1. Suctioning and Care of Tracheostomy Tube
Respiratory Care

2. Suctioning and Care of Tracheostomy Tube
Suction is indicated for patients incapable of mobilizing secretions due to decreased or absent cough reflex, which could be caused by muscular weakness/disease, coma, drug overdose. It is also indicated for patients with artificial airways in place, and for obtaining sterile sputum specimens for laboratory analysis.

3. Suctioning and Care of Tracheostomy Tube
Complications of suctioning include:
hypoxia
vagal stimulation
damage to mucous membranes
sudden death
When artificial airways are in place, occlusion of the airway can occur when an inappropriate catheter size is chosen.

4. Catheter Size
Suction catheters should not have an outer diameter (OD) greater than two-thirds of the inner diameter (ID) of the tube being suctioned.

5. Catheter Size Recommended Catheter Sizes include: Newborn size 6
up to 3 years old size 8
5-16 years old size 10
adult female size 12
adult male size 14

6. Negative Suction
Recommended negative suction pressures are as follows:
neonates mmHg
pediatrics mmHg
Adults mmHg
Pressures exceeding 120mmHg may cause damage to the mucous membranes, and should not be used.

7. Orders for Suction
A physician’s order is not needed to perform any of the following suction procedures:
nasotracheal suction
oral suction
tracheal suction
endotracheal suction

8. Suctioning and Care of Tracheostomy Tube
Total suction time should not exceed 15 seconds.
Never store or reuse a suction catheter.
In the event of vacuum failure, portable suction pumps are requisitioned from Central Service.

9. Suctioning and Care of Tracheostomy Tube
Please refer to the Respiratory Care Policy and Procedure Manual for additional procedural instructions.

10. Tracheostomy Tube Care
General tracheostomy tube care
nursing is responsible for regularly scheduled trach care, but RC personnel will also do PRN trach care and trach change outs.

11. Tracheostomy Tube Care
First trach tube change after surgery will require a physician present who can intubate if necessary, preferably an anesthesiologist.
Two health care professionals should be present for any other non emergent tube replacement.

12. Tracheostomy Tube Care
Unless the trach tube is plugged off, patients with trach tubes in place should always have heated humidity or cool aerosol for humidification as the normal mode of humidifcation (the nose) is bypassed.

13. Tracheostomy Tube Care
All patients that have a trach tube in place should have an extra tube at their bedside.

14. Passy-Muir Valves
Tracheostomy tube cuff should ALWAYS be deflated when using Passy-Muir speaking valves, as they are one-way valves that allow only inspiration, and expiration occurs around the trach tube and out the mouth to allow for speech.
Passy-Muir valves should be removed for breathing treatments.

15. Types of Trach Tubes Bivona Cuffed with internal sponge
Cuff will inflate without inserting air and needs to have air removed from cuff purposefully -deflate with syringe.
After deflation, syringe must be left attached to balloon for cuff to remain deflated.

16. Types of Trach Tubes Jackson Portex Metal, twisted lock inner cannulas
Un-cuffed, and are made to clean and re-use between patients
Portex
Have a partial detachable ring at proximal end of the inner cannula used to grip and pull out the inner cannula.

17. Types of Trach Tubes Shiley Cuffed and un-cuffed available
Fenestrated and non-fenestrated
Made of plastic
Most commonly used type of trach tube

18. Types of Trach Tubes
Pediatric and neonatal trach tubes are usually un-cuffed.

19. EXIT
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