1. Tracheostomy Suctioning
NUR 171

2. 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

3. 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

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.

5. 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

6. 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.

7. 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???

8. Suctioning Rules NEVER SUCTION ON THE WAY IN!!!!
Limit suctioning to 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.

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

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

12. 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