Trach Suctioning

Purpose
1. To clear secretions from existing tracheostomy tube
2. Should be performed before tracheostomy care so that any secretions that may be released can be cleaned with trach care
3. The respiratory tract is sterile, therefore this procedure should be performed with sterile technique

Nursing Points

General

Supplies needed
1. Suction catheter kit
  1. Catheter
    1. Size of trach x 2 – 2
    2. i.e. size 6 trach → 10fr catheter
  2. Sterile gloves
  3. Disposable water container
2. Small bottle of sterile water
3. Suction setup
  1. Suction regulator
  2. Suction canister
  3. Suction tubing
Position yourself on the side of the patient that corresponds to your dominant hand
1. i.e. if you are right handed, work from the patient’s right
Goggles or a face shield are highly recommended

Assessment

Assess need for suctioning
1. Auscultate lung sounds
2. Assess SpO2

Nursing Concepts

Steps and nursing considerations
1. Gather supplies
2. Explain procedure to patient
3. Perform hand hygiene
4. Set up suction setup
  1. Attach tubing to canister to regulator
  2. Place the end of the suction tubing within reach, usually over the head of bed or across the patient’s chest
  3. Regulator should be on continuous medium suction
5. Hyperoxygenate patient if appropriate
6. Raise bed to comfortable working height and bring bedside table close to bed
  1. Recommend 45 degrees HOB to promote effective airway clearance
7. Open bottle of sterile water and set on the table between sterile field and patient
8. Open the sterile suction catheter kit
9. Carefully grasp sterile gloves by the inner cuffs and apply to dominant hand first using sterile technique. Then apply to non-dominant hand.
  1. Your dominant hand should stay sterile throughout the entire procedure
10. Open the disposable water container and set it plastic side up on the sterile field
11. Pick up the catheter
  1. Place the tip of the catheter facing down in the palm of your dominant hand
  2. Wrap the catheter around your dominant hand until you can grasp the plastic suction control port
12. With your non-dominant hand, pour sterile saline into the container
  1. *NOTE: this hand is now NONsterile
13. With your non-dominant hand grab the suction tubing and connect it to the plastic suction control port on the catheter (keep your dominant hand sterile!)
14. Carefully remove any oxygen mask from in front of the trach with your nondominant hand
15. Suction the patient
  1. Control the suction using the control port with your nondominant hand
  2. Insert the suction catheter with your nondominant hand, being careful not to let the suction catheter touch anywhere other than the inside of the trach.
  3. Insert 4-6 inches or until the patient coughs
    1. Insert WITHOUT suctioning
    2. If the patient coughs, remove 1 cm before initiating suction
  4. Apply intermittent suction with the thumb of your non-dominant hand and gently rotate the catheter as you remove it
16. Once the catheter is out, use your non-dominant hand to replace the oxygen mask while you determine if the patient needs a second pass with the catheter
17. If secretions are thick, quickly dip the catheter into the sterile saline and suction water through the catheter to clear it out
18. You may perform up to 3 passes with one catheter, no more than 10 seconds per pass
  1. Remember, you’re blocking their airway!
19. If at any point the catheter becomes unsterile, reapply the patient’s oxygen and start over with a new catheter if suction is still required
20. When complete:
  1. Ensure patient’s oxygen mask is in place if appropriate
  2. Reassess patient’s lungs and SpO2 to determine effectiveness of suction
  3. Discard all supplies in the appropriate waste container
  4. Remove gloves
  5. Perform Hand Hygiene
21. Return bed to low/locked position
22. Ensure patient is comfortable
23. Document procedure and patient response/tolerance
Can now move on to trach care if needed

Patient Education

Purpose for suctioning
Keep hands down to avoid touching sterile field/catheter
Patient can cough during suctioning to improve the effectiveness

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Transcript

In this video we’re going to talk about suctioning a tracheostomy. You may need to do this before you do trach care or just because the patient requires suctioning. Make sure that you assess the patient before you start so that you know what their one sounds are, and what their oxygen saturation is.

Make sure your suction setup is working – you should have tubing attached to a canister, attached to a regulator. For this, you want to set it on continuous medium suction. You also want to make sure you can reach the end of the suction tubing – sometimes I lay it over the head of the bed or on the patient’s chest.

Now, usually I will loosen or unsnap the patient’s trach collar or oxygen source just to make sure I can easily move it with one hand – as long as you’re still able to deliver oxygen while you finish getting ready.

So, first, you’re going to open the sterile water and set the bottle on the table between you and the suction kit.
Now you can open your suction kit and put on your sterile gloves from in that kit. Sometimes they’re all bunched up and sometimes they have their own package, just be careful to keep them sterile.

Now you’ll open the little water container in the package and set it up on your sterile package.
Next you’re going to grab the suction catheter in your dominant hand. Put the catheter pointing downward in the palm of your hand and wrap it around your hand til you can grab the plastic suction control port.

Now at this point your non-dominant hand is going to go unsterile. Grab the water bottle and pour some in the container.
Then grab the suction tubing and push it onto the plastic suction control port without touching your other glove or the catheter.
Now you’re ready to suction. Use your non-dominant hand to move the oxygen source to the side.
With the same hand, grab the suction control port – this is the hand that is going to control the suction. When your thumb is over the port, suction is active.

Carefully unwrap and insert the suction catheter without suctioning. You’ll go in about 4 to 6 inches, or if the patient coughs, stop and pull it out 1 cm.

Then you’ll apply intermittent suction with your thumb while you gently pull out and twist the catheter in circles. This whole thing should take less than 10 seconds! Remember – you’re blocking their airway!

Once you’re out, hold the catheter away from the patient to keep it sterile and replace their oxygen source with your non-dominant hand while you decide whether they need another pass.

If the secretions were super thick, you can suction some of the sterile water through the catheter to clear it out.
You can do up to 3 passes with one catheter, no more than 10 seconds per pass. But if at any point the catheter becomes unsterile, you need to stop and get a new one before continuing!

When you’re done, be sure to re-attach the patient’s oxygen source. Then discard all of your supplies.
Of course, you’ll also want to reassess the patient to make sure the suctioning was successful. And you can move on to trach care now if you need to.

We hope that was helpful! Now, go out and be your best selves today. And, as always, happy nursing!