Lecture Notes: Tracheostomy Care and Suctioning by Ellis

Overview

• Presenter: Ellis, LevelUp RN
• Demonstrates tracheal suctioning, tracheal site care, and working with a nondisposable inner cannula.
• Based on steps and best practices in LevelUp RN’s clinical nursing skills deck.

Key Procedures and Steps

Equipment Types

• Different procedures based on the type of tracheal equipment:
  • Reusable inner cannula: Demonstrated steps for removing, cleaning, and reinserting.
  • Non-reusable inner cannula: Steps for disposal and replacement of the cannula.

Initial Preparation

1. Oxygen Administration

• Pull down oxygen slightly to maintain oxygen supply during the procedure.
• Set oxygen aside if necessary for better visual clarity (for demonstration purposes).

2. Sterile Setup

• Use clean hands and clean gloves initially.
• Open sterile saline with the palm against the label and pour into a container.

3. Removing the Inner Cannula

• Pinch the flanges to remove the inner cannula.
• Place the cannula in a sterile saline bath.

4. Switch to Sterile Gloves

• Remove initial gloves, discard, and put on sterile gloves.

Cleaning Tracheostomy Site

1. Setup Sterile Field

• Use cotton swabs, a brush, pipe cleaners, a new trach tie, and pre-cut trach dressing.

2. Remove Old Dressings

• Note: The left hand becomes non-sterile.

3. Use Saline and Cotton Swabs

• Clean the stoma and faceplate, always moving outward from the stoma to prevent infection.

4. Dry the Site

• Use dry sterile gauze to clean and discard.

5. Clean and Dry the Inner Cannula

• Use a brush inside the cannula, then dry with pipe cleaners.

6. Reinsert the Inner Cannula

• Ensure it clicks back into place to verify secure placement.

7. Replace the Trach Dressing

• Use only pre-cut gauze sponges.

8. Replace Trach Ties

• Secure the new tie before removing the old one to prevent accidental expulsion.
• Check the tightness of the tie (one finger breadth under the tie is appropriate).

Suctioning the Trachea

1. Patient Positioning and Oxygenation

• Semi or high Fowler's position.
• Hyper-oxygenate the patient by turning up oxygen or using ventilator settings.

2. Setup for Suctioning

• Make sure suction canister and tubing are ready and functional.
• Loosen cap on saline bottle for one-handed use.

3. Maintain Sterility

• Wear sterile gloves, set up sterile field, and manage equipment sterility meticulously.

4. Suction Procedure

• Insert catheter into the trachea until resistance or coughing occurs.
• Use non-dominant hand to control suction and dominant hand to maneuver the catheter.
• Perform suction for about 15 seconds per pass, allow patient to re-oxygenate between passes.
• Clear tubing with saline after each pass.

Tips and Best Practices

• Maintain strict sterility throughout the procedure.
• Be mindful of equipment placement and hand movements to avoid contamination.
• Verify suction strength before starting the procedure.
• Pre-plan actions to avoid errors and ensure sterility.
• Practice according to facility or school guidelines.
• Secure trach ties properly without causing discomfort or risk.
• Perform a maximum of three suction passes to prevent patient stress and oxygen deprivation.
• Ensure careful handling of gauze and other materials to prevent fraying and potential respiratory contamination.

Wrap-Up

• Tracheostomy care and suctioning involve multiple detailed steps and require meticulous attention to maintain sterility and patient safety.
• The demonstration combines various skills often used together in clinical practice.
• Practice and familiarity with the procedures, maintaining a sterile environment, and being proactive are key elements for successful execution.