Tracheostomy Care: Suctioning

Critical Elements

• Emergency airway management should tube become dislodged.
• Assessment of patient’s need for treatment.
• Assessment of response to treatment.
• Protects patient privacy.
• Utilizes patient identifiers and safety practices.
• Universal precautions.
• Sterile technique.

Procedure

Prior to Treatment: (Critical Thinking)

• Assess patients need for treatment by monitoring lung sounds and saturation levels.
• Confirm order.
• Administer pain medication if needed.
• Gather equipment: sterile suction kit, sterile saline, clean gloves, sterile gloves, goggle, gowns and mask, bag-valve mask, oxygen, functioning suction.
• Ensure emergency equipment is at bedside: bag-valve mask, oxygen, obturator from current trach, spare trash of the same side and one smaller, working suction.

Patient Interaction: (Safety)

• Patient identifiers.
• Provide for privacy.
• Wash hands.
• Explain procedure. Agree on a method of communication is the patient has any difficulty breathing/pain.
• Educate patient about reporting of discomfort.

Steps of the Procedure (Patient Centered Care, Safety)

1. Assess respiratory rate, depth, O2 saturation and lung sounds.
2. Assist patient to a semi-fowler’s position and place towel or pad across chest.
3. Bring over-bed table close.  Put trash receptacle at bedside.
4. Turn on suction to appropriate pressure.
   1. Wall unit: Adult – 100-120 mm Hg.
   2. Portable unit: Adult – 10-15 mm Hg.
5. Apply protective equipment.
6. Open sterile kit or set up equipment and prepare to suction.
   1. Place sterile drape, if available, across patient’s chest.
   2. Open sterile container and place on bedside table or overbed table without contaminating inner surface.  Pour sterile saline into it.
   3. Hyperoxygenate patient using bag-valve mask or sign option on ventilator.
   4. Apply sterile gloves or one sterile glove on dominant hand and clean glove on nondominant hand.
   5. Connect sterile suction catheter to suction tubing held with unsterile gloved hand.
7. Holding catheter with sterile dominant hand, moisten by dipping into container of sterile saline.  Check suction on catheter by occluding the suction catheter y-port. 
8. Remove oxygen delivery setup with unsterile gloved hand if it is still in place.
9. Using sterile gloved hand, gently and quickly insert catheter into the trachea.  Advance about 10 to 12 cm (4-5 inches) or until patient coughs.  Do not occlude y-port when inserting catheter.
10. Applying intermittent suction by occluding y-port with thumb of unsterile gloved hand.  Gently rotate catheter with thumb and index finger of sterile gloved hand as catheter is being withdrawn.  Do not allow suctioning to continue for more than 10 seconds.  Hyperventilate three to five times between suctions or encourage patient to cough and breathe deeply between suctions. 
11. Flush catheter with saline and repeat suctioning as needed and according to patient’s tolerance of the procedure.  Allow patient to rest at least 1 minute between suctioning’s and replace oxygen delivery setup if necessary.  Limit suctioning events to three times.
12. When procedure completed, turn off suction and disconnect catheter from suction tubing.  Remove gloves inside out and dispose of gloves, catheter and container with solution in proper receptacle.  Perform hand hygiene.
13. Reapply patient’s oxygen supply, auscultate check and evaluate breath sounds and pulse ox readings.

After Procedure (Patient Centered Care, Infection Control)

• Remove protective equipment.
• Straighten room making patient comfortable, replace call light.
• Wash hands before leaving room.

Documentation (Informatics, Communication)

• Patient’s response to procedure including drainage amount and color, respiration before and after suctioning.

Resources

• Suctioning
• American Speech, Language and Hearing Association
• National Heart, Lung and Blood Institute