TRACHEOSTOMY & ENDOTRACHEAL TUBE SUCTIONING

Some patients need help in removing secretions from their airways. For patients who have a tracheostomy, secretions commonly build up, necessating suctioning. Suctioning a tracheostomy or endotracheal tube is a sterile, invasive technique requiring application of scientific knowledge and problem solving. This skill is perormed by a nurse or respiratory therapist.

Purposes

To maintain a patient airway and prevent airway obstruction.

To promote respiratory function (optimal exchange of oxygen and carbon dioxide into and out of the lungs).

To prevent pneumonia that may result from accumulated secretions

Equipment

Sterile suction catheter ( the outer diameter of the suction catheter should be no greater than one half the inner diameter of the artificial airway)

# 14-16 (adult) # 8-10 (child) Sterile gloves Sterile water

Equipment

Suction source Resuscitation bag with a reservoir

connected to 100% oxygen source Normal Saline solution Sterile kidney basin

Preparation

Nursing Action Monitor heart rate and auscultate breath

sounds. If arterial blood gases (ABGs) are done routinely, know baseline values.

Implementation

Explain to the client what you are going to do, why it is necessary, and how he can cooperate. Inform the client that suctioning usually causes some intermittent coughing and that this assists in removing the secretions.

Wash hands and observe other appropriate infection control procedures.

Provide for client privacy.

Prepare the client

If not contraindicated, place the client in the Semi Fowler’s position to promote deep breathing, maximum lung expansion, and productive coughing.

If necessary, provide analgesia before suctioning. Endotracheal suctioning stimulates the cough reflex, which can cause pain for clients who have had thoracic or abdominal surgery or who have experienced traumatic injury.

Prepare the client

If the patient is on mechanical ventilation, test to make sure disconnection of ventilator attachment may be made with one hand.

Prepare the Equipment

Check function of suction and manual resuscitation bag,

Attach the resuscitation apparatus to the oxygen source. Adjust the oxygen flow to 100% flush.

Open the sterile supplies in readiness for use.

Prepare the Equipment

Place a sterile towel, if used, across the client’s chest below the tracheostomy.

Turn on the suction, snd set the pressure in accordance with agency policy.

wall unit = 100-120 mmHg is normally used for adults

50-95 mmHg for children and infants.

Prepare the Equipment

Put on a sterile gloves. Designate one hand as contaminated for disconnecting, bagging, and working the suction control. Usually the dominant hand is kept sterile and will be used to thread the suction catheter.

Flush and lubricate the catheter.

Using the dominant hand, place the catheter tip in the sterile saline solution.

Using the thumb of the non dominant hand. Occlude the thumb control and suction a small amount of the sterile solution through the catheter.

If the client does not have copious secretions, hyperventilate the lungs with

a resuscitation bag before suctioning.

Summon an assistant, if one is available for this step.

Using your non dominant hand, turn on the oxygen to 12 – 15 liters/min.

If the client is receiving oxygen, disconnect the oxygen source from the tracheostomy tube using your non dominant hand.

Attach the resuscitator to the tracheostomy or endotracheal tube.

Compress the Ambu bag three to five times, ass the client inhales. This is best done by a second person who can use both hands to compress the bag, thus, providing a greater inflation volume.

Observe the rise and fall of the client’s chest to assess the adequacy of ventilation.

Remove the resuscitation device and place it on the bed of the client’s chest with connector facing up.

VARIATION USING A VENTILATOR TO PROVIDE HYPERVENTILATION

If the client is on ventilator, use the ventilator for hyperventilation and hyper oxygenation. Newer models have a mode that provides 100% oxygen for 2 minutes and then switches back to the previous oxygen setting as well as a manual breath or sigh button.

If the client has copious secretions, do not hyperventilate with resuscitator. Instead:

Keep the regular oxygen delivery device on and increase the liter flow or adjust the FiO2 to 100% for several breaths before suctioning.

Quickly but gently insert the catheter

without applying any suction.

With your non dominant thumb off the suction port, quickly but gently insert the catheter into the trachea through the tracheostomy tube.

Insert the catheter about 1 to 2 cm(0.4 to 0.8) before applying suction.

Perform Suctioning

Apply intermittent suction for 5 to 10 seconds by placing the non dominant thumb over the thumb port.

Rotate the catheter by rolling it between your thumb and forefinger and slowly withdrawing it.

Withdraw the catheter completely, and release the suction.

Hyperventilate the client. Then suction again

Reassess the client’s oxygenation status and repeat suctioning. Observe the client’s respirations and skin

color. Check the client’s pulse if necessary, using your non dominant hand.

Encourage the client to breathe deeply and to cough between suctions.

Allow 2-3 minutes between suctions when possible.

Flush the catheter and repeat suctioning until the air passage is clear and the breathing is relatively effortless and quiet.

After each suction pick-up the resuscitation bag with your non dominant hand and ventilate the client with no more than three breaths.

Return the patient to the ventilator machine. Suction oral secretions from the oropharynx above the artificial airway cuff. Use another set of suction catheter.

Dispose of equipment and ensure availability for the next suction

Flush the catheter and suction tubing. Turn off the suction and disconnect the

catheter from the suction tubing. Wrap the catheter around your sterile

hand and peel the gloves off so that it turns inside out over the catheter.

Discard the glove and the catheter in the moisture-resistant bag.

Replenish the sterile fluid and supplies so that the suction is ready to use again.

Provide for client comfort and safety.

Assist the client to a comfortable, safety position that aids breathing. If the person is conscious, a semi Fowler’s position is frequently indicated. If the person is unconscious, Sim’s position aids on the drainage of secretions from the mouth.

Document relevant data. Record the suctioning, including the amount and description of suction returns and any other relevant assessment.

Lifespan Considerations

Have an assistant gently restrain the child to keep the child’s hands out of the way. The assistant will need to keep the child’s head in the midline position.

Elders often have cardiac and/or pulmonary disease increasing their susceptibility to hypoxemia related to suctioning. Watch closely for signs of hypoxemia. If noted, stop suctioning and hyper oxygenate.

Do a thorough lung assessment before and after suctioning to determine effectiveness of suctioning and to be aware of any special problems.

Unexpected situations and Associated Interventions

Secretions are blood-tinged when suctioning

Patient coughs hard enough to dislodge tracheostomy

Lung sounds do not improve greatly and oxygen saturation remains low after three suctioning.