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Tracheostomy suctioning: Clinical skills notes

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Notes

Respiratory

Tracheostomy Suctioning

INTRODUCTION

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. 

SIGNS, SYMPTOMS, AND SITUATIONS WHERE THE PROCEDURE IS NEEDED
Common signs and symptoms that suggest that a client may require suctioning include:
  • a non-productive cough
  • increased heart and respiratory rate
  • noisy breathing
  • shortness of breath
  • visible secretions
  • the presence of coarse breathing sounds or rattling lung sounds
TYPES OF SUCTION CATHETERS

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 you 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, you can use the regular, or clean, gloves.
Figure 1: A. One-time use catheter with a control port and B. a closed suction catheter.
SUPPLIES
Supplies for this procedure include:
  • mask and goggles or face shield
  • bath towels, cloth, or disposable paper drape
  • sterile cup
  • sterile water or saline
  • sterile or regular gloves depending on the type of catheter
  • a suction device, connecting tubing, and suitable-size catheter
  • a nasal or oral airway, if needed

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.
PROCEDURE
For the procedure, the client should be in a semi-Fowler or sitting position with a bath towel, cloth, or paper draped 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.
  1. Ensure that the tracheostomy tube is securely tied.
  2. Hyperoxygenate the client for 30–60 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.
  3. Prepare the supplies and fill a sterile container with sterile water or saline.
  4. 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, rinse the catheter line by placing the tip into the sterile water or