1Tracheostomy Tube Suctioning & Tracheostomy Care Presented by:Helen Fitzpatrick, RN, ADN,Sandra Zsikla, RN, BSN, WCC& Elizabeth Gifford, LPN
2Normal RespirationNormal upper airway inspiration heats, humidifies and cleans the air we breathe.A tracheostomy tube bypasses this mechanism. Therefore, the air is cooler, drier and less cleaned.
3Why Suction Secretions from Airways? Purpose:1. Remove excess secretions to maintainpatent airway using sterile technique.2. To improve oxygenation and improve thework of breathing.3. To prevent aspiration of food, blood and gastricfluid.4. To prevent infection and atelectasis.5. Collect secretions for diagnostic testing.
4When to Suction prn After chest PT/nebs/inexsuffilator/trach changes Before and after sleep
5Assessment Assess respiratory system: Note rate, depth & rhythm of respirations.Note noisy, wet, or gurgling respirations.Note signs & symptoms of hypoxemia & hypercapnea (restlessness, confusion, etc.)Auscultate breath sounds.Assess patient’s ability to cough:Note amount & character of sputum (normal secretions should be clear or white).
6Assessment Assess vital signs and signs & symptoms of infection: Compare to baseline vital signs.Note any elevation in temperature.Note signs & symptoms of infection.Note change in sputum color or consistency.Assess level of consciousness and ability to protect airway:Note presence of cough reflex.Note any drainage from mouth.
7Assessment Assess ability to communicate: Develop a communication system.Provide clear explanations to the patient.Assess accidental extubation:Keep extra tracheostomy tube and obturator at bedside.
8Equipment Portable or wall suction with tubing and reservoir. Sterile suctioning kit containing:Appropriate-sized suction catheter (14 Fr)Pair of glovesContainer of saline to flush and lubricatethe suction catheterDrapePulse oximeterAmbu (10-15 liters)
10Tracheostomy Tube Suctioning Procedure 1.Wash hands to prevent transmission ofmicro-organisms/cross contamination.Don PPE (goggles or glasses and mask)2. Explain procedure to patient to reduceanxiety & encourage cooperation.3. Position the patient (Fowler’s unlessunresponsive: side lying position)
11Tracheostomy Tube Suctioning Procedure 4. Turn on suction (adults: mm Hg).Secure connecting tube to suction source.(Excessive negative pressure traumatizesmucosa & can induce hypoxia.)5. Open and prepare suction catheter kit.6. Preoxygenate patient with 100% oxygen toprevent hypoxemia. Hyperinflate with ambu todecrease atelectasis r/t suctioning.7. Don sterile gloves.
12Tracheostomy Tube Suctioning Procedure 8. Pick up catheter with dominant hand and theconnecting tube with non-dominant hand. Attachcatheter to tubing using sterile technique.9. Place catheter end into saline. Test equipmentby applying thumb from non-dominant handover open port to create suction.10. Insert catheter into tracheostomy tube (duringinspiration when epiglottis is open) withoutapplying suction, using sterile technique.11. Advance catheter until you feel resistance.Retract catheter 1cm before applying suction.
13Tracheostomy Tube Suctioning Procedure 12. Apply intermittent suction while withdrawingthe catheter. Limit suctioning timeto 10 seconds to prevent hypoxemia.13. Hyperoxygenate and hyperinflate if needed.14. Rinse catheter with saline to clear secretions.15. Repeat Steps until airway is clear.Oropharynx suctioning:16. Without applying suction, insert the cathetergently along one side of mouth. Advance tooropharynx. Suction oropharynx after trachea.
14Tracheostomy Tube Suctioning Procedure 17. Apply suction 5-10 seconds while rotating &withdrawing catheter.18. Allow 1-2 minutes between passes for thepatient to recover. Encourage deep breathing.Replace oxygen if applicable.19. Repeat Steps as needed to clear oropharynx.20. Rinse catheter and tubing by suctioning salinethrough.21. Remove glove by pulling it over the catheter inother hand.
15Tracheostomy Tube Suctioning Procedure 22. Turn off suction device.23. Assist patient to a comfortable position.24. Dispose of disposable supplies.25. Wash your hands!26. Ensure sterile suction catheter kit is available at patient’s bedside.27. Ensure suctioning equipment is changed every 24 hours.28. Document procedure and outcomes.
16TipsIf possible, have patient lean forward & cough out secretions from tracheostomyIf secretions are dry or thick, utilize humidificationIf appropriate, deflate the cuff to keep secretions from poolingIf patient in respiratory distress, don’t leave him/her alone
19Assessment Assess for excess secretions Soiled tracheostomy dressing and tiesAssess respiratory statusIdentify type of tracheostomy tubeAssess client’s ability for self-careIdentify factors that influence tracheostomy care
20Factors Influencing Tracheostomy Care Nutritional statusRespiratory infectionsFluid statusHumidity
21Equipment Two specimen cups 4”X4”’s and tracheostomy dressing hydrogen peroxide and salinesterile glovesSterile cotton tipped applicatorsZinc/bacitracin as orderedTracheostomy suction suppliesOxygenation humidification as needed
22Procedure Wash hands and don gloves Explain procedure to patient Place patient in Fowler’s positionSuction the tracheostomy tubeDiscard soiled tracheostomy dressingReplace oxygen/humidity on the patientGather supplies
23Procedure Open peroxide/saline solution cups Don gloves Open cotton tipped applicators and solutionsOpen precut tracheostomy dressingRemove oxygen/humidity source
24Procedure Clean dried secretions from outer cannula and stoma Using peroxide solution clean in one direction and repeat as necessary.Using saline solution, repeat same procedure.Wipe away foaming secretionsPat moist surface dry with gauzeApply zinc/bacitracin as orderedPlace sterile tracheostomy dressing around stomaDo not use cut 4X4 gauzeAssess that velcro ties are not too tight
25Procedure Remove gloves and discard equipment Assist patient to comfortable positionOffer oral hygieneWash your handsDocument procedure and observations