot imagine that as a person afraid of contracting a disease caring for someone afflicted with the virus. I never had to do anything like that. Surgeons screaming at me was small potatoes compared to what nurses must do today.

      I was into social isolation before it became so popular so I'm doing just fine. I hope the young nurses of today thrive despite the formidable obstacles.

  6. A fascinating post.

  7. It was great reading you blog post. You have mentioned everything very point to point. When i was searching for the answer i am very much curious to know how things work but after reading your post all my doubts about this got cleared. I got my answer by reading your post. Keeping posting stuff like this future. I will look forward to your post.


  8. Remember the old Wagansteens well. As an orderly ( before becoming a diploma RN) during late fifties we had the newest Gomco, but as backup there was a shiny chrome plated Wagansteen 3 bottle system where both upper and lower bottle attached to a long rod on a swivel that rotated top bottle to lower and vice versa. Bill

  9. Hi Bill,
    There is something special about elegant simplicity. I fondly recall all the complex surgeries performed with nothing more than a precordial stethoscope and BP cuff. Of course, for the high tech anesthetist there were custom molded ear pieces connected to a stop cock for seamless switching from the stehoscope to the cuff. Thanks so much for taking the time to leave a comment!