Tracheostomy suctioning

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This topic contains 6 replies, has 5 voices, and was last updated by Avatar of Becky Oloo LPN b_oloo2008 11 months, 4 weeks ago.

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  • #8934
    Avatar of Becky Oloo LPN
    b_oloo2008
    Member

    I have an 18 and 21 year old that I am going to be taking care of for the rest of the school year. They both have trachs. I know how to clean a trach but have not suctioned since nursing school. What is the depth you can suction? If I remember right it’s no more than 6 inches or as ordered. Please advise. Thank you.

    #8935
    Avatar of Jason Hautala RN
    Jason Hautala RN
    Moderator

    6″ or until you meet resistance. If you are going to be doing it frequently, stick it down until you meet resistance, note how far down that is, and then from that point on, go just shy of that mark so it goes as deep as it can without hitting anything.

    Suck on the way out, no more than 10 seconds. Let the patient catch his breath between suctionings.

    Most important, don’t stand in front of trach … when they cough, and they will, the spray zone is a dangerous place to be standing, so come at it from the side.

    #9040
    Avatar of cwkmom
    cwkmom
    Member

    What is the safest frequency of suctioning a 7 month old preemie?

    #9041
    Avatar of Jan
    Jan
    Member

    The trach has a length, do not suction past that length. Very painful and stimulates cough. Only suction past that if point if you meet resistance, then use saline drops first and then suction again to remove mucus plug. If unable to remove with suctioning, then preform and emergency trach change.

    I know that respiratory folks in hospitals suction deep, please do not do that to these kiddos.

    #9042
    Avatar of Susabella
    Susabella
    Member

    This may come across as mean to some of the previous responders, but I have to voice this. I used to be a pediatric pulmonary nurse. I served on a committee to review/drastically change our trach policy in the pediatric hospital where I work. Many of the things mentioned above are not correct. We did lots of research, including consulting hospitals and lit reviews before deciding on what to change in our policy.
    First, the suction length should ALWAYS correspond to the trach length. ALWAYS. If you are unsure, or just want to double check, take the CORRECT size catheter (which should be half the size of the diameter of the trach), insert it into the extra trach you should always have at the patient’s bedside, even in homecare (which I also do). The first (or only) hole in the catheter should just appear at the bottom of the trach. This is your suction length. Suction length is in centimeter, not inches. The hole needs to be just through the bottom to provide the correct suction to adequately remove secretions. DO NOT go past this, ever! You will cause abrasions in the trachea, which can provide a place for bacteria to grow. This is especially important in kids/adults who do not have a gag reflex-they will not respond or cough, but you are still scraping the trachea.
    As far as suctioning only on the way out, at my hospital, we suction in and out. There is no research that supports either way. We also just went to sterile suctioning at my hospital. A pain, yes, but with all of the healthcare changes going on, our goal is to prevent nosocomial infections that are no longer covered by medicare/medicaid.
    And as to the rrequency question above, we try to suction as infrequently as possible. In fresh trachs, we have to suction every two hours (they are sutured in, and in case of a plug off it is a code situation, so we do it to prevent that situation). Otherwise, only as needed. You are not preventing secretions from developing by more frequent suctioning, and could be making them cough, thus increasing secretions. In other words, if they are not goopy, don’t suction them.

    Also, saline drops have not been proven to break up secretions, and have been shown to lead to pneumonia(flowing down to lungs). We are not permittted in my hospital to use saline, ever.

    #9043
    Avatar of Susabella
    Susabella
    Member

    Also, in my hospital system, we have “safe suction” cards that hang at the bedside (espeically in peds, but also in adults). These cards have the trach size, emergency trach size, suction length and correct catheter size, trach change date. This way, anyone coming in the room to help can see it and not guess. Lots of people take these home and use them for their homecare nurses.

    #9051
    Avatar of Becky Oloo LPN
    b_oloo2008
    Member

    Found out on day one that both of my clients have standing orders from their doctors on specifics how they are to be suctioned. Thank you all for your advice.

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