SUCTIONING THE TRACHEOSTOMY

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1. Explain the procedure to the patient and reassure him or her that you will interrupt the procedure if the patient indicates respiratory difficulty. Administer pain medication to postoperative patient before suctioning.
2. Gather equipment and provide privacy for patient.
3. Perform hand hygiene.
4. Assist the patient to a semi-Fowler’s or Fowler’s position if conscious. An unconscious patient should be placed in the lateral position facing you.
5. Turn suction to appropriate pressure.

1. Wall unit

• Adult: 100 to 120 cm Hg
• Child: 95 to 110 cm Hg
• Infant: 50 to 95 cm Hg

2. Portable unit

• Adult: 10 to 15 cm Hg
• Child: 5 to 10 cm Hg
• Infant: 2 to 5 cm Hg

6. Place clean towel, if being used, across patient’s chest. Don goggles, mask, and gown, if necessary.
7. Open sterile kit or set up equipment and prepare to suction.

1. Place sterile drape, if available, across patient’s chest.
2. Open sterile container and place on bedside table or overbed table without contaminating inner surface. Pour sterile saline into it.
3. Hyperoxygenate patient using manual resuscitation bag or sigh mechanism on mechanical ventilator.
4. Don sterile gloves or one sterile glove on dominant hand and clean glove on nondominant hand.
5. Connect sterile suction catheter to suction tubing held with unsterile gloved hand.

8. Moisten catheter by dipping it into the container of sterile saline, unless it is one of the newer silicone catheters that does not require lubrication.
9. Remove oxygen delivery setup with unsterile gloved hand if it is still in place.
10. Using sterile gloved hand, gently and quickly insert catheter into the trachea. Advance about 10 to 12.5 cm (4-5 inches) or until patient coughs. Do not occlude Y-port when inserting catheter.
11. Apply intermittent suction by occluding Y-port with thumb and index finger of sterile gloved hand as catheter is being withdraw. Do not allow suctioning to continue for more than 10 seconds. Hyperventilate three to five times between suctioning or encourage patient to cough and deep breathe between suctioning.
12. Flush catheter with saline and repeat suctioning as needed and according to patient’s tolerance of the procedure. Allow patient to rest at least 1 minute between suctioning, and replace oxygen delivery setup if necessary. Limit suctioning events to three times.
13. When procedure is completed, turn off suction and disconnect catheter from suction tubing. Remove gloves inside out and dispose of gloves, catheter, and container with solution in proper receptacle. Perform hand hygiene.
14. Adjust patient’s position. Auscultate chest to evaluate breath sounds.
15. Record time of suctioning and nature and amount of secretions. Also note character of patient’s respirations before and after suctioning.
16. Offer oral hygiene.

image courtesy of http://www.med.umich.edu

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• SUCTIONING NASOPHARYNGEAL AND OROPHARYNGEAL AREAS Determine need for suctioning. Administer pain medication before suctioning to postoperative patient. Explain procedure to patient. Assemble equipment. Perform hand hygiene. Adjust bed to comfortable working position. Lower side
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