TEACHING SHEET ON: SUCTIONING THE NOSE AMD MOUTH

The patient needs help to keep the mouth and nose clear of mucus.
Suctioning equipment, a humidifier, and other supplies will be
needed. While the patient is in the hospital, you should use the
same suction machine that you will be using at home. This allows
you a chance to become familiar with the equipment. You will also
need a mucus trap or nasal aspirator that can be used to remove
mucus when you and the patient are away from home. Practice with
these items while the patient is in the hospital.


Certain guidelines are helpful for the patient who has problems
clearing mucus from the back of the nose and mouth (pharynx) . To
keep the mucus liquid so that it is easy to remove by both
suctioning and coughing, added moisture is needed. Encourage the
patient to drink at least 1 quart (four 8-ounce cups) of liquid a day
and place a cool mist humidifier in the room where the patient
sleeps. Change the water in the humidifier each day and clean the
humidifier regularly, according to the manufacturer's instructions.

All of the people who provide care for the patient must know how to
suction the patient so that they can assist you. Tape the emergency
phone numbers, such as 911 (if available in your area), the local
hospital, your health professional, and any numbers that are
necessary, to each telephone in the house. Notify your health
professional if any of the following occur:

  • -Temperature above 102
  • -Presence of yellow or green mucus
  • -Change in the smell of the mucus
  • -Increased amount of mucus
  • -If the patient is very irritable
  • -If the patient is having difficulty breathing call 911

SUCTIONING:
Suctioning keeps the airway (nose and mouth) (Fig. I) clear of
mucus to help the patient breathe more easily. Suctioning is not
done routinely, but only when needed. Suction when the following
occur:
  • -The patient is having trouble breathing
  • -The patient appears very restless
  • -The patient has difficulty eating or sucking
  • -The patient's color becomes paler
  • -The patient's nostrils flare (spread out)
  • -You will hear the sound of air bubbling through the mucus.


When the patient has a cold, more mucus is produced, so you mill probably need to suction more often. The patient may cough or gag when you insert or remove the suction catheter Gently tell the patient when you are almost finished. , If the patient is old enough, teach him how to help you by holding the supplies.



Equipment:

  • Suction machine with tubing
  • Suction catheters
  • Sterile water
  • Clean container for rinsing catheter
  • Gloves


Instructions:


1.   Gather all the equipment you will need.
2.   Wash your hands with soap and water.  Count to 10 while
washing, then rinse with clear water and dry with a clean
paper or cloth towel. Wear gloves.
3.   Open the suction catheter package and connect the catheter
to the suction machine.
4.   Make sure the suction machine is plugged in and working.
5.   Measure the tube for the distance you will have to insert
it.  Place the tip of the catheter at the patient's ear lobe
and mark the distance to the tip of the patient1 s nose. Hold
the catheter at this mark
6.   Place the tip of the catheter in the sterile saline
and place your thumb over the opening to obtain suction.
The saline wets the catheter (Fig. 3).
7.   Tell the patient to take a deep breath.
8.   With your thumb off the opening (no suction), insert
the suction catheter in one nostril up to the measured
distance (Fig. 4,A).
9.    Place your thumb on the suction port to obtain
suction.
10.  Rotate or twist the catheter as you remove it with a
slow steady motion (Fig. 4B), Both inserting the catheter
and suctioning should take no longer than 4 seconds.
Remember, the patient may not breathe while you are
suctioning. Try holding your breath whenever your thumb is
on the suction port.  This will be a reminder to you for
timing.
11.  Look at the mucus. Check the color, smell, and
consistency for any change.
12.  Rinse the suction catheter in the sterile saline with
your thumb on the suction port.
13.  Allow the patient to take a few deep breaths.
14.  Repeat steps 7 through 14 up to 2 times if needed (for
large amounts of mucus), then repeat for the other nostril.
15.  After suctioning the nose, you can use the same
catheter to clear the patient's mouth.
16.  Place the tip of the catheter in the saline and place
your thumb over the opening to obtain suction.
17.  Tell the patient to take a deep breath.
18.  With your thumb off the opening (no suction), insert
the suction catheter in the patient's mouth along one side of
the mouth until it reaches the back of the throat.
19.  Place your thumb on the suction port to obtain
suction.
20.  Rotate or twist the catheter as you 'remove it with a
slow steady motion.  Both inserting the catheter and
suctioning should take no longer than 5 seconds. Remember,
the patient may not breathe while you are suctioning. Try
holding your breath whenever your thumb is on the suction
port. This will be a reminder to you for timing.
21.  Look at the mucus. Check the color, smell and
consistency for any change.
22.  Rinse the suction catheter in the saline with your
thumb on the suction port.
23.  Allow the patient a chance to take a few deep breaths.
24.  Repeat steps 17 through 2 3 up to three times.
25.  Hold and comfort the patient.
26. After each use, throw away the saline and clean the container. The suction machine should be clean and ready for the next
tine that you will have to use it.
27. Your health professional will Instruct you on the care of
the suction catheters or use the method described below.
28. Wash your hands with soap and water.  Count to 20 while
washing your hands, then rinse with clear water and dry
with a clean paper or cloth towel.




