8/3/2019 Suctioning a Tracheostomy
1/20
Suctioning a Tracheostomy
8/3/2019 Suctioning a Tracheostomy
2/20
Care Techniques
Sterile Technique: sterile catheters and sterile
gloves ModifiedSterile Technique: sterile catheters
and clean gloves
Clean Technique: clean catheter and cleanhands
8/3/2019 Suctioning a Tracheostomy
3/20
8/3/2019 Suctioning a Tracheostomy
4/20
Suction Depths
ShallowSuctioning: Suction secretions at the openingof the trach tube that the child has coughed up.
P
re-measured
Suctio
ning:Su
ction the length of thetrach tube. Suction depth varies depending on the sizeof the trach tube. The obturator can be used as ameasuring guide.
Deep Suctioning: Insert the catheter until resistance is
felt. (Deep su
ctioning isu
su
ally not necessary. Becareful to avoid vigorous suctioning, as this may injurethe lining of the airway).
8/3/2019 Suctioning a Tracheostomy
5/20
Indication
Signs That a patient Needs Suctioning
Rattling mucus sounds from the trach
Fast breathing
Bubbles of mucus in trach opening
Dry raspy breathing or a whistling noise from trach
Older children may vocalize or signal a need to besuctioned.
Signs of respiratory distress under tracheostomycomplcations
8/3/2019 Suctioning a Tracheostomy
6/20
Equipment
Suction machine
Suction connecting tubing
Suction catheters
Normal saline Sterile or clean cup
3cc saline ampules (bullets)
Ambu bag
Tissues
Gloves (optional for home care, use powder-freegloves)
8/3/2019 Suctioning a Tracheostomy
7/20
Procedure
Explain procedure in a way appropriate for patients age andunderstanding.
Wash hands.
Set up equipment and connect suction catheter to machine tubing.
Pour normal saline into cup.
Put on gloves (optional).
Turn on suction machine (suction machine pressure for small children 50-100mm Hg, for older children/adults 100-120mm Hg)
Place tip of catheter into saline cup to moisten and test to see that suctionis working.
Instill sterile normal saline with plastic squeeze ampule into the trach tubeif needed for thick or dry secretions. Excessive use of saline is notrecommended. Use saline only if the mucus is very thick, hard to cough upor difficult to suction. Saline may also be instilled via a syringe or eyedropper, which is less expensive than single dose units. Recommendedamount per instillation is approximately 1cc.
8/3/2019 Suctioning a Tracheostomy
8/20
Gently insert catheter into the trach tube without applyingsuction. (Suction only length of trach tube - premeasuredsuctioning. Deeper insertion may be needed if the child hasan ineffective cough.)
Put thumb over opening in catheter to create suction anduse a circular motion (twirl catheter between thumb andindex finger) while withdrawing the catheter so that themucus is removed well from all areas. Avoid suctioninglonger than 10 seconds because of oxygen loss. Note: Someresearch has shown that by applying suction both going inand then out of the tube takes less time and thereforeresults there is less hypoxia. Also, there are now holes onall sides of the suction catheters, so twirling is notnecessary.
8/3/2019 Suctioning a Tracheostomy
9/20
Draw saline from cup through catheter to clear catheter.
For trach tubes with cuffs, it may be necessary to deflatethe cuff periodically for suctioning to prevent pooling ofsecretions above trach cuff.
Let patient rest and breathe, then repeat suction if neededuntil clear (allow at least 30 seconds between suctioning).
Oxygenate as ordered (extra oxygen may be given beforeand after suction to prevent hypoxia).
Some patients need extra breaths with an Ambu bag
(approximately 3 - 5 breaths). Purposes ofbagging:hyperoxygenation, hyperinflation, and hyperventilation ofthe lungs. However, this is usually not needed for stablepatients with no additional respiratory problems.
8/3/2019 Suctioning a Tracheostomy
10/20
The patients mouth or nose may also be suctioned, ifneeded after suctioning the trach, then dispose of thatcatheter (do not put same catheter back into trach).
Dispose of suction catheter, saline and gloves, turn off
machine. In home care, catheters may sometimes be usedmore than once before disposal or cleaning if child needfrequent suctioning. Keep tip of catheter sterile, and storeinto original package.
A bulb syringe may be used between suctioning if the
patient is ab
le to cou
ghu
p some secretions on his/her own. Be aware of color, odor, amount and consistency of the
secretions and notify doctor of changes in secretions.
8/3/2019 Suctioning a Tracheostomy
11/20
8/3/2019 Suctioning a Tracheostomy
12/20
Suctioning equipment
8/3/2019 Suctioning a Tracheostomy
13/20
Suctioning equipment
8/3/2019 Suctioning a Tracheostomy
14/20
Technique
8/3/2019 Suctioning a Tracheostomy
15/20
Set suction pressure
8/3/2019 Suctioning a Tracheostomy
16/20
Sequence of process
8/3/2019 Suctioning a Tracheostomy
17/20
8/3/2019 Suctioning a Tracheostomy
18/20
8/3/2019 Suctioning a Tracheostomy
19/20
Ending process
8/3/2019 Suctioning a Tracheostomy
20/20