TRACHEOSTOMY SUCTIONING – Definition, Purpose, Equipment, Preliminary Assessment and Procedure
DEFINITION
Tracheostomy is an artificial airway which requires being maintained secretion free, thereby insuring adequate ventilation for the patient
PURPOSE
- To clear secretions from the artificial airway or tracheobronchial tree
- To maintain the patency of the tracheostomy tube
- To ensure maximum ventilation of the patient
- To reduce maximum ventilation of the patient
- To reduce the risk of respiratory infection
EQUIPMENT
- A clean tray
- Sterile suction catheters size 14, 16 adult, 10, 12 pediatric with thumb control
- Sterile gloves
- Sterile towel
- Sterile container and water or normal saline for flushing the catheter and tubing
- Normal saline for installation
- Sterile syringe 2 ml, 5 ml
- Resuscitation bag with reservoir connected to 100% oxygen source. Add positive end expiratory pressure valve to exhalation valve on resuscitation bag in an amount equal to that on the ventilator or (PAP, CPAP device)
- Receptacle for disposables
- Suction apparatus, e.g. portable machine or wall suction set at 80 to 120 mm Hg
PRELIMINARY ASSESSMENT
- Check physician’s order, progress notes and nursing care plan
- Explain the procedure to the patient. Include instructions on how to splint the surgical incision as coughing will be induced during the procedure
- Ensure the patient’s privacy
- Position the patient in suitable position
- Monitor heart rate, respiration rate and type and arterial blood pressure. If blood gases are ordered, know baseline values
- Collect and assemble equipment. Check function of suction and resuscitation bag connected to 100% oxygen source
- Wash and dry hands
Procedure
- Open sterile towel and place in bib like fashion on patient’s chest
- Open sterile gloves and place on sterile field
- If the patient is attached to ventilator test to ensure that disconnection of ventilator may be with one hand
- Fill the sterile container with sterile water
- Open the end of the pack containing the suction catheter and connect it to the tubing of the suction machine
- Using the contaminated hand disconnect the patient from the ventilator CPAP device or other oxygen source
- Ventilate and oxygenate the patient with the resuscitator bag 5 to 6 times
- In the spontaneously breathing patient coordinate ventilation with patients own respiratory effort
- Slide the cover off the catheter and rinse it through with sterile water/saline to lubricate it
- Insert the catheter into the tracheostomy as for as possible without applying suction
- Apply suction and quickly rotate the catheter while it is being withdrawn
- Limit suction time 10 to 15 seconds. Discontinue if heart rate decreases by 20 beats per minute or if cardiac ectopy is observed
- Ventilate the patient between suction with 4-5 manual ventilation
- Sterile normal saline 2 to 3 ml may be instilled into the airway followed by manual ventilation then suction
- Rinse catheter between suctioning. Procedure with sterile water/saline
- Continue procedure as necessary to a maximum of 4 suction passes
- Give the patient 6 to 8 ‘sigh’ breaths with the bag
- Return the patient to the ventilator or apply CPAP or other oxygen delivery device
- Suck oral secretions from the oropharynx above the artificial cuff
- Deliver tracheostomy care as required
- If patient is not an respiratory assistance apply filter or humidifier as indicated
- Check vital signs
- Leave the patient as comfortable as possible
- Clear and clean equipment
- Wash and dry hands
- Document the procedure including patient’s response in appropriate nursing notes
