Suctioning a Tracheostomy Tube

This systematic, predetermined, step-by-step description of the entire tracheostomy suctioning procedure is an excerpt from Fundamentals of Nursing by Kozier & Erb.

• Introduce yourself and use agency protocol to confirm the client's identity before beginning the procedure. The customer should be informed of what you want to do, why it is required, and how they may help. Tell the client that intermittent coughing is usually caused by suctioning and that this helps to remove secretions.
• Practice good hand hygiene and adhere to other necessary infection control measures.
• Ensure the privacy of the client.
• Get the client ready.
• Place the patient in the semi-Fowler position, if it is not dangerous for their health, to encourage deep breathing, maximum lung expansion, and productive coughing.

Rationale

Deep breathing oxygenates the lungs, counteracts the hypoxic effects of suctioning, and may induce coughing. Coughing helps to loosen and move secretions.

• Provide analgesia if required before suctioning. The cough reflex is triggered by endotracheal suctioning, which can hurt patients who have had thoracic or abdominal surgery or who have sustained a traumatic injury.

Rationale

Premedication can increase the client’s comfort during the suctioning procedure.

• Prepare the Equipment.
  • Connect the resuscitation equipment to the oxygen supply.
  • Set the oxygen saturation to 100%.
  • In order to use the sterile materials, open them.
  • If one is being used, lay it across the client's chest just below the tracheostomy.
  • Suction should be activated, and pressure should be set in accordance with agency guidelines. For a wall unit, an adult setting of about 100 to 120 mm Hg and an infant or child setting of 50 to 95 mm Hg are typically used.
  • If required, put on a mask, gown, and eye protection.
  • Don a pair of sterile gloves. To protect the nurse, some organizations advise using sterile gloves on the dominant hand and non-dominant gloves.
  • Connect the suction catheter to the suction tubing while holding the connector in your non-dominant hand and the catheter in your dominant hand.
• Flush and Lubricate the Catheter.
  • The catheter tip should be inserted into the sterile saline solution with the dominant hand.
  • Occupy the thumb control with the thumb of the non-dominant hand and suction a tiny amount of the sterile solution through the catheter.

Rationale

This determines that the suction equipment is working properly and lubricates the outside and the lumen of the catheter. Lubrication eases insertion and reduces tissue trauma during insertion. Lubricating the lumen also helps prevent secretions from sticking to the inside of the catheter.

• If the client does not have a lot of secretions, hyperventilate the lungs with a resuscitation bag before sucking.
  • If one is available, call one in for this stage.
  • Turn the oxygen on to 12 to 15 L/min with your non-dominant hand.
  • Use your non-dominant hand to detach the oxygen source from the tracheostomy tube if the patient is receiving oxygen.
  • Connect the resuscitator to the endotracheal tube or tracheostomy.
  • As the client inhales, compress the Ambu bag three to five times. It is better to have a second person do this so they can compress the bag with both hands and increase the amount of the inflation.
  • To determine whether each ventilation is adequate, watch the client's chest rise and fall.
  • The connector should be facing up and the resuscitation device should be removed and placed on the client's chest or the bed.

Variation

Providing Hyperventilation Using a Ventilator

Use the ventilator for both hyperventilation and hyperoxygenation if the patient is on one. The manual breath or sigh button, as well as a mode that supplies 1 0 0% oxygen for 2 minutes before returning to the previous oxygen setting, are features of more recent models.

Rationale

The use of ventilator settings delivers oxygenation and hyperinflation more reliably than a resuscitation device.

• Do not use a resuscitator to hyperventilate if the client has a lot of secretions. Instead:
  • Before sucking, increase the liter flow or set the Fi02 to 100% while leaving the regular oxygen delivery device on.

Rationale

Hyperventilating a client who has copious secretions can force the secretions deeper into the respiratory tract.

• Insert the catheter swiftly but softly without using any suction.
  • Insert the catheter swiftly but gently through the tracheostomy tube while keeping your dominant thumb off the suction port.

Rationale

To prevent tissue trauma and oxygen loss, suction is not applied during insertion of the catheter.

• Adults should only insert the catheter around 12.5 cm (5 in) into the patient; minors should only do so until they cough or you feel resistance. Justification: Resistance typically indicates that the catheter tip has reached the tracheal bifurcation. Before using suction, withdraw the catheter by 1 to 2 cm (0.4 to 0.8 in.) to avoid damaging the mucous membranes at the bifurcation.

Perform Suctioning.

• Placing the non-dominant thumb over the thumb port will apply suction for 5 to 10 seconds.

Rationale

Suction time isrestricted to 10 seconds or less to minimize oxygen loss.

• Roll the catheter slowly out of the way by rolling it between your thumb and forefinger.

Rationale

This prevents tissue trauma by minimizing the suction time against any part of the trachea.

• Completely remove the catheter, then let go of the suction.
• Make the customer breathe heavily.
• Reapply suction if necessary.

Reassess the client’s oxygenation status and repeat suctioning.

• Keep an eye on the client's breathing and skin tone. Using your nondominant hand, if necessary, check the client's pulse.
• Instruct the customer to take deep breaths and cough in between suctions.
• When possible, allow 2 to 3 minutes between suctions when using oxygen. Reason: This offers a chance for the lungs to reoxygenate.
• Once the airway is clear and breathing is largely effortless and quiet, flush the catheter and repeat suctioning.
• With your non-dominant hand, pick up the resuscitation bag after each suction, then ventilate the patient for no more than three breaths.

Dispose of equipment and ensure availability for the next suction.

• Clean the suction tubing and catheter.
• Disconnect the catheter from the suction tubing and turn off the suction.
• Peel the glove off and turn it inside out over the catheter after wrapping it around your sterile hand.
• Place the moisture-resistant bag containing the glove and catheter in the trash.
• Replenish the sterile fluid and supplies so that the suction is ready for use again.

Rationale

Clients who require suctioning often require it quickly, so it is essential to leave the equipment at the bedside ready for use.

• Make sure the oxygen and ventilator settings are set to their pre-suctioning positions.

Rationale

On some ventilators this is automatic, but always check. It is very dangerous for clients to be left on 100% oxygen.

Provide for Client Comfort and Safety.

• Help the client choose a safe, comfortable position that allows for easy breathing. A semi-position Fowler's is frequently indicated if the subject is awake. Sims' position helps the drainage of secretions from the mouth if the subject is unconscious.

Document Relevant Data.

• Record the suctioning, as well as the quantity, nature, and conclusions of any relevant evaluations.