TRACHEOSTOMY &

ENDOTRACHEAL
TUBE SUCTIONING
Some patients need help in removing
secretions from their airways. For patients
who have a tracheostomy, secretions
commonly build up, necessating
suctioning. Suctioning a tracheostomy or
endotracheal tube is a sterile, invasive
technique requiring application of scientific
knowledge and problem solving. This skill
is perormed by a nurse or respiratory
therapist.
Purposes
 To maintain a patient airway and prevent
airway obstruction.
 To promote respiratory function (optimal
exchange of oxygen and carbon dioxide
into and out of the lungs).
 To prevent pneumonia that may result
from accumulated secretions
Equipment
 Sterile suction catheter ( the outer diameter of
the suction catheter should be no greater than
one half the inner diameter of the artificial
airway)
 # 14-16 (adult)
 # 8-10 (child)
 Sterile gloves
 Sterile water
Equipment
 Suction source
 Resuscitation bag with a reservoir
connected to 100% oxygen source
 Normal Saline solution
 Sterile kidney basin
Preparation
Nursing Action
 Monitor heart rate and auscultate breath
sounds. If arterial blood gases (ABGs) are
done routinely, know baseline values.
Implementation
 Explain to the client what you are going to do,
why it is necessary, and how he can cooperate.
Inform the client that suctioning usually causes
some intermittent coughing and that this assists
in removing the secretions.
 Wash hands and observe other appropriate
infection control procedures.
 Provide for client privacy.
Prepare the client
 If not contraindicated, place the client in the
Semi Fowler’s position to promote deep
breathing, maximum lung expansion, and
productive coughing.
 If necessary, provide analgesia before
suctioning. Endotracheal suctioning stimulates
the cough reflex, which can cause pain for
clients who have had thoracic or abdominal
surgery or who have experienced traumatic
injury.
Prepare the client
 If the patient is on mechanical ventilation,
test to make sure disconnection of
ventilator attachment may be made with
one hand.
Prepare the Equipment
 Check function of suction and manual
resuscitation bag,
 Attach the resuscitation apparatus to the
oxygen source. Adjust the oxygen flow to
100% flush.
 Open the sterile supplies in readiness for
use.
Prepare the Equipment
 Place a sterile towel, if used, across the client’s
chest below the tracheostomy.
 Turn on the suction, snd set the pressure in
accordance with agency policy.
wall unit = 100-120 mmHg is normally used
for adults
50-95 mmHg for children and
infants.
Prepare the Equipment
 Put on a sterile gloves. Designate one
hand as contaminated for disconnecting,
bagging, and working the suction control.
Usually the dominant hand is kept sterile
and will be used to thread the suction
catheter.
Flush and lubricate the catheter.
 Using the dominant hand, place the
catheter tip in the sterile saline solution.
 Using the thumb of the non dominant
hand. Occlude the thumb control and
suction a small amount of the sterile
solution through the catheter.
If the client does not have copious
secretions, hyperventilate the lungs with
a resuscitation bag before suctioning.
 Summon an assistant, if one is available
for this step.
 Using your non dominant hand, turn on the
oxygen to 12 – 15 liters/min.
 If the client is receiving oxygen, disconnect
the oxygen source from the tracheostomy
tube using your non dominant hand.
 Attach the resuscitator to the
tracheostomy or endotracheal tube.
 Compress the Ambu bag three to five
times, ass the client inhales. This is best
done by a second person who can use
both hands to compress the bag, thus,
providing a greater inflation volume.
 Observe the rise and fall of the client’s
chest to assess the adequacy of
ventilation.
 Remove the resuscitation device and
place it on the bed of the client’s chest
with connector facing up.
VARIATION USING A
VENTILATOR TO PROVIDE
HYPERVENTILATION
 If the client is on ventilator, use the
ventilator for hyperventilation and hyper
oxygenation. Newer models have a mode
that provides 100% oxygen for 2 minutes
and then switches back to the previous
oxygen setting as well as a manual breath
or sigh button.
 If the client has copious secretions, do not
hyperventilate with resuscitator. Instead:
 Keep the regular oxygen delivery device
on and increase the liter flow or adjust the
FiO2 to 100% for several breaths before
suctioning.
Quickly but gently insert the catheter
without applying any suction.
 With your non dominant thumb off the
suction port, quickly but gently insert the
catheter into the trachea through the
tracheostomy tube.
 Insert the catheter about 1 to 2 cm(0.4 to
0.8) before applying suction.
Perform Suctioning
 Apply intermittent suction for 5 to 10
seconds by placing the non dominant
thumb over the thumb port.
 Rotate the catheter by rolling it between
your thumb and forefinger and slowly
withdrawing it.
 Withdraw the catheter completely,
and release the suction.
 Hyperventilate the client.
 Then suction again
Reassess the client’s oxygenation
status and repeat suctioning.
 Observe the client’s respirations and skin
color. Check the client’s pulse if
necessary, using your non dominant hand.
 Encourage the client to breathe deeply
and to cough between suctions.
 Allow 2-3 minutes between suctions when
possible.
 Flush the catheter and repeat suctioning
until the air passage is clear and the
breathing is relatively effortless and quiet.
 After each suction pick-up the
resuscitation bag with your non dominant
hand and ventilate the client with no more
than three breaths.
Return the patient to the ventilator
machine. Suction oral secretions from the
oropharynx above the artificial airway cuff.
Use another set of suction catheter.
 Dispose of equipment and ensure
availability for the next suction
 Flush the catheter and suction tubing.
 Turn off the suction and disconnect the
catheter from the suction tubing.
 Wrap the catheter around your sterile
hand and peel the gloves off so that it
turns inside out over the catheter.
 Discard the glove and the catheter in the
moisture-resistant bag.
 Replenish the sterile fluid and supplies so
that the suction is ready to use again.
 Provide for client comfort
and safety.
 Assist the client to a comfortable, safety
position that aids breathing. If the person
is conscious, a semi Fowler’s position is
frequently indicated. If the person is
unconscious, Sim’s position aids on the
drainage of secretions from the mouth.
Document relevant data. Record
the suctioning, including the
amount and description of suction
returns and any other relevant
assessment.
 Lifespan Considerations
 Have an assistant gently restrain the child to
keep the child’s hands out of the way. The
assistant will need to keep the child’s head in the
midline position.
 Elders often have cardiac and/or pulmonary
disease increasing their susceptibility to
hypoxemia related to suctioning. Watch closely
for signs of hypoxemia. If noted, stop suctioning
and hyper oxygenate.
 Do a thorough lung assessment before
and after suctioning to determine
effectiveness of suctioning and to be
aware of any special problems.
Unexpected situations and
Associated Interventions
 Secretions are blood-tinged when
suctioning
 Patient coughs hard enough to dislodge
tracheostomy
 Lung sounds do not improve greatly and
oxygen saturation remains low after three
suctioning.