INSTRUCTIONS FOR CLEANING THE SUCTION CATHETERS


1.   Rinse the suction catheters in cool tap water. Do not use
hot water because it "cooks" the mucus, which makes it more
difficult to remove.
2.   Place the catheters in a clean jar filled with hot, soapy
water.
3.   Rinse both the inside and outside of the tube under hot
running water. Hold the tube with kitchen tongs so that
you don't burn yourself.
4.   Shake off the excess water.
5.   Place on a clean paper towel to dry. When tube is completely
dry, place it in a clean plastic bag.
6.   Close the bag and store until the next time you suction the
patient.
7.   If you notice any moisture in the bag, repeat the entire cleaning procedure.

 

 

 

TEACHING SHEET ON; CARING FOR THE. PATIENT WITH A TRACHEOSTOMY

A small opening (stoma) was made on the patients windpipe (or
trachea) (Fig. 1) to help her breathe easier.  The. tracheostomy
("trachea")  will require special care while you are at home.
Suctioning equipment, a humidifier, and other supplies will be
needed.  While the patient is in the hospital, you should use the
same suction machine (and monitor) that you will be using at home.
This helps you to become familiar with the equipment.


Supplies that you will need when you are outside the house are the
following: portable suction machine, sterile water, water-soluble
lubricant, trach tube with ties attached, ambu, scissors, and
emergency phone numbers. These items should be kept in a "to-go
bag" that Is ready at all times. Practice with these items while
the chiId is in the hospital.

SPECIAL CONSIDERATIONS

Certain precautions are needed for the patient with a trach. Since
the air that the patient breathes no longer passes through the nose
and mouth, it is no longer warmed, moistened, and filtered before
it enters the lungs.
Humidifying/filtering devices can be bought.. To keep food and
liquids from falling into the trach, use a cloth bib with short
ties when the patient is eating.

Communication

The trach makes it harder for the patient to make her needs known.
Nursery monitors or intercoms can be used to listen for changes in
the patient's breathing. This may signal that the patient needs you.
Older patientren can use bells to call you or "talking" boards, where
they can point to different words. Some patientren are able to talk
by placing their finger over the trach for short periods of time.

Skin care

The moist secretions from the trach can irritate the skin. It is
important to keep the area around the tracheostomy clean and dry to
prevent skin irritation and infection. Wash the skin with soap and
water and dry well.  Change the trach ties each day or if they become wet or dirty. 
Do not apply any ointments or other medications on the skin 
unless you are told to do so by your health
professional

Safety

Careful adult supervision is needed when the patient is near water.
Tub baths can be given, but be careful not to allow water into the
trach. Swimming and boating must be avoided. However, the patient
can use a wading pool with supervision.

Any smoke, aerosol sprays, powder, or dust can irritate the lining
of the patient's trachea. Therefore the patient should not be in the
same room with anyone who is smoking or where aerosol sprays such
as hair spray and antiperspirants are being used. Strong cleaning
liquids such as ammonia are also irritating. Hair from furry
animals that shed can clog the patient's trachea. Avoid stuffed
tale end toys with small parts that can be removed end put into
the) trach by a curious patient.

All of the people who provide care for the patient must be aware of
hoar to suction the trach so that they can help you. Anyone caring
for the patient alone must also know cardiopulmonary resuscitation
(CPR), Tape the emergency phone numbers to each telephone in the
house. Include (if available in your area), the local
hospital, your health professional, and any others that are needed.

Call your health professional if any of the following occur:

  • -Temperature above 100.4F
  • -Yellow or green mucus from trach or stoma
  • -Bright red blood from the trach
  • -Change in the smell of the mucus
  • -Increased amount of mucus
  • -The patient is very irritable
  • -The patient is having trouble breathing

SUCTIONING

You will need to suction the patient's trach to keep the airway clear
of mucus. Suctioning helps the patient to breathe more easily.
Suctioning should be done when the patient wakes up and before sleep.
Suction the patient when any of the following occur:
  • -She. is having trouble breathing
  • -She appears very restless
  • -She has trouble eating or sucking
  • -Her color becomes paler
  • -Her nostrils flare (spread out)
You hear the sound of air bubbling through mucus or stridor (whistling)
When the patient has a cold, more mucus is produced so you will need
to suction more often, but only when needed. Suctioning too often
can cause the body to make more mucus.

