Tracheostomy Suctioning: Preparation and Pre-procedure (Nursing)

00:04 Welcome to the skill, Trach Suctioning.

00:06 So, before we get started, let's talk about some emergency equipment that is very important that we have at our bedside.

00:13 So, one of those is a resuscitation bag.

00:16 The next will be an oxygen source.

00:19 And of course, because we're protecting the patient's airway, for any reason that maybe the existing trach gets dislodged or it comes out, we want to make sure we have a sterile trach replacement tube at bedside.

00:31 And for any reason the patient can't clear their airway on their own, we also want to make sure we have functioning structured equipment ready at the bedside as well.

00:40 Now, before we begin, we need to look at our system.

00:44 So, we need to determine, if it's an open or closed suctioning system in place.

00:48 And I'm going to show you that a little bit later in the video.

00:51 And of course, assessment is key.

00:53 We want to make sure we get a baseline assessment of the patient's respiratory status.

00:58 And it's an appropriate time to suction the patient as well and they're going to be able to tolerate this.

01:04 Next, we want to go ahead and gather unnecessary equipment.

01:07 Now, some of the equipment we're going to need is a suction canister and tubing.

01:11 And that's going to look a lot like this right back here.

01:14 So it's also very important that when you gather your equipment and you're talking about suctioning, make sure your units are functioning before you start.

01:23 So you want to make sure you check that as well.

01:25 Next, we want to make sure because we're talking about respiratory secretions, we need appropriate PPE or Personal Protective Equipment.

01:35 So, if you think you might get some splashes or something like that, you want to protect yourself.

01:41 One of those things that's a really good idea is either a face shield, or maybe even some goggles such as these.

01:47 You also want to consider a face mask or a surgical mask, and of course a protective gown.

01:53 Again, if you think that's applicable to your patient.

01:56 One thing to note that might be helpful is also a drape of some sort.

02:00 This is really nice to drape across the patient's chest when you're suctioning because of course all those secretions that can come out.

02:07 So this gives you a nice clean place to protect your patient's chest.

02:10 And of course, we're going to need the trach suction kit itself.

02:14 So most of the time, you're going to see a trach suction kit that looks a lot like this.

02:18 And inside this, this actually does indeed have our sterile gloves and our suction catheter.

02:23 Now one thing to note about these particular kits is usually there's a one standard size of glove in here.

02:31 I lucky enough that usually they fit me.

02:33 But be familiar with your facilities equipment because they may not fit you. So, if that's the case, remember to bring the appropriate size sterile gloves with you to your patient's bedside.

02:44 And of course, to clear the catheter, we want to make sure we gather sterile water or saline for clearing the catheter.

02:51 Don't forget to check the expiration date on that as well l before you use your patient.

02:56 Now, when you're talking about suctioning, a really good tip is to also get a continuous Pulse Ox.

03:02 So, while I'm doing this procedure on the patient, this is a very easy way just to take it, and obviously I don't have the other half, but just connect it to your patient's finger and you can keep an eye on their pulse oximetry rate as you're suctioning the patient.

03:16 This is a really helpful thing for you for assessment purposes.

03:20 Now, before we start a procedure, of course, we want to perform our hand hygiene.

03:24 We want to check our two patient identifiers and also provide privacy for our client.

03:29 Now, because we are suctioning the patient's airway, please take time to explain the procedure to the patient.

03:36 This can be a little alarming and maybe a little stressful for the patient.

03:41 So please make sure you explain this thoroughly and answer any questions the patient might have before you start.

03:47 It's also a good idea to prepare to collect a sputum sample in case it's order.

03:51 So, you want to make sure you check that before you go in to suction the patient.

03:55 And we're going to raise the head of the bed to the appropriate working height for you.

03:59 So, you have good body mechanics and elevate the head of the patient's bed as well.

04:04 We usually are looking about at least 30-45 degrees but whatever the patient can tolerate.

04:09 So, we want to make sure we elevate the bed here as well.

04:13 Now, we talked about this a little bit before but with your suction equipment, you just never know what might happen in the hospital.

04:20 So make sure that it's functioning properly before you start.

04:24 So, typically back here on your suction device, you can just turn this on. You will hear it, and you want to test to make sure the suction is adequately working.

