Respiratory: Tracheostomy suctioning (for nursing assistant training)

Tracheostomy. Suctioning is a procedure used to remove secretions from the trachea.

In individuals with tracheostomy tubes. A tracheostomy tube is an alternative airway for breathing that is inserted through a hole made on the neck and trachea into the tracheal lumen.

Tracheostomy tubes are used to bypass an upper airway obstruction to prevent aspiration and enable easier suction of tracheal secretions which can block the normal airflow and lead to an insufficient oxygen supply.

Generally, nursing assistants should alert the nurse if they think a client requires suctioning, they can assist with tracheostomy suctioning by gathering the required supplies.

Now, common signs and symptoms that suggest that a client may require suctioning include a nonproductive cough, increased heart and respiratory rate, noisy breathing, shortness of breath, visible secretions and the presence of coarse breathing sounds or rattling lung sounds.

Now, there are two types of suction. Catheters used for tracheostomy suctioning.

The first one is a one time use catheter with a control port which comes in a sterile kit along with sterile gloves and connecting tubing.

This catheter is sterile which minimizes the risk of infection. It's transparent, which lets the nurse see the secretions and fluids being suctioned out and it has the thumb control port which enables suction control one time use, suction catheters typically have a tip with a single opening and come in various sizes for clients who require mechanical ventilation.

A closed or in line suction catheter can be used without disconnecting the mechanical ventilator. They are typically used in intensive care units.

These catheters are wrapped by a sterile plastic sleeve. So sterile gloves are not necessary.

Instead, the nurse can use the regular or clean gloves, switching gears and moving on to the supplies. If this procedure is within your authorized duties and facility policy, and you're assigned to gather supplies.

Confirm with the nurse what supplies are needed and the proper sizes. Supplies for this procedure include mask and goggles or face shield, bath towels, cloth or disposable paper, drape, sterile cup, sterile water, or saline and sterile or regular gloves depending on the type of catheter.

Most importantly, you need a suction device connecting tubing and suitable size catheter if needed. You should also get a nasal or oral airway.

Additionally, make sure there is an extra sterile tracheostomy of the same size and an obturator in the client's room in case of complications such as blockage or accidentally dislodging the tube for the procedure.

The client should be in a semi Fowler or sitting position with a bath towel, cloth or paper drape over their chest, perform hand hygiene and apply clean gloves.

Use a face shield or mask because suctioning can cause splashing. Now, let's focus on one time use sterile catheters.

The nurse will ensure that the tracheostomy tube is securely tied and will hyperoxygenate the client for 30 to 60 seconds with 100% oxygen hyperoxygenation refers to the administration of excess oxygen in order to prevent hypoxia, which is a condition when there is not enough oxygen to meet the needs of the body.

Next, the nurse will prepare the supplies and fill a sterile container with sterile water or saline. Then the nurse will insert the catheter into the trachea and rotate it to make sure that all of the secretions are suctioned out.

If the catheter becomes plugged with secretions, the nurse will rinse the catheter line by placing the tip into the sterile water or saline and blocking the thumb port to activate the suction.

It's important to note that suctioning should not be performed for longer than 10 seconds because prolonged suction can damage tracheal mucosa or cause hypoxia because the client can't breathe while they are being suctioned.

Once the procedure is done, the nurse may hyperoxygenate the client again, remove the bath towel, cloth or disposable drape, reposition your client and clean up the supplies.

Finally remove the gloves, face shield or mask and don't forget to perform hand hygiene. Now, switching gears and moving on to reporting if you're assisting in the procedure, be sure to bring any abnormal observations to the nurse's attention during and after the procedure, these include bloody sputum, abnormal heart rate and breathing and a decrease in oxygen saturation.

All right. As a quick recap, tracheostomy sectioning is a procedure used to remove secretions from the trachea in individuals with tracheostomy tubes.

Understand your authorized duties and facility policy before assisting in the procedure. Two types of catheters include one time use sterile catheters with a control port and closed or in line suction.

Catheters. Supplies for this procedure include mask and goggles or face shield, bath towels, cloth, or disposable paper, drape, sterile cup, sterile water or saline and sterile or regular gloves depending on the type of catheter.

Most importantly, don't forget a suction device connecting tubing and suction catheters if needed. You should also get a nasal or oral airway.

Also always ensure there is an extra sterile tracheostomy of the same size and an obturator in the client's room in case of complications during and after the procedure.

Be sure to report any abnormal observations to the licensed