Medical Vacuum (Suction) 
In Resource-Limited Settings 
Jason Fader and Richard Davis 
 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
Introduction:  
Medical Vacuum, more commonly called 
“Suction,” is an integral part to any hospital, used in 
the operating room, recovery room, endoscopy suite, 
and on the ward. Sometimes it is used for negative 
pressure wound therapy as well. Centralized suction 
is usually built into hospitals in high-resource 
settings, including piping within the walls and outlets 
in patient care areas. We discuss the components of 
centralized suction at the end of this chapter. 
In a low-resource setting, mobile units such 
as the Schuco S230A pictured below are very 
valuable. One drawback to a machine like this is that 
they are very loud: if it is in regular use in one place, 
build a wooden box to contain it. 
 
An electrical suction with cannister and tubing. This machine 
is very loud and will disrupt patients’ sleep or clinicians’ 
conversation if placed in a ward. Note also that the provided 
suction cannister is made of plastic and intended for single use. 
If washed and reused, it will inevitably develop cracks, making 
suction less effective.  
 
For Low-Continuous suction, it is better to 
get a fish tank aerator pump and reverse the motor so 
that it sucks instead of blows. This conversion is 
described at the end of this chapter.  
If you are installing individual suction 
machines in every patient care area (operating room, 
casualty bay, recovery room, intensive care unit,) 
here are some helpful modifications to make: 
• Enclose the suction machine in a box fixed to the 
wall to keep the noise down. You can connect the 
plug to a switch so that the units are easy to turn 
on and off.  
• Include 2 canisters in series so that fluid does not 
arrive at the motor.  
• Plastic canisters can be made to last a little longer 
without cracking if you don’t remove the entire 
lid, but instead empty it and clean it through one 
of the small ports. Note that this technique will 
not be effective if the material in the cannister 
contains hardened clots or debris.  
• Suction machines should be portable so that they 
get to the patient, but not too portable so that they 
easily go to other services. Build a cart or strap 
them to a stool.  
• Once fluid gets into the motor, it will need to be 
taken apart and the bearing changed. The bearing 
type and name can be found stamped on the seal 
of the motor.  
• If dedicated plastic suction tubing is difficult to 
source in-country, silicone tubing works well and 
can be steam sterilized.  
• Use glass or polycarbonate bottles rather than 
plastic ones. The latter are intended for single use; 
if reused they will eventually develop cracks 
which will decrease the effectiveness of the 
suction.  
 
Glass (left) or polycarbonate plastic (right) suction bottle with 
rubber seals in the lids. These will last longer than plastic ones. 
The rubber seals can often be purchased separately when these 
wear out and compromise the suction.  
Medical Vacuum (Suction) 
In Resource-Limited Settings 
Jason Fader and Richard Davis 
 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
  
This plastic suction canister was originally intended for single 
use in a high-resource setting. As it has been reused multiple 
times, “patchwork” is needed to repair it and maintain suction. 
Such canisters are probably more trouble than they are worth 
in a low-resource setting. If it is possible to empty and wash the 
cannister through one of the smaller holes on the lid, rather 
than removing the lid itself, this can prolong the lifetime of the 
cannister.  
 
 
The suction apparatus in an operating room, housed inside a 
wooden box for noise reduction (the front cover has been 
removed. The suction bottle can be seen below the box. A wall 
switch (Black arrow) allows the machine to be turned on and 
off without opening the box. 
 
Guide: Converting a Fish Tank Aerator for Use 
as a Suction Device 
Name brand negative pressure wound 
therapy machines (KCI Wound Vac®) can be 
expensive and often have proprietary, single use 
parts which can be also expensive and hard to acquire 
in resource-limited settings. And yet, negative 
suction wound care is excellent for many types of 
wounds. It also decreases the demand for nursing 
Medical Vacuum (Suction) 
In Resource-Limited Settings 
Jason Fader and Richard Davis 
 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
care. Maintaining suction on chest tubes, when 
indicated, also requires continuous low-pressure 
suction. 
It is possible to use a portable suction 
machine for this purpose, such as the machine 
described above. But these are often not designed to 
be in operation for days at a time. Furthermore, they 
are noisy. Fish tank aerators, on the other hand, are 
made to function constantly and quietly, and they are 
relatively inexpensive. The only issue is that as 
manufactured, they push air, instead of pulling air. It 
is possible to modify many types of fish tank aerators 
such they pull air and allow for a very effective, yet 
inexpensive negative pressure wound therapy device.  
The air pump in the photos below was 
sourced in the USA through Amazon.com. There are 
different sizes available. This one is for a 40-60 
gallon (150-225L) fish tank size and it works well for 
negative pressure wound therapy. The one pictured 
here is 110v and so you will need a very small 
transformer to run it (it only uses 4 watts of power). 
Ideally, source the pump in your country, or in a 
country that uses the same voltage that yours does.  
 
