03.03 Trach Suctioning

Overview

1. Purpose
   1. To clear secretions from existing tracheostomy tube
   2. Should be performed before tracheostomy care so that any secretions that may be released can be cleaned with trach care
   3. The respiratory tract is sterile, therefore this procedure should be performed with sterile technique

Nursing Points

General

1. Supplies needed
   1. Suction catheter kit
      1. Catheter
         1. Size of trach x 2 – 2
         2. i.e. size 6 trach → 10fr catheter
      2. Sterile gloves
      3. Disposable water container
   2. Small bottle of sterile water
   3. Suction setup
      1. Suction regulator
      2. Suction canister
      3. Suction tubing
2. Position yourself on the side of the patient that corresponds to your dominant hand
   1. i.e. if you are right handed, work from the patient’s right
3. Goggles or a face shield are highly recommended

Assessment

1. Assess need for suctioning
   1. Auscultate lung sounds
   2. Assess SpO2

Nursing Concepts

1. Steps and nursing considerations
   1. Gather supplies
   2. Explain procedure to patient
   3. Perform hand hygiene
   4. Set up suction setup
      1. Attach tubing to canister to regulator
      2. Place the end of the suction tubing within reach, usually over the head of bed or across the patient’s chest
      3. Regulator should be on continuous medium suction
   5. Hyperoxygenate patient if appropriate
   6. Raise bed to comfortable working height and bring bedside table close to bed
      1. Recommend 45 degrees HOB to promote effective airway clearance
   7. Open bottle of sterile water and set on the table between sterile field and patient
   8. Open the sterile suction catheter kit
   9. Carefully grasp sterile gloves by the inner cuffs and apply to dominant hand first using sterile technique. Then apply to non-dominant hand.
      1. Your dominant hand should stay sterile throughout the entire procedure
   10. Open the disposable water container and set it plastic side up on the sterile field
   11. Pick up the catheter
       1. Place the tip of the catheter facing down in the palm of your dominant hand
       2. Wrap the catheter around your dominant hand until you can grasp the plastic suction control port
   12. With your non-dominant hand, pour sterile saline into the container
       1. *NOTE: this hand is now NONsterile
   13. With your non-dominant hand grab the suction tubing and connect it to the plastic suction control port on the catheter (keep your dominant hand sterile!)
   14. Carefully remove any oxygen mask from in front of the trach with your nondominant hand
   15. Suction the patient
       1. Control the suction using the control port with your nondominant hand
       2. Insert the suction catheter with your nondominant hand, being careful not to let the suction catheter touch anywhere other than the inside of the trach.
       3. Insert 4-6 inches or until the patient coughs
          1. Insert WITHOUT suctioning
          2. If the patient coughs, remove 1 cm before initiating suction
       4. Apply intermittent suction with the thumb of your non-dominant hand and gently rotate the catheter as you remove it
   16. Once the catheter is out, use your non-dominant hand to replace the oxygen mask while you determine if the patient needs a second pass with the catheter
   17. If secretions are thick, quickly dip the catheter into the sterile saline and suction water through the catheter to clear it out
   18. You may perform up to 3 passes with one catheter, no more than 10 seconds per pass
       1. Remember, you’re blocking their airway!
   19. If at any point the catheter becomes unsterile, reapply the patient’s oxygen and start over with a new catheter if suction is still required
   20. When complete:
       1. Ensure patient’s oxygen mask is in place if appropriate
       2. Reassess patient’s lungs and SpO2 to determine effectiveness of suction
       3. Discard all supplies in the appropriate waste container
       4. Remove gloves
       5. Perform Hand Hygiene
   21. Return bed to low/locked position
   22. Ensure patient is comfortable
   23. Document procedure and patient response/tolerance
2. Can now move on to trach care if needed

Patient Education

1. Purpose for suctioning
2. Keep hands down to avoid touching sterile field/catheter
3. Patient can cough during suctioning to improve the effectiveness