04:33 Now, the other thing we want at bedside is to verify that there's a backup trach tube or an obturator, and bag valve mask available at the bedside like you see we have back here.

04:46 Now we want to go ahead and turn on the suctioning and set that suction pressure based on the patient's age or by the physician's order.

04:53 Now, for adult, you may see a range of about 80 to 120 mm/Hg for adults.

04:59 If they're about less than a year old you may only see a range about 20 to 80 mm/Hg.

05:05 And about one year to adult size, you may see about 80 to 100 mm/Hg.

05:11 So, now, we're going to get the suction tubing, and places within easy reach of the patient.

05:17 Now, this one has a Yonker attached but clearly we usually want this covered in a clean plastic cover to keep this in.

05:24 But for this demonstration, so you can easily see the attachment for suctioning we're going to keep this open.

05:32 Now, before we start, we want to assess the patient's baseline respiratory status.

05:36 We want to see if they're having any trouble breathing, any difficulty with their airway before we start this procedure.

05:43 And it's always a good idea for further assessment, we can apply a continuous pulse oximetry.

05:49 Now, when we're looking and we're starting to suction the patient, we also want to look at the patient's stoma, the condition of the trach dressing as well.

05:57 Even if it's very soiled, we want to go ahead and discard those soiled dressings and get rid of that and change that as needed.

06:04 And we would also want to do, of course, our hand hygiene and don new gloves at this point.

06:09 Now, we want to go ahead and prepare a work area much like this.

06:13 And usually a hard service like the bedside table is going to be great.

06:20 Let's take a closer look at our skill trach suctioning.

06:23 So, before we start, we're going to perform our hand hygiene.

06:26 We're also going to check our two patient identifiers and provide privacy for our client.

06:31 Now, I'm going to go ahead just for good body mechanics is go ahead drop the side rail here.

06:40 We also want to make sure we explain the procedure thoroughly to the client.

06:44 Now, this may be a little bit of a stressful procedure.

06:48 So you want to make sure you thoroughly explain this to them and answer any questions they have before you start.

06:55 Now, you want to check your orders before you start this skill because sometimes you may need to speed on sample.

07:01 And if that's the case, make sure you bring all your supplies before you start the procedure.

07:05 Now, I've already raised my bed to the appropriate working height for me.

07:09 And we've elevated the head of the bed of the patient.

07:11 So, at least about 45 degrees or so would be good.

07:15 Now, before we start, obviously, we need our suction equipment to work.

07:19 So, we want to make sure that this is functioning properly.

07:22 So we want to make sure we check our suction unit.

07:25 And we've got our canister and our tubing in place.

07:27 And that is working appropriately.

07:30 Now, if you remember, any time we're doing trach suctioning, we want to make sure there's emergency backup.

07:36 So, we want to make sure we have our spare trach tube or obturator in our valve mask available at the bedside just in case we need to in case of emergencies.

07:47 Now, at this point, we would go ahead and turn on our suctioning and we're going to set that suction pressure based on the patient's age.

07:55 So, at this point, we're going to say we have an adult patient, and we'd set them to about 120 mm/Hg for adults.

08:04 Now, I've already laid our patients suction tubing here within easy reach.

08:08 Now, just know for this demonstration, so you can see, we've got our suction tubing and our Yonker here.

08:15 But we usually have this covered in a clean cover for a patient.

08:19 And before we start, remember, assessment is key.

08:23 So, we want to check our patient assess their baseline respiratory status, so we know what our baseline is, and seeing if the patient can tolerate this procedure before we start.

08:32 Now, a key piece of assessment. If you have the ability, apply the continuous pulse ox to the patient's finger.

08:40 So, real easy way just to keep an eye on the patient's pulse ox while you're doing the procedure to see if they dip at all.

08:47 Now, when we're going to look at the stoma itself and the trait, it's a great idea to take a look at this because sometimes you may come into your client to do this, the dressing may be completely soiled, it may really just need to be changed.

09:02 So, if that's the case, this is a great time to do that.

09:05 Change the soil dressing assess your stoma, and then discard of any soil dressing or gloves used.

09:12 We will of course perform our hand hygiene again at that point.

09:15 Now, when we're going to do this, we want to prepare a hard work surface here for us.

09:20 Preferably the bedside table because this is nice here and within reach for us.