One example of a commercially available, small fish tank 
aerator. This one is made for a 60 gallon (225L) aquarium, 
which in our experience generates the proper amount of suction 
when modified as shown below. 
 
Even if your hospital does not have constant 
power, this uses such a small amount of wattage that 
you could use an inverter and car battery to keep it 
running for many hours at a time. 
 
There are many different brands of fish tank 
aerators, but most are the same on the inside. The 
process shown here can easily be adapted to any 
aerator that uses a similar mechanism: the main idea 
is to find the pump itself, which usually connected to 
a rubber bellows that is driven by an electric motor. 
Disconnect the bellows from the pump, remove the 
pump, reverse its orientation, and reattach it to the 
bellows.  
 
Once this aerator has been opened, the bellows (Red arrow) is 
clearly seen attached to the pump itself (White plastic piece.) 
When the bellows is activated, air enters the pump as shown by 
the Green arrow and exits as shown by the Blue arrow.  
 
 
The first step of the conversion is to detach the bellows from the 
pump. If possible, this should be done without disconnecting it 
from the motor, as shown here.  
Medical Vacuum (Suction) 
In Resource-Limited Settings 
Jason Fader and Richard Davis 
 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
 
 
The pump is then removed from its slot and reversed, so that its 
entry and exit are now facing the opposite directions from 
before.  
 
 
Once the pump is reinserted, it is reconnected to the bellows. 
Now the motor drives the air in the opposite direction, as shown 
by the Green and Blue arrows. This process is repeated on the 
other pump and bellows, if two are present as in this device.  
 
After the cover is replaced, the air will flow 
through the pump in the opposite direction: it now 
“sucks” instead of “blowing” air as it did before.  
 
Here, the modified pump draws 100mmHg of pressure; the 
ideal is within 50-125mmHg. 
 
When connecting the device to a patient, be 
sure that the canister stays upright and prevents any 
wound exudate from getting into the aerator, 
otherwise, it will need to repaired. When this 
happens, it is not difficult to dismantle and clean the 
device: disconnect and remove the pump bellows in 
a similar way to that shown above, wash and dry 
them, out, and reassemble.  
Medical Vacuum (Suction) 
In Resource-Limited Settings 
Jason Fader and Richard Davis 
 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
 
The entire negative pressure assembly, including the modified 
pump on the left. It is important to make sure the cannister 
remains upright to prevent liquid from entering the pump; this 
can be difficult in a crowded ward.  
 
Guide: Components of Centralized Medical 
Vacuum 
 
Most high-resource hospitals have a vacuum 
connection at the wall in patient-care areas. A 
regulator connected here allows the user to adjust the 
level of suction and connect devices. Each wall 
connection is supported by tubing, which runs 
through the walls or ceiling, to the central vacuum 
apparatus.  
 
The central vacuum apparatus consists of 
pumps (usually several), buffer tank, and controls. 
The buffer tank usually has a volume of 100 -1000L, 
an inlet filter, and a draining valve.  
 
Components of a centralized medical vacuum system for 
hospital use: 1.Vacuum Pumps 2.Digital Electrical Control 
Panel 3.Bacterial Filter 4.Vacuum Reservoir 5.Non-Return 
Valves and Connection Pipe Source: DOI: 10.35629/5252-
45122323  
 
 
Centralized vacuum system in a hospital in a resource-limited 
setting, with a control panel in the foreground and a back-up 
system in the background (Red circle.) 
 
 
The buffer tank of the same system as above, with a pressure 
gauge that can easily be checked to confirm that the system is 
working properly.  
 
The pitfalls of central vacuum include the 
need for the pumps to be run continuously and the 
potential for leakage from the tubing and connecting 
systems. Leakage can occur at the connecting 
systems themselves, especially if the machinery is 
old. It can also occur from the pipes, which is very 
Medical Vacuum (Suction) 
In Resource-Limited Settings 
Jason Fader and Richard Davis 
 
OPEN MANUAL OF SURGERY IN RESOURCE-LIMITED SETTINGS 
www.vumc.org/global-surgical-atlas 
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License  
 
difficult to address if the pipes are inside a concrete 
or stone wall.  
The wall connection is usually proprietary to 
the system being used: once you decide on this 
system, you will need to use compatible regulators to 
connect to the suction. When building a new hospital 
out of donated materials, it may be tempting to use 
donated regulators. Be sure that you will be able to 
purchase more devices in-country if you need them. 
“Future-proof” your hospital by using equipment 
that can be sourced locally.  
 
A wall connection for medical vacuum, unconnected (left) and 
connected to a regulator (right). Other brands or types of 
regulators cannot be used with this system.  
 
Jason Fader, MD  
Kibuye Hospital  
Burundi 
 
Richard Davis MD FACS FCS(ECSA) 
AIC Kijabe Hospital  
Kenya 
 
October 2023 
