Tracheostomy Tube Suctioning & Tracheostomy Care Presented by: Helen Fitzpatrick, RN, ADN, Sandra Zsikla, RN, BSN, WCC & Elizabeth Gifford, LPN

Normal Respiration Normal upper airway inspiration heats, humidifies and cleans the air we breathe. A tracheostomy tube bypasses this mechanism. Therefore, the air is cooler, drier and less cleaned.

Why Suction Secretions from Airways? Purpose: 1. Remove excess secretions to maintain patent airway using sterile technique. 2. To improve oxygenation and improve the work of breathing. 3. To prevent aspiration of food, blood and gastric fluid. 4. To prevent infection and atelectasis. 5. Collect secretions for diagnostic testing.

When to Suction prn After chest PT/nebs/inexsuffilator/trach changes Before and after sleep

Assessment Assess respiratory system: Note rate, depth & rhythm of respirations. Note noisy, wet, or gurgling respirations. Note signs & symptoms of hypoxemia & hypercapnea (restlessness, confusion, etc.) Auscultate breath sounds. Assess patient’s ability to cough: Note amount & character of sputum (normal secretions should be clear or white).

Assessment Assess vital signs and signs & symptoms of infection: Compare to baseline vital signs. Note any elevation in temperature. Note signs & symptoms of infection. Note change in sputum color or consistency. Assess level of consciousness and ability to protect airway: Note presence of cough reflex. Note any drainage from mouth.

Assessment Assess ability to communicate: Develop a communication system. Provide clear explanations to the patient. Assess accidental extubation: Keep extra tracheostomy tube and obturator at bedside.

Equipment Portable or wall suction with tubing and reservoir. Sterile suctioning kit containing: Appropriate-sized suction catheter (14 Fr) Pair of gloves Container of saline to flush and lubricate the suction catheter Drape Pulse oximeter Ambu (10-15 liters)

Suction Catheters

Tracheostomy Tube Suctioning Procedure 1.Wash hands to prevent transmission of micro-organisms/cross contamination. Don PPE (goggles or glasses and mask) 2. Explain procedure to patient to reduce anxiety & encourage cooperation. 3. Position the patient (Fowler’s unless unresponsive: side lying position)

Tracheostomy Tube Suctioning Procedure 4. Turn on suction (adults: 100-120mm Hg). Secure connecting tube to suction source. (Excessive negative pressure traumatizes mucosa & can induce hypoxia.) 5. Open and prepare suction catheter kit. 6. Preoxygenate patient with 100% oxygen to prevent hypoxemia. Hyperinflate with ambu to decrease atelectasis r/t suctioning. 7. Don sterile gloves.

Tracheostomy Tube Suctioning Procedure 8. Pick up catheter with dominant hand and the connecting tube with non-dominant hand. Attach catheter to tubing using sterile technique. 9. Place catheter end into saline. Test equipment by applying thumb from non-dominant hand over open port to create suction. 10. Insert catheter into tracheostomy tube (during inspiration when epiglottis is open) without applying suction, using sterile technique. 11. Advance catheter until you feel resistance. Retract catheter 1cm before applying suction.

Tracheostomy Tube Suctioning Procedure 12. Apply intermittent suction while withdrawing the catheter. Limit suctioning time to 10 seconds to prevent hypoxemia. 13. Hyperoxygenate and hyperinflate if needed. 14. Rinse catheter with saline to clear secretions. 15. Repeat Steps 10-14 until airway is clear. Oropharynx suctioning: 16. Without applying suction, insert the catheter gently along one side of mouth. Advance to oropharynx. Suction oropharynx after trachea.

Tracheostomy Tube Suctioning Procedure 17. Apply suction 5-10 seconds while rotating & withdrawing catheter. 18. Allow 1-2 minutes between passes for the patient to recover. Encourage deep breathing. Replace oxygen if applicable. 19. Repeat Steps 16-18 as needed to clear oropharynx. 20. Rinse catheter and tubing by suctioning saline through. 21. Remove glove by pulling it over the catheter in other hand.

Tracheostomy Tube Suctioning Procedure 22. Turn off suction device. 23. Assist patient to a comfortable position. 24. Dispose of disposable supplies. 25. Wash your hands! 26. Ensure sterile suction catheter kit is available at patient’s bedside. 27. Ensure suctioning equipment is changed every 24 hours. 28. Document procedure and outcomes.

Tips If possible, have patient lean forward & cough out secretions from tracheostomy If secretions are dry or thick, utilize humidification If appropriate, deflate the cuff to keep secretions from pooling If patient in respiratory distress, don’t leave him/her alone

Providing Tracheostomy Care

Purpose Maintain airway patency Promote cleanliness Prevent infection Prevent skin breakdown

Assessment Assess for excess secretions Soiled tracheostomy dressing and ties Assess respiratory status Identify type of tracheostomy tube Assess client’s ability for self-care Identify factors that influence tracheostomy care

Factors Influencing Tracheostomy Care Nutritional status Respiratory infections Fluid status Humidity

Equipment Two specimen cups 4”X4”’s and tracheostomy dressing hydrogen peroxide and saline sterile gloves Sterile cotton tipped applicators Zinc/bacitracin as ordered Tracheostomy suction supplies Oxygenation humidification as needed

Procedure Wash hands and don gloves Explain procedure to patient Place patient in Fowler’s position Suction the tracheostomy tube Discard soiled tracheostomy dressing Replace oxygen/humidity on the patient Gather supplies

Procedure Open peroxide/saline solution cups Don gloves Open cotton tipped applicators and solutions Open precut tracheostomy dressing Remove oxygen/humidity source

Procedure Clean dried secretions from outer cannula and stoma Using peroxide solution clean in one direction and repeat as necessary. Using saline solution, repeat same procedure. Wipe away foaming secretions Pat moist surface dry with gauze Apply zinc/bacitracin as ordered Place sterile tracheostomy dressing around stoma Do not use cut 4X4 gauze Assess that velcro ties are not too tight

Procedure Remove gloves and discard equipment Assist patient to comfortable position Offer oral hygiene Wash your hands Document procedure and observations

Changing the Disposable Inner Cannula Supplies: disposable inner cannula two vinyl examination gloves two sterile gloves Procedure gather supplies explain procedure to patient wash hands open inner cannula package

Disposable Inner Cannula Glove and remove old inner cannula Discard gloves and cannula Glove using sterile gloves Insert new inner cannula into tube

Tips These supplies are required to be in the patient’s room: An exact spare tracheostomy Tracheostomy care supplies Ambu bag Suction kits Requires a priority light (call system)

The End