TRACHEOSTOMY SUCTIONING

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
TRACHEOSTOMY SUCTIONING – Definition, Purpose, Equipment, Preliminary Assessment and Procedure
TRACHEOSTOMY SUCTIONING – Definition, Purpose, Equipment, Preliminary Assessment and Procedure

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