Suctioning and Tracheostomy Care for Radiation Therapists Thunder Bay Regional Health Sciences Centre 2014 Kendra Walt, RN, Interprofessional Educator

Types of Suctioning Devices at TBRHSC Yankauer- used for oral suctioning Suction Catheter- used for suctioning clients with a tracheostomy

Indications for Suctioning Patient is unable to clear their own secretions Difficulty breathing and/or changes in breathing Evidence of cyanosis

Equipment needed for Tracheal Suctioning 1. Sterile suction kit (includes sterile glove, 12 French suction catheter and container for saline). A correctly sized suction catheter should occlude no more than half of the interior diameter of the tracheostomy. 2. Clean gloves, fluid shield mask with eye protection, and gown if required 3. Sterile saline 4. Separate suction tubing designated for tracheotomy suctioning only if client also requires oral suctioning

Suction Process Assess respiratory status prior to suctioning to determine if suctioning is required. Only suction when clinically indicated. 1. Have patient take several large breaths before beginning and during breaks in suctioning. Rationale: The patient can become hypoxic during suctioning. Some patients may need to be hyper-oxygenated with manual ventilation bag for 1-2 minutes prior to suctioning if known desaturation during procedure. 2. Open sterile suction kit and fill compartment with sterile saline. 3. Set the suction pressure as low as possible, yet effective enough to clear the secretions • 80-100 mmHg for adults • 60-80 mmHg for child • 40-70 mmHg for newborns 4. Apply fluid shield mask with eye protection and gown if necessary. Put on clean gloves. 5. If patient has fenestrated tracheostomy tube, remove fenestrated inner cannula and insert non-fenestrated inner cannula before suctioning. This will prevent suction catheter from becoming caught in the fenestration. 6. Apply sterile glove to dominant hand. 7. Attach suction catheter to suction source while maintaining sterility of catheter.

14. Dispose of suction kit and gloves. Wash hands. Con’t 8. Wet the tip of the catheter in sterile saline to lubricate it before suctioning. Insert catheter gently until cough is stimulated or until resistance is felt. 9. Do not suction while inserting catheter. Apply intermittent suction as you rotate and withdraw the suction catheter. The hand that controls suction can be clean; hand that feeds catheter into tracheostomy must remain sterile. You should suction for no longer than 10 seconds. 10. Place catheter tip in normal saline and activate suction to rinse the inside of the catheter. 11. If additional suctioning is required, allow patient a few minutes to re-oxygenate before further suctioning is repeated. (Maximum two attempts per suctioning session) 12. Dispose of catheter by coiling it in gloved hand and removing the glove to cover the catheter. 13. For fenestrated tracheostomy, ensure to remove non- fenestrated inner cannula and replace with fenestrated inner cannula once suctioning is complete. 14. Dispose of suction kit and gloves. Wash hands. 15. Assess breath sounds post procedure.

Accidental Decannulation of the Trach DO NOT attempt to re-insert the trach Stay Calm Observe and assess the client to see if he/she can breath through the stoma/mouth itself Apply oxygen over mouth (or stoma) and call RRT (624-1060) Call MRP (most responsible physician)

TBRHSC Policies Tracheostomy Care (PAT-5-125) IC-Routine Practices-Body Substance Precautions (IPC-2-04)