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Tracheostomy Tube Suctioning & Tracheostomy Care

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Tracheostomy Tube Suctioning & Tracheostomy Care Presented by: Helen Fitzpatrick, RN, ADN, Sandra Zsikla, RN, BSN, WCC & Elizabeth Gifford, LPN Normal Respiration ... – PowerPoint PPT presentation

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Title: Tracheostomy Tube Suctioning & Tracheostomy Care


1
Tracheostomy Tube Suctioning
Tracheostomy Care
  • Presented by
  • Helen Fitzpatrick, RN, ADN,
  • Sandra Zsikla, RN, BSN, WCC
  • Elizabeth Gifford, LPN

2
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.

3
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.

4
When to Suction
  • prn
  • After chest PT/nebs/inexsuffilator/trach changes
  • Before and after sleep

5
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).

6
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.

7
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.

8
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)

9
Suction Catheters
10
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)

11
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.

12
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.

13
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.

14
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.

15
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.

16
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

17
Providing Tracheostomy Care
18
Purpose
  • Maintain airway patency
  • Promote cleanliness
  • Prevent infection
  • Prevent skin breakdown

19
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

20
Factors Influencing Tracheostomy Care
  • Nutritional status
  • Respiratory infections
  • Fluid status
  • Humidity

21
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

22
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

23
Procedure
  • Open peroxide/saline solution cups
  • Don gloves
  • Open cotton tipped applicators and solutions
  • Open precut tracheostomy dressing
  • Remove oxygen/humidity source

24
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

25
Procedure
  • Remove gloves and discard equipment
  • Assist patient to comfortable position
  • Offer oral hygiene
  • Wash your hands
  • Document procedure and observations

26
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

27
Disposable Inner Cannula
  • Glove and remove old inner cannula
  • Discard gloves and cannula
  • Glove using sterile gloves
  • Insert new inner cannula into tube

28
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)

29
  • The End
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