Tracheostomy Suctioning: Procedure Skills and Post-Procedure (Nursing)

00:04 So, now our patient, if you see, they have this trach collar oxygen mask.

00:09 So, we're going to make sure we oxygenate them at 100% oxygen for the least 30 to 60 seconds.

00:15 So it makes sure we do this.

00:17 Now, once we knew that, and the patients been hyper oxygenated, we want to go ahead and open up our suction catheter package here.

00:26 So, when I open this up, remember, don't pull this away, so, you're hovering over the field.

00:32 You want to make sure you open this towards you, or however you want to say that to where you're not hovering over this and for this sake, so you guys can see, I'm going to go ahead and pull this off.

00:45 Now, when we're looking in this kit, most of the kits now have sterile gloves in these.

00:50 You want to remember if this is not your standard size, make sure to bring those sterile gloves with you that way you're not leaving your sterile field.

00:58 But these so happened to fit me.

01:00 So, I'm going to remove these packages here.

01:04 Now, before I don those, I want to make sure I'm going to go ahead and just crack and release the seal a little bit of my sterile fluid.

01:13 Make sure I easily get that off and then check the expiration date on this as well.

01:21 Now, as you can see, I've already done my PPE.

01:24 So, it's one thing I want you to remember that anytime we're worried about extra splashes, such as secretions, patient coughing, a face mask with a shield is great.

01:35 Also, as you can see here, I have goggles and a mask is recommended.

01:39 Now, I've got my mask here, but obviously, I'm not going to wear that today.

01:43 Otherwise, you wouldn't be able to hear me.

01:45 But I also have my gown on here as well.

01:47 Now, let me go ahead and don on my sterile gloves.

01:57 Now, as you know, they just kind of open up like a book going to make sure I fold these corners in.

02:06 So, these don't fold on to themselves.

02:09 So, now, I'm going to go ahead and put these on.

02:14 You know, pinch the cuff and just slide my hand in like a pizza and make sure you're raising that enough.

02:20 So, these don't drag across your sterile field.

02:26 So, that one's on. So, now I'm going to go ahead for sterile the sterile may get on the inner cuff and don my gloves.

02:35 I'm going to slide my hand in like a pizza and be patient and don my gloves here.

02:45 and then put those on.

02:46 So, now that I've got these on, I'm going to go ahead and remove this out of the way.

02:50 And, as you can see, I've already put a drape across my patient's chest or a towel, something just to help try to keep the area clean and to just help protect the patient from any extra secretions.

03:03 Now, I want to go ahead and remove the suction catheter.

03:06 Now, before we start, I want you to know something in regards to this procedure.

03:11 You are going to have a dominant sterile hand.

03:14 Now, this other hand is going to become non sterile.

03:17 So, you've got to make sure, you keep the two delineated during this procedure.

03:21 So, this since I'm right-handed, this is going to be my dominant sterile hand.

03:26 So, this is the hand I'm going to use to remove the suction catheter.

03:35 So, now we remove this suction catheter from the kit, we want to just make sure we're very careful since this is we're both still sterile, placing this that we're going to keep our in sterile and making sure we don't lose control of our catheter.

03:49 So, again, this is going to stay my sterile dominant hand.

03:53 Now, one thing to keep in mind is we can clearly see that this catheter is not greater than half the circumference of the trach tube, which is going to allow for easy passing.

04:05 So, now that we've got the catheter coiled up in her hand, this is our sterile dominant hand.

04:10 I may go ahead and now pour my water.

04:12 So, this is going to be my nondominant, nonsterile hand now.

04:16 So, I can go ahead and remove this.

04:19 I'm going to pour my water, making sure my hands stay up and then move this to the side.

04:27 Now, that we've oxygenated, I'm going to go ahead and move the trach collar as well, so I can have access to my patient.

04:34 Now, with my non-dominant, non-sterile hand, this is the great time to go ahead and disconnect my suction oral suction device here.

04:42 So, I'm going to get a hold of this.

04:46 Let go of that. And then I'm going to go ahead and attach my tubing.

04:52 So, this is my non-dominant hand and this is the one that's going to help occlude the valve here for suction.

04:58 So, I can go ahead and test this and lubricate the sterile catheter by dipping this into sterile saline.

05:05 And then I would include this and you would hear the sucking to where it's clearing the catheter and making sure that this is working appropriately before I do this on my patient.

05:15 Alright, so now that this is how we've done this, I'm going to go ahead and feed this for my patients.

05:21 So, when I'm doing this, I'm going to slowly go ahead and insert the catheter.

05:25 Now, very important, notice my thumb is up, make sure you're very conscientious of this because when I feed the catheter, notice there is no suction being applied and I am not forcing the catheter.

05:39 So, if it's shallow suctioning, we're going to go about the length of the trach tube.

05:44 And then once we're ready, we're going to go ahead and pull up and suction.

05:48 However, if we're doing deep suctioning, we're going to insert this until we meet resistance, or if the patient starts coughing.

05:56 If they do, go ahead withdraw this about a centimeter or so.

06:00 then once we've gotten there, we're going to now twist this in between our hand and apply suction intermittently, or some people do it continuously just depending on the patient's needs.

06:13 Now, each pass cannot be any more than 10 to 15 seconds per pass, because you want to allow the patient to rest and to recover.

06:23 So, if we were going to make another pass, let's call it a deep suctioning pass.

06:27 I'm going to go ahead and clear my catheter, insert my saline, apply my suction, so we can clear out those secretions, then we're going to make another pass.

06:35 So if I was to do this, again, I'm going to make sure I keep be very careful about this, feed the catheter, not forcing it, no suction is being applied.

06:46 We're deep suctioning our patients and then when we're ready, we're going to withdraw it and rotating it between our fingers and intermittently applying suction.