Equipment

  • Ambu
  • Suction machine with tubing
  • Cardiorespiratory monitor (if ordered)
  • Suction catheters
  • Sterile saline (cool) (available in individual containers or clean
  • syringe or dropper)
  • Clean plastic container for rinsing catheter
  • Sterile gloves

Instructions

1.   Gather all equipment you will need.
2.   Wash your hands with soap and water.  Count to 10 while
washing, then rinse with clear water and dry with clean
paper or cloth towel.
3.   Make sure the suction machine is plugged in and working.
Check that the suction pressure is not above 100 mm Hg
for infants or 120 mm Hg for older patientren.
4.   Put on sterile gloves.
5.   Open the suction catheter package and connect the catheter
to the suction machine using sterile technique.
6.   If the-mucus is thick, place normal saline in the trach.
Use up. to 0.5 cc for infants, 1 -2 cc for toddlers, and 2 - 3 cc. for older patientren.
7.   Before suctioning, you must measure the right distance to
insert the tube. Holding the extra trach in one hand,
place the suction catheter next to the trach tube.  Slowly
push the catheter until it is 1/4 inch longer than the
trach tube.  Hold this spot with your fingers.  Now measure
the distance from the tip of the catheter to the spot you are
holding. Write it down     This is how far you should place
the catheter each time you suction.
8.   Place the tip of the catheter in the sterile saline and
place your thumb over the opening to get suction. The
sterile water lubricates the catheter





9. With your thumb off the opening (no suction), insert the
suction catheter to a distance 1/4 inch longer than the
tube (about 2 to 3 inches in an infant and small patient)


10. Place your thumb on the suction port to obtain suction.
Rotate or twist the catheter as you remove it with a slow
steady motion (Fig  4). Both inserting the catheter and
suctioning should take no longer than 3 or 4  seconds.
Remember,  the patient cannot breathe during suctioning. As a
reminder, count 1-one thousand, 2-one thousand, and so on.
Look as the secretions. Check the color, smell, and thickness
for any change.


11. Anbu a few breaths.
12. Rinse the suction catheter in the sterile saline with your
thumb on the suction port.
13. Repeat steps 6 though 12 up to three tines.
14. Hold and comfort the" patient.
15. Praise the patient for helping.
16. After each use, discard the saline and clean the container.
clean the suction machine to have it ready for the next tine.
17. Use the following instructions, or your health professional
will discuss the care of the suction catheters.
18. Wash your hands with soap and water. Count to 10 while washing
then rinse with clear water and dry with a clean paper or
cloth towel.


CHANGING THE TRACHEOSTOMY TUBE

The tracheostomy tube is changed routinely to allow for a thorough
cleaning of the tube. The change should be done 2 to 3 hours after
meals to avoid any chance of the patient vomiting. When you change
the tube, check the skin around the trach for any redness,
swelling, cuts, or bruises.
Change the trach tube in a' quiet place where' you will- not be
disturbed. If the patient is active, you will need someone to hold
the patient.

Equipment

  • Clean trach tube with trach ties attached if needed
  • Suction machine with catheters
  • Sterile saline in clean container
  • Pipe cleaners
  • Hot soapy water


Instructions  for changing the tube


1. Gather all the equipment you will need.
2. Wash your hands with soap and water.  Count to 10 while
washing, then rinse with clear water and dry with a clean
paper or cloth towel.
3. Place the patient lying on his/her back and place a towel roll
under the shoulders.
4. If the patient is unable to help, have your helper hold the
patient's arms while the tube is being changes.
5. Suction the trach until it is clear (see instructions for
suctioning) and ambu a few breaths.
6. Untie or carefully cut the old trach tiee. Use scissors
with a rounded tip.
7. Remove the trach tube (Fig. 6).
8. Quickly check the skin.
9. Quickly dip the clean trach tube in the sterile saline or
water soluble lubricant.
10. Insert the clean tracheostomy tube (with or without on
obturator) into the opening (stoaa),
11. Remove the obturator if used.
12 Secure the tracheostomy ties, either at the side or back of
the neck.  Change the position of the knot each time the
tube or ties are changed.  Make sure that the ties ere enuq
enough to let you put only one finger under them (Fig. 7) .
13. If you are unable to put the new tube in, attempt to inaert
e smaller size tube and call 911.
14. Hold an comfort the patient.
15. Wash your hands with soap and water. Count to 20 while
washing, then rinse with clear water and dry with a clean
paper or cloth towel, The patient may cough or gag during
the insertion or removal Of the tracheostomy tube.  Gently
tell the patient when you are almost finished.  If the patient
is old enough, teach her how to help you by handing you
supplies.

MECHANICAL INHALATION AND EXHALATION (MIE) PROCEDURE

Cough- assist ( MIE) mechanical inhale and exhale helps ALS weakened muscles due to degeneration of motor neurons to remove secretions and clear lungs.

* Place tubing on machine and check settings.

* Inhale time - 2;     Exhale - 1.5;         Pause - 2

* Check pressures on machine

A.  Occlude open end

B.   Turn machine on

C.    Check pressures and adjust as needed

*  Inhale -  30;         Exhale  +  40

*   Place on patient's trach and turn on machine

*   Perform 5 cycles 30/40 and stop

*   Allow recovery time ( ask patient if ready);   Repeat times 5

*   Assess for clear lungs. Continue if not clear

*   For secretion clearance: no more than 5 cycles at a time until clear

To deflate cuff ( trach balloon) and capture secretions above the trach

*   Change settings of MIE to: Inhale -  5;  Exhale -  0;  Pause -  5

*   Use 10 ml syringe to deflate cuff, after 2 seconds, inflate the cuff and turn of the machine, remove tubing off patient and suction trach and mouth.

*  Use PMV ( Posse Muir Valve ) as speaking valve after deflating the cuff.