Considerations for Suctioning a Patient with a Tracheostomy

QUESTION

Case Study: Please read the assigned readings for this week in both the textbook and ATI. Using your new knowledge, please fill out the attached case study questions.

Tracie Oximistry- Age 33 years old Male/Jamaican
Catholic/Full Code
Vitals:

BP-98/54
HR-60
RR-16
SPO2-98% on 60 percent oxygen via ventilator

Temp-98.9 F

Awake, Alert, and Oriented

Mr. Oximistry was in a car accident and sustained injuries which has left him on a ventilator for 3 weeks. In order to help Mr. Oximistry transition off the ventilator more easily, the decision has been made to give Mr. Oximistry a tracheostomy. You have come on shift just after Mr. Oximistry has returned from surgery. He is coughing a little and you decide to try to suction his tracheostomy with the inline suction on the ventilator. This however is not working as desired, so you decide to use a suction catheter that is independent from the setup.

1. Please describe some considerations that would go with suctioning someone with a tracheostomy.
2. What assessments would you perform prior to tracheal suctioning? Is tracheal suctioning clean or sterile technique?
3. Describe the process of suctioning out a patient with a tracheostomy tube?
4. How would you go about performing a dressing change on a tracheostomy site? What is the main difference between fresh tracheostomy site care and established tracheostomy care?

ANSWER

Considerations for Suctioning a Patient with a Tracheostomy

Suctioning a patient with a tracheostomy requires careful considerations to ensure patient safety and effectiveness of the procedure. Some important considerations include:

Assessment of Indications: Prior to suctioning, it is crucial to assess the patient’s need for suctioning. Signs of increased secretions, audible or visible congestion, or difficulty breathing indicate the need for suctioning. It is important to assess the patient’s oxygen saturation, respiratory rate, and overall respiratory status to determine the frequency and necessity of suctioning.

Preoxygenation: Prior to suctioning, the patient should be preoxygenated with 100% oxygen for at least 30 seconds to prevent hypoxemia during the procedure.

Selection of Suction Catheter: Choosing the appropriate size and length of the suction catheter is important to ensure effective suctioning without causing trauma to the tracheal mucosa. The size of the catheter should be no larger than half the inner diameter of the tracheostomy tube.

Technique: Suctioning should be performed using aseptic technique to minimize the risk of infection. Proper hand hygiene and use of sterile gloves are essential. Maintaining a closed system and using sterile saline solution for lavage can also help reduce the risk of contamination.

Process of Suctioning a Patient with a Tracheostomy Tube

Preparations: Gather all necessary equipment, including suction catheter, gloves, sterile saline solution, suction source, and suction tubing. Perform hand hygiene and don sterile gloves.

 Preoxygenation: Administer 100% oxygen to the patient for 30 seconds to ensure adequate oxygenation during the procedure.

 Insertion of Suction Catheter: Insert the suction catheter gently through the tracheostomy tube until resistance is felt or the patient coughs. Withdraw the catheter slightly to ensure it is positioned in the trachea rather than the bronchus.

Suctioning Technique: Apply suction intermittently while rotating and withdrawing the catheter in a circular motion. Suction should be applied for no more than 10-15 seconds to prevent hypoxemia and trauma to the tracheal mucosa. Observe the patient’s response and monitor for signs of distress.

Post-suctioning Care: After suctioning, provide oral care and reassess the patient’s respiratory status, oxygen saturation, and overall comfort. Document the procedure, including the amount and characteristics of secretions.

Performing a Dressing Change on a Tracheostomy Site

A dressing change on a tracheostomy site is an important aspect of tracheostomy care to prevent infection and promote healing. The main difference between fresh tracheostomy site care and established tracheostomy care lies in the level of caution exercised during the dressing change.

Fresh Tracheostomy Site Care: For a newly created tracheostomy site, the dressing change requires sterile technique. The nurse should use sterile gloves, sterile saline solution, and sterile gauze to clean the site and apply a sterile dressing. The dressing should be secured with sterile tape or ties.

Established Tracheostomy Care: Once the tracheostomy site is well healed, dressing changes can be performed using clean technique. Clean gloves and clean gauze can be used to cleanse the site with normal saline solution. The dressing can be changed as needed to maintain cleanliness and prevent moisture accumulation.

Conclusion

Suctioning a patient with a tracheostomy requires careful considerations, proper technique, and adherence to infection control practices. Assessments prior to suctioning, selection of appropriate suction catheter, and maintenance of aseptic technique are crucial in ensuring patient safety and minimizing complications. Performing a tracheostomy dressing change involves following either sterile or clean technique, depending on whether the site is fresh or established. By implementing these practices, nurses can effectively manage tracheostomy care and promote patient comfort and recovery.