06:59 Now, most policies say only about two to three times and you want to avoid contaminating the catheter as you remove it from the trach tube.

07:07 Now, we're going to suction the tubing again with sterile saline to remove and to clear the secretions that we just got.

07:16 Now, during this procedure, we want to try to allow the patient to rest as much as possible between each pass.

07:23 We also as you remember, attach the patient's pulse ox and making sure we keeping an eye on this.

07:29 Now, post procedure, I can look down, check the pulse ox and making sure that patient's pulse ox level has returned to baseline.

07:36 This is also a great time to encourage the patient to cough and deep breathe at this point.

07:41 Now, when done, we can completely remove the catheter from the trach tube, remove the gloves while holding the catheter inside the glove for disposal.

07:50 So a lot of the times I just like to wrap it into here to remove this and then I'm going to dispose of it within my glove.

07:57 Now, if there's any additional trach care at this point, this would be good time to do this, if we need to clean anything up, we also can pull back the tray collar for patients.

08:10 And I'm going to go ahead and remove the rest of my gloves and perform hand hygiene here.

08:16 Now, post procedure after we've suctioned again.

08:19 We looked at their pulse ox but we also want to assess the patient's respiratory status and how they tolerated that procedure.

08:25 We want to ensure airway patency for a patient, and just make sure we put any preexisting oxygen orders back in place.

08:33 We will dispose of our equipment before more hand hygiene and we can go ahead and turn off our suction device.

08:40 This would be a great time to go ahead and just don standard gloves, we can reassess the patient's lung sounds, their heart rate and rhythm, and their pulse ox again.

08:49 And for comfort or go ahead perform oral care for a patient.

08:52 We want to assist the patient to a comfortable position and answer any questions they might have.

08:58 So, this is a great time to ensure safety measures are in place for your patient.

09:02 So, I'm going to put the side rail back up.

09:05 I'm going to lower the patient's bed to the lowest position, put the call light within reach, and thank them for their time and their assistance with the procedure.

09:13 We of course would document this thoroughly for our patient and thank them for the procedure.

09:21 We can go ahead and put on standard gloves.

09:24 And we want to make sure we reassess the patient's lung sounds, their heart rate and rhythm, and their pulse ox.

09:31 Now, we want to make sure before we leave the patient perform oral care for comfort.

09:36 We want to assist the patient in a comfortable position, make sure we answer any questions that they may have and thank them for their time and their assistance.

09:44 And we want to make sure every safety measure before we leave is in place.

09:48 So, make sure you lower the patient's bed, put the call light within reach and make sure the side rail is up.

09:55 Now, post procedure, we've got to make sure we document the findings of this procedure, how the patient tolerate it and any assessment findings.

10:04 Now, we also want to make sure, we report any concerns according to agency policy.

10:09 Once we complete a procedure, it's obviously very important that we document that.

10:15 Now, let's take a look at some great examples of expected and unexpected findings you might see when you're doing trach suctioning.

10:23 So, let's look at this first example of an expected finding.

10:26 So, if you take a look at this example, you notice that the nurse hyperoxygenated the patient, which is great.

10:32 Patient's oxygen saturations were maintained about 92 to 96%.

10:37 And then following the procedure, you can see here that the patient obviously tolerated well, and the vital signs were stable.

10:44 They also know in here about there was a moderate quantity of dense, white, odorless mucus that was extracted.

10:53 So, one thing I want you to note on this particular documentation piece, it was specific, there were a patient assessment.

11:00 It also shows the patient's follow up and how they tolerate the procedure and the expected outcome.

11:06 Now, let's take a look at a documentation piece of an unexpected finding during trach suctioning.

11:12 Now, upon assessment, the nurse notes that the patient's pulse ox was already dropped to 88% and the respirations were labored.

11:20 Now, the nurse documented her due diligence that she hyperoxygenated the patient, but it did result in a bradycardia for the patient.

11:29 And the nurse specifically noted how low the heart rate dropped at about the 50s.

11:34 They stopped the suctioning there and they did call emergency support.

11:39 Now, they documented the outcome which is a considerable amount of thick, white, odorless mucus that was removed.

11:47 Also following the procedure, once this is done, the patient did even now and their vitals were stabled.

11:54 But one thing I want you to note here is how specific and objective that the nurse got when they documented this that yes, they were bradycardic, but they also noted how low that the heart rate had dropped that they stopped the intervention and they call for emergency support.

12:11 Let's take a look at some special considerations when we're talking about trach suctioning with our patients.

12:17 Now, PPE guidelines for trach suctioning typically recommend the use of face shield like we had talked about before.

12:23 Goggles and a gown, especially if you think the patient has excessive secretions, there's going to be a lot of coughing or high likelihood of splash exposure.

12:34 One thing to note there also might be a balloon cough that you might see here that is attached to the patient's tracheostomy.

12:41 Now, periodic cuff deflation is recommended to minimize potential for infection from pulled secretions above the cuff.

12:49 However, you do not need to adjust balloon pressure for a sectioning procedure.

12:56 Now, when we're doing this, just make sure anytime you're trach suctioning continuously assess the patient's response to this.

13:04 Now, hyperoxygenation, before that we start the procedure is required and it is a great idea for your patient to tolerate the procedure.

13:14 And any time like you saw on that nurses note, if there's dysrhythmia or bradycardia occurs or any negative patient outcome, stop the procedure immediately.

13:24 Let's finish up by discussing a few possible complications that you might see with trach suctioning.

13:30 So, we could accidentally dislodge or remove that trach tube.

13:34 You may cause signs of infection or infection in your patient.

13:38 We could cause hypoxemia as well, where we see a dip in their pulse ox, and aspiration could also occur.

13:45 Thanks for taking time and watching this skill with us today.