Patient Care Procedures

Suctioning

Suctioning a patient should never be considered routine. Your decision to suction your patient should be based upon several observations: increasing airway pressures, increasing patient apprehension, or rhonchi heard by auscultation. Both sides of the chest should be routinely auscultated with a stethoscope. To suction a patient just because an hour has passed is insufficient reason, but to wait until there are secretions evident in the bronchial tree may not be appropriate.

When you have gathered all of the equipment, take time to reassure and explain the procedure to your patient. Remember, with the tracheostomized patient, communication is quite difficult. Give the patient pencil and paper, or word your questions so that the patient can indicate "Yes" or "No" by nodding his/her head or blinking his/her eyes.

Always remember to preoxygenate your patient before the suction procedure. Constantly observe clinical signs that may indicate hypoxia.

Supplies:

1. Portable suction pump or tracheal wall suction

2. Disposable suction catheter kits of appropriate size or single disposable suction catheters

3. Gloves

4. Basin

5. Small jar of sterile normal saline.

NOTE: All necessary equipment, gloves, catheter, basin, and sterile saline are available from SIMS Portex Inc. in several kit forms.

Procedure:

1. Gather your supplies and equipment.

2. Explain the procedure to your patient.

3. Wash your hands with surgical soap.

4. Prepare equipment, open kit or catheter pack, saline, etc.

5. Put on sterile gloves.

NOTE: Sterile technique is to be followed throughout procedure.

6. Remove sterile suction catheter from package.

7. Lubricate tip of catheter by dipping tip in sterile saline or by rolling in sterile water-soluble lubricant.

8. Be sure patient is preoxygenated.

9. Open suction port on swivel. If the patient is not on mechanical ventilation, disconnect from the supplemental oxygen source and humidifier.

10. If the patient is cooperative, ask him/her to take a deep breath and quickly but gently insert the catheter into the trachea. If resistance is felt, withdraw the catheter slightly. The catheter control valve is left open or not depressed during insertion so that no suction is applied during insertion.

11. Apply intermittent suction. Rotate the catheter between your thumb and forefinger during withdrawal.

NOTE: The suction procedure should not take any longer than 15 seconds from insertion to completion of withdrawal.

12. As soon as the catheter is withdrawn, reconnect to
the ventilator, or oxygen supply source. Reoxygenate the patient.

13. Clear the catheter with saline.

14. Repeat procedure if necessary until airway is clear of secretions.

NOTE: The patient's chest should be auscultated frequently to determine if suctioning of the airways is required. Suctioning should never be considered a routine procedure and should be employed only on an as-needed basis.

At the completion of tracheal suctioning, the oral pharynx and laryngopharynx may be suctioned to remove secretions that are present.

15. Clear secretions from catheter and suction tubing and
discard catheter, gloves, and saline.

Record and Report:

1. Quantity, color, and consistency of secretions

2. Number of times the patient required suctioning per shift

3. Patient's tolerance

4. Condition of skin around the tracheostomy site

5. Any complications associated with the suctioning procedure

6. The volume of air required to obtain a cuff seal.
NOTE: Make sure that the cuff is not overinflated.

Changing Tracheostomy Dressings

It is very important to change tracheostomy dressings as soon as they become soiled.

While changing the tracheostomy ties or holders, one clinician holds the tube in place while the other removes the old ties or holders and replaces them with new. NEVER tie tracheostomy ties with a bow. Ties should always be tied with a square knot.

Supplies:

1. Tracheostomy dressings

 

NOTE: Plain sterile gauze pads should not be used to create tracheostomy dressings, as fibers that become loose may be aspirated into the airway.

2. Clean tracheostomy ties or a Velcro® tracheostomy tube holder

3. 1/2-strength hydrogen peroxide

4. Dry sterile pad or towel.

Procedure:

1. Remove old dressing, being careful to keep tracheostomy tube in place.

2. Clean around tube at stoma site with hydrogen peroxide solution.

3. Place clean tracheostomy dressing under the flange, inserted from below.

4. Change tracheostomy ties as necessary.

5. Change dressing as necessary.

Skin Care

The care of the skin around the stoma site should be considered one of the more important procedures in the care of the tracheostomy patient. The new surgical site needs to be cleaned and dressed frequently as it heals. As the incision heals, the frequency will decrease.

Supplies:

1. Cotton-tipped swabs

2. Normal saline or 1/2-strength hydrogen peroxide.

Procedure:

1. Gather all necessary supplies.

2. Wash your hands with surgical soap and water.

3. Inspect the site around the tracheostomy stoma for signs of skin breakdown, infection, or irritation.

4. Moisten the swabs in either the peroxide solution or with normal saline.

5. With a rolling motion, clean the skin area around the stoma and under the flange of the tube.

6. Pat dry with a clean dry swab or pad.

7. Replace tracheostomy dressing.