Tracheostomy Care and Suctioning

Overview

• Patients with tracheostomies often cannot clear their own mucus.
• Nurses and respiratory therapists can suction mucus using either in-line suction or a sterile suction kit.

Equipment and Setup

• Tracheostomy Setup:
  • Venturi setup attached to wall oxygen unit.
  • Hose connects to a collar over the patient's tracheostomy.
• Venturi System:
  • Controls oxygen delivery, mixes room air and oxygen.
  • Adjustable collar for oxygen percentages (28%, 30%, 35%, 40%, 50%, 70%, 100%).
  • Oxygen flow rates: 6 liters for 28%, 8 liters for 30%, 10 liters for 35%, 12 liters for higher percentages.
  • Use the center of the floating metal ball for accurate oxygen measurement.

Suctioning Indications

• Visible secretions or auscultation of coarse crackles.
• Decreased oxygen saturation or blood gas values.
• Inability to cough effectively, respiratory distress, suspected aspiration.
• Need for sputum sample or increase in ventilator peak airway pressure.

Suctioning Procedure

• Preparation:
  • Gather PPE (mask, eye protection), sterile gloves, and suction kit.
  • Use a suction catheter not larger than half the trach tube diameter (14 French for trachs > size 7).
  • Sterile water/saline for cleaning catheter if secretions are thick.
• Pre-Oxygenation:
  • Pre-oxygenate with 100% oxygen before suctioning.
  • Adjust Venturi and wall oxygen to deliver 12 liters O2 for 100% oxygen.
  • Monitor patient's oxygen and heart rate.
• Suctioning:
  • Use sterile technique; dominant hand remains sterile.
  • Insert catheter without suction until resistance or coughing.
  • Suction for 10-15 seconds maximum; retract slowly while rolling catheter.
  • Reapply oxygen between multiple attempts (up to three).
• Post-Procedure:
  • Return patient to baseline oxygen settings.
  • Dispose of catheter and gloves properly.
  • Chart intervention in Epic: document secretions and patient tolerance.

Risks and Side Effects

• Hypoxemia, arrhythmia, bradycardia (stop if detected).
• Tissue trauma, infection risk, atelectasis.

Documentation and Follow-Up

• Charting in Epic under Respiratory Interventions.
• Monitor patient for any adverse effects after suctioning.