Tracheostomy Suctioning NUR 171

Tracheostomy Definition: Indications: Advantages: Definition: Surgical incision into the trachea to establish an airway pt will have a “Stoma” that results from tracheotomy Indications: Bypass upper airway obstruction Facilitate removal of secretions Long-term mechanical ventilation Advantages Permit oral intake Less risk of long-term damage to airway, Increased comfort, Increased mobility because tube is more secure

Outer cannula Inner cannula De-cannulation plug Pilot balloon Cuff pressure limits Inform patient and family of inability to speak while inflated cuff is used! Cuffless tube is used when patient can protect against aspiration and does not require mechanical ventilation. Cuffed tube with inflated cuff is used for risk of aspiration or in mechanical ventilation Inflate cuff with minimum volume required to create an airway seal Should not exceed 20 mm Hg or 25 cm H2O Risk for aspiration Not used if trach is bypassing upper airway construction Excessive cuff pressure can Compress tracheal capillaries Limit blood flow Predispose to tracheal necrosis More on this in block 4

Nursing Diagnoses Ineffective airway clearance Impaired verbal communication Risk for infection Impaired swallowing Ineffective therapeutic regimen management Think about ways to communicate with a patient that cannot speak. It is important to establish communication signals when suctioning a patient.

Suctioning Purpose Types Sterile VS Non –Sterile Frequency: Determined by assessment Equipment Required Purpose: Clear airway, facilitate breathing Types: Oropharyngeal/Nasopharyngeal/Orotrachael/Nasotracheal/Artificial Airway Sterile: oropharynx, trachea Non-Sterile-mouth (Yankauer) Frequence: Cardiac : Heart rate, quality Respiratory: Resp rate, effort, O2 sat, LOC, color (lips, nail beds) Frequent suctioning risk: desaturation, be sure to oxygenate prior to sxn Equipment: portable or wall sxn supply with regulator, collection canister/tubing, sterile disposable sxn kit, NS, O2, gloves [both] clean towel/drape

Policy/Procedure Above is an example of a Hospital policy and procedure Get out our rubric and review the Policies for Phoenix College Medical Center. These are your rubric for practicums.

Procedure Positioning Draping Evaluate wall suction regulator [ how much suction??] Don eye protection Open sterile NS container Open sterile suction kit Apply sterile gloves Grasp coiled catheter with “sterile” hand Attach to wall suction tubing with “clean” hand Rinse set with NS to evaluate proper function What’s missing with this nurse???

Suctioning Rules NEVER SUCTION ON THE WAY IN!!!! Limit suctioning to 10-15 seconds MAX!!! Clean suction catheter between suction passes with NS ONLY 2 passes with sterile catheter per suction kit. Monitor respiratory status continuously during procedure.

Turn off suction. Wrap catheter around dominant hand Disconnect from suction tubing Remove gloves, enclosing catheter inside used gloves. Throw away used equipment. Reassess

Documentation Date & Time of suctioning. Amount, consistency, color & odor of secretions. Pts tolerance of procedure. Breathe sounds & respiratory status (pre- & post- suctioning)!

Tracheostomy Care Supplies Refer to Mosby Skills videos When you open the package it will look very similar to the picture above. Each compartment is for a purpose Soak Clean Rinse