Tracheostomy Suctioning Procedure

Introduction

• Patients with tracheostomies often cannot clear their own mucus secretions.
• Nurses can remove mucus and secretions through suctioning.
• Suctioning can be done with in-line suction or a sterile suction kit.

Tracheostomy Setup

• General Supplies: Venturi setup connected to the wall oxygen unit, a hose, and a collar over the tracheostomy.
• Venturi Setup:
  • Controls oxygen delivery to the patient.
  • Mixes room air with oxygen from the wall unit.
  • Adjustable oxygen delivery settings: 28%, 30%, 35%, 40%, 50%, 70%, 100%.
  • Oxygen liters for Venturi settings are printed on the sterile water bottle.
  • Adjust wall oxygen by turning the knob and measuring from the center of the floating metal ball.

Suctioning Indications

• Visible secretions, coarse crackles, low oxygen saturation, ineffective cough, respiratory distress, suspected aspiration, need for sputum sample, increased peak airway pressure on ventilator.
• No physician order needed for suctioning.

Preparation for Suctioning

• PPE Needed: Surgical mask, eye protection, sterile gloves.
• Supplies Needed: Suction kit, suction catheter (14 French for trach > size 7), potential sterile water/saline for thick secretions.
• Hand hygiene and PPE application.
• Pre-oxygenate patient with 100% oxygen for at least 1 minute.
• Monitor oxygenation and heart rate with pulse oximeter.

Suctioning Process

• Set Suction: Wall suction to 'reg'; adjust to 150 for adults, 100 for children.
• Procedure:
  • Open suction kit and don sterile gloves.
  • Insert catheter into trach without applying suction.
  • Retract slightly upon cough or resistance.
  • Apply suction by covering port on adapter.
  • Roll catheter between fingers while retracting.
  • Limit suctioning to 10-15 seconds.
• Post-Suction:
  • Reapply oxygen between attempts.
  • Clean catheter with sterile solution if clogged.
  • Dispose of catheter and gloves properly.

Post-Procedure

• Return patient to original oxygen settings.
• Be aware of side effects: hypoxemia, arrhythmia, bradycardia, tissue trauma, pathogen introduction, atelectasis.
• Stop suction and reapply oxygen if adverse effects occur.

Documentation

• Chart in Epic under Basic Assessment tab > Respiratory Interventions > Airway Suction.
• Note secretions and patient tolerance.

Conclusion

• Suctioning is performed by respiratory therapists or RNs based on assessments.
• No physician order is required for suctioning.