suctioning a tracheostomy

8/3/2019 Suctioning a Tracheostomy

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Suctioning a Tracheostomy


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Care Techniques

Sterile Technique: sterile catheters and sterile

gloves ModifiedSterile Technique: sterile catheters

and clean gloves

Clean Technique: clean catheter and cleanhands


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Suction Depths

ShallowSuctioning: Suction secretions at the openingof the trach tube that the child has coughed up.

P

re-measured

Suctio

ning:Su

ction the length of thetrach tube. Suction depth varies depending on the sizeof the trach tube. The obturator can be used as ameasuring guide.

Deep Suctioning: Insert the catheter until resistance is

felt. (Deep su

ctioning isu

su

ally not necessary. Becareful to avoid vigorous suctioning, as this may injurethe lining of the airway).


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Indication

Signs That a patient Needs Suctioning

Rattling mucus sounds from the trach

Fast breathing

Bubbles of mucus in trach opening

Dry raspy breathing or a whistling noise from trach

Older children may vocalize or signal a need to besuctioned.

Signs of respiratory distress under tracheostomycomplcations


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Equipment

Suction machine

Suction connecting tubing

Suction catheters

Normal saline Sterile or clean cup

3cc saline ampules (bullets)

Ambu bag

Tissues

Gloves (optional for home care, use powder-freegloves)


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Procedure

Explain procedure in a way appropriate for patients age andunderstanding.

Wash hands.

Set up equipment and connect suction catheter to machine tubing.

Pour normal saline into cup.

Put on gloves (optional).

Turn on suction machine (suction machine pressure for small children 50-100mm Hg, for older children/adults 100-120mm Hg)

Place tip of catheter into saline cup to moisten and test to see that suctionis working.

Instill sterile normal saline with plastic squeeze ampule into the trach tubeif needed for thick or dry secretions. Excessive use of saline is notrecommended. Use saline only if the mucus is very thick, hard to cough upor difficult to suction. Saline may also be instilled via a syringe or eyedropper, which is less expensive than single dose units. Recommendedamount per instillation is approximately 1cc.


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Gently insert catheter into the trach tube without applyingsuction. (Suction only length of trach tube - premeasuredsuctioning. Deeper insertion may be needed if the child hasan ineffective cough.)

Put thumb over opening in catheter to create suction anduse a circular motion (twirl catheter between thumb andindex finger) while withdrawing the catheter so that themucus is removed well from all areas. Avoid suctioninglonger than 10 seconds because of oxygen loss. Note: Someresearch has shown that by applying suction both going inand then out of the tube takes less time and thereforeresults there is less hypoxia. Also, there are now holes onall sides of the suction catheters, so twirling is notnecessary.


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Draw saline from cup through catheter to clear catheter.

For trach tubes with cuffs, it may be necessary to deflatethe cuff periodically for suctioning to prevent pooling ofsecretions above trach cuff.

Let patient rest and breathe, then repeat suction if neededuntil clear (allow at least 30 seconds between suctioning).

Oxygenate as ordered (extra oxygen may be given beforeand after suction to prevent hypoxia).

Some patients need extra breaths with an Ambu bag

(approximately 3 - 5 breaths). Purposes ofbagging:hyperoxygenation, hyperinflation, and hyperventilation ofthe lungs. However, this is usually not needed for stablepatients with no additional respiratory problems.


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The patients mouth or nose may also be suctioned, ifneeded after suctioning the trach, then dispose of thatcatheter (do not put same catheter back into trach).

Dispose of suction catheter, saline and gloves, turn off

machine. In home care, catheters may sometimes be usedmore than once before disposal or cleaning if child needfrequent suctioning. Keep tip of catheter sterile, and storeinto original package.

A bulb syringe may be used between suctioning if the

patient is ab

le to cou

ghu

p some secretions on his/her own. Be aware of color, odor, amount and consistency of the

secretions and notify doctor of changes in secretions.


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Suctioning equipment


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Suctioning equipment


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Technique


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Set suction pressure


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Sequence of process


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Ending process


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suctioning a tracheostomy

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