Explain procedure to client. Apply eye protection. Test suction apparatus.
Open suction kit. Don gloves.
Pour saline into container.
Attach catheter to suction tubing.
Wrap catheter in hand to maintain its sterility while you turn on suction equipment.
Lubricate tip of the catheter with saline.
Have assistant instill 5 cc sterile normal saline into trach on inspiration.
Have assistant hyperoxygenate lungs with 100% oxygen via self inflating breathing (Ambu) bag (2-3 times as client inhales) prior to suctioning (suctioning reduces oxygen saturation).
Without applying suction, insert suction catheter about 6 inches or until client coughs.
Upon stimulation of cough reflex, apply suction intermittently and slowly rotate the catheter between dominant thumb and forefinger as the catheter is withdrawn (within 10 seconds).
Assess apical pulse and breath sounds.
Repeat steps 12 and 13 based on assessment; limit suctioning to 3 passes of catheter.
Assistant should hyperoxygenate client as per Step 3 between each suctioning pass.
Discard equipment, wash hands and document procedure.
TRACHEOSTOMY CARE (performed every 8 hours and PRN)
Gather equipment: Sterile tracheostomy care tray, normal saline, hydrogen peroxide, eye protection, suction apparatus, and anesthesia bag.
Wash hands. Put on clean gloves and remove dressing (keep obturator at bedside in clean, clear package).
Remove clean gloves and rewash hands. Loosen caps on hydrogen peroxide and normal saline.
Open sterile tracheostomy care tray.
Don sterile gloves.
Remove drape with plastic liner from tray and set up sterile field.
Arrange contents of tray onto sterile field.
Pour saline and cleaning solution into two separate containers.
Remove trach collar.
Remove inner cannula (may use sterile 4X4 to stabilize trach plate with sterile dominant hand) and immerse in cleaning solution. Clean inner cannula with brush and pipe cleaners. (Shiley has inner cannula; bivona foam cuff does not have inner cannula).
Immerse and rinse inner cannula in sterile saline/sterile water.
Replace inner cannula and resume oxygen therapy if ordered.
Clean trach stoma site with cotton tipped applicator and/or 4X4 moistened with saline.
Assess for evidence of wound erosion.
Use 4X4 with saline to clean trach plate and outer cannula (excessive movement in handling will irritate trachea causing coughing spasm).
Apply dressing to trach site.
If twill tape ties are soiled, replace ties. Do not remove old ties until new ties are secure. Tie tightly with head flexed. You should be able to insert one finger between tie and neck. (Trach ties must be secure enough to prevent tube movement in and out of wound insertion site, causing tracheal damage. When skin on neck is excoriated, use padded ties.)
For new trach, change ties after 48 hours; then every 8 hours if needed; progressing to every 24 hours if dry and clean.
Discard equipment, wash hands, and document procedure
Anna C. RN-BC, BSN, PHN, CMSRN
Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process. She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.