Tracheostomy Suctioning: Procedure Steps (Nursing)

00:03 Now, because we're going to be working with the patient's airway, it's really important step here for us to remember.

00:10 We want to hyperoxygenate the patient at about 100% oxygen for 30 to 60 seconds.

00:17 So, what do I mean by this? I'm really just making sure that we turn up the oxygen at 100% and we're giving 30 to 60 seconds of uninterrupted oxygen flow for a patient.

00:28 Now, this can be done a couple of different ways.

00:31 So, it's going to depend on the patient's scenario, but we may need to use a bag mask valve attached to an oxygen source.

00:39 We may be able to use the trach collar oxygen mask like you see here. Or if the patient doesn't have an oxygen source, we just want to alternatively, ask the patient to take two to three deep breaths.

00:53 Now, we can go ahead and open up the suction catheter package like you will see here.

00:58 Now, we want to make sure we're not crossing over the sterile field.

01:02 And they're sterile gloves inside this package that we're going to utilize.

01:06 Now, when we're looking at our suction fluids, don't forget to check the expiration date and it's a good idea to go ahead and open this.

01:16 Now, we can go ahead and get ready to don our appropriate PPE per our agency protocol.

01:22 So, this typically is going to include either like a face mask with shields, so you may see something like that.

01:28 Or you may decide just to use a face mask and goggles such as these that you might see.

01:34 We also want to make sure we use a protective gown as well if we think that might be an issue with our patient while we suction.

01:42 We can go ahead now and start to don our sterile gloves.

01:45 And this is a great time to protect the patient imply or sterile drape or just a drape for a patient's chest.

01:51 We want to remove the suction catheter from the kit itself and coil that with a dominant hand that's going to stay sterile.

01:59 Now, we want to make sure when we get this catheter, it's usually about a 14-French that you'll see in the catheter kits.

02:06 But please make sure it is not greater than half of the inner diameter of the trach tube itself.

02:13 We're going to keep that catheter sterile by holding it in our dominant sterile hand and attach it to the suction tubing here like you see with your nondominant hand and this one's going to be our non-sterile hand.

02:26 Note, again, that our non dominant hand is no longer our sterile one.

02:30 So we got to keep this in mind during the procedure.

02:33 Now, using your nondominant and nonsterile gloved hand, remove the oxygen mask if there was one in place from covering the trach entry, so we would have removed this device.

02:44 We want to go ahead and test that suction and lubricate the sterile catheter by using our sterile hand to dip the end of that catheter into the saline making sure we include that so we can suction through the catheter and we see that that suctioning is functioning properly.

03:01 Now, we want to insert the catheter into the patient's trachea tube while using our sterile hand without applying suctioning.

03:10 So, when you first enter into the trach tube do not apply any suctioning with your nondominant hand.

03:17 Again, I want to repeat.

03:19 When you initially inserted, do not apply suction, so keep your thumb off of the control.

03:24 And do not force the catheter.

03:26 Now, if we're going to a little bit more shallow suctioning, insert the catheter about the length of the trach tube before beginning any suctioning.

03:35 And remember, we're just feeding the catheter, no suctioning here.

03:38 Now, for deep suctioning, insert the catheter until you feel a little resistance and then pull back about a centimeter.

03:46 Or you may start to feed the catheter and the patient may cough That's a good time to stop.

03:51 Pull that back and then before you begin suctioning at this point.

03:55 So, while feeding the catheter, keep the dominant sterile hand at least one inch away from the trach tube.

04:01 We want to make sure that we're not bumping this with our sterile hand.

04:04 And to apply suction, place your nondominant, so I'm over the control valve.

04:09 And with this hand, you're going to cover the valve to use the first suction pressure.

04:15 So, we're going to withdraw the catheter while continually rotating it between our fingers to suction all sides of the trach tube.

04:23 Now typically, we do not apply suction pressure for more than about 10 to 15 seconds per pass.

04:29 Now, most policies recommend that you don't do any more than three passes, allowing that patient to recover and reoxygenate between each pass.

04:39 Ensure that you avoid contaminating the catheter as you remove it from the trach tube.

04:44 Then you're going to suction the tubing with sterile saline to clear secretions.

04:49 Now, allow the patient to rest as much as needed in between each pass and ensure the patient's pulse ox returns to baseline if a second suctioning passes indicated.

05:00 So, and you can also encourage the patient to cough and deep breathe to remove secretions between each path that you make.

05:08 Now, when we're finished with this completely remove the catheter from the trach tube, remove the gloves while holding that catheter inside the glove and then we can dispose of it.

05:18 Now, at this point, we may need to perform any additional trach care as indicated.

05:23 So, you may need to clean that up a little bit for your patient before you leave.

05:27 So, we just discussed the procedure sets for an open system.

05:31 Now, let's talk about the differences with the closed system.

05:34 So, we're talking about a closed system.

05:37 All this really means that there's an actual an indwelling catheter there already.

05:41 So, as you see here, this is a closed system.

05:44 There's an actual indwelling catheter inside of here, which is much different than the external trach kit.

05:51 This is not used in the closed system.

05:53 So again, with a closed system, notice inside here, there is a already indwelling catheter inside here.

06:00 Now, notice the nice thing about this is if this was attached to a patient, this is attached to suctioning, this is attached to the vent.

06:09 I don't need sterile gloves here.

06:11 I can just with a standard glove, use this path, because this is a closed system and there's already indwelling catheter.

06:19 Now, many guidelines recommend a lower time for inline suctioning so about no more than 10 seconds with each pass.

06:27 And instead of clearing the catheter using the sterile water in a tray, a sterile sterile saline nebule is connected to a suction port.

06:35 So, that's going to look like this.

06:39 So, we're doing this, you see that this is going to go to the patient to the vent.

06:43 This is actually going to go to the suction device itself.

06:47 So we use this nebule we want to make sure that the saline is going to travel away.

06:53 So we want to make sure we put the nebule on here, and it's going to go in the direction of the suctioning not towards the patient.

06:59 That's very important for you to note with a closed system.

07:04 Now, after we suction, evaluate the effectiveness of the procedure and the patient's respiratory status.

07:10 Ensure that their airway is patent and check the any preexisting oxygen orders or went ahead and resume for our patient.

07:17 Now, we can dispose of our equipment, perform our hand hygiene, and turn off the suction equipment.