Tracheostomy Tube Suctioning

& Tracheostomy Care

Presented by:
Helen Fitzpatrick, RN, ADN,
Sandra Zsikla, RN, BSN, WCC
& Elizabeth Gifford, LPN

Normal Respiration
Normal upper airway inspiration heats,
humidifies and cleans the air we breathe.
A tracheostomy tube bypasses this
mechanism. Therefore, the air is cooler,
drier and less cleaned.
Why Suction Secretions from
Airways?
Purpose:
1. Remove excess secretions to maintain
patent airway using sterile technique.
2. To improve oxygenation and improve the
work of breathing.
3. To prevent aspiration of food, blood and gastric
fluid.
4. To prevent infection and atelectasis.
5. Collect secretions for diagnostic testing.
When to Suction

prn
After chest PT/nebs/inexsuffilator/trach
changes
Before and after sleep



Assessment

Assess respiratory system:
Note rate, depth & rhythm of respirations.
Note noisy, wet, or gurgling respirations.
Note signs & symptoms of hypoxemia &
hypercapnea (restlessness, confusion, etc.)
Auscultate breath sounds.
Assess patients ability to cough:
Note amount & character of sputum (normal
secretions should be clear or white).



Assessment
Assess vital signs and signs & symptoms
of infection:
Compare to baseline vital signs.
Note any elevation in temperature.
Note signs & symptoms of infection.
Note change in sputum color or consistency.
Assess level of consciousness and ability
to protect airway:
Note presence of cough reflex.
Note any drainage from mouth.

Assessment

Assess ability to communicate:
Develop a communication system.
Provide clear explanations to the patient.

Assess accidental extubation:
Keep extra tracheostomy tube and obturator at
bedside.
Equipment
Portable or wall suction with tubing and reservoir.
Sterile suctioning kit containing:
Appropriate-sized suction catheter (14 Fr)
Pair of gloves
Container of saline to flush and lubricate
the suction catheter
Drape
Pulse oximeter
Ambu (10-15 liters)
Suction Catheters
Tracheostomy Tube
Suctioning Procedure

1.Wash hands to prevent transmission of
micro-organisms/cross contamination.
Don PPE (goggles or glasses and mask)
2. Explain procedure to patient to reduce
anxiety & encourage cooperation.
3. Position the patient (Fowlers unless
unresponsive: side lying position)

Tracheostomy Tube
Suctioning Procedure

4. Turn on suction (adults: 100-120mm Hg).
Secure connecting tube to suction source.
(Excessive negative pressure traumatizes
mucosa & can induce hypoxia.)
5. Open and prepare suction catheter kit.
6. Preoxygenate patient with 100% oxygen to
prevent hypoxemia. Hyperinflate with ambu to
decrease atelectasis r/t suctioning.
7. Don sterile gloves.


Tracheostomy Tube
Suctioning Procedure
8. Pick up catheter with dominant hand and the
connecting tube with non-dominant hand. Attach
catheter to tubing using sterile technique.
9. Place catheter end into saline. Test equipment
by applying thumb from non-dominant hand
over open port to create suction.
10. Insert catheter into tracheostomy tube (during
inspiration when epiglottis is open) without
applying suction, using sterile technique.
11. Advance catheter until you feel resistance.
Retract catheter 1cm before applying suction.
Tracheostomy Tube
Suctioning Procedure
12. Apply intermittent suction while withdrawing
the catheter. Limit suctioning time
to 10 seconds to prevent hypoxemia.
13. Hyperoxygenate and hyperinflate if needed.
14. Rinse catheter with saline to clear secretions.
15. Repeat Steps 10-14 until airway is clear.
Oropharynx suctioning:
16. Without applying suction, insert the catheter
gently along one side of mouth. Advance to
oropharynx. Suction oropharynx after trachea.


Tracheostomy Tube
Suctioning Procedure

17. Apply suction 5-10 seconds while rotating &
withdrawing catheter.
18. Allow 1-2 minutes between passes for the
patient to recover. Encourage deep breathing.
Replace oxygen if applicable.
19. Repeat Steps 16-18 as needed to clear oropharynx.
20. Rinse catheter and tubing by suctioning saline
through.
21. Remove glove by pulling it over the catheter in
other hand.

Tracheostomy Tube
Suctioning Procedure
22. Turn off suction device.
23. Assist patient to a comfortable position.
24. Dispose of disposable supplies.
25. Wash your hands!
26. Ensure sterile suction catheter kit is available at
patients bedside.
27. Ensure suctioning equipment is changed every 24
hours.
28. Document procedure and outcomes.

Tips
If possible, have patient lean forward &
cough out secretions from tracheostomy
If secretions are dry or thick, utilize
humidification
If appropriate, deflate the cuff to keep
secretions from pooling
If patient in respiratory distress, dont leave
him/her alone


Providing Tracheostomy Care
Purpose
Maintain airway patency
Promote cleanliness
Prevent infection
Prevent skin breakdown
Assessment
Assess for excess secretions
Soiled tracheostomy dressing and ties
Assess respiratory status
Identify type of tracheostomy tube
Assess clients ability for self-care
Identify factors that influence tracheostomy
care
Factors Influencing
Tracheostomy Care
Nutritional status
Respiratory infections
Fluid status
Humidity
Equipment

Two specimen cups
4X4s and tracheostomy dressing
hydrogen peroxide and saline
sterile gloves
Sterile cotton tipped applicators
Zinc/bacitracin as ordered
Tracheostomy suction supplies
Oxygenation humidification as needed

Procedure
Wash hands and don gloves
Explain procedure to patient
Place patient in Fowlers position
Suction the tracheostomy tube
Discard soiled tracheostomy dressing
Replace oxygen/humidity on the patient
Gather supplies
Procedure
Open peroxide/saline solution cups
Don gloves
Open cotton tipped applicators and
solutions
Open precut tracheostomy dressing
Remove oxygen/humidity source
Procedure
Clean dried secretions from outer cannula and
stoma
Using peroxide solution clean in one direction and
repeat as necessary.
Using saline solution, repeat same procedure.
Wipe away foaming secretions
Pat moist surface dry with gauze
Apply zinc/bacitracin as ordered
Place sterile tracheostomy dressing around stoma
Do not use cut 4X4 gauze
Assess that velcro ties are not too tight


Procedure
Remove gloves and discard equipment
Assist patient to comfortable position
Offer oral hygiene
Wash your hands
Document procedure and observations
Changing the Disposable Inner
Cannula
Supplies:
disposable inner cannula
two vinyl examination gloves
two sterile gloves
Procedure
gather supplies
explain procedure to patient
wash hands
open inner cannula package

Disposable Inner Cannula
Glove and remove old inner cannula
Discard gloves and cannula
Glove using sterile gloves
Insert new inner cannula into tube
Tips
These supplies are required to be in the
patients room:
An exact spare tracheostomy
Tracheostomy care supplies
Ambu bag
Suction kits
Requires a priority light (call system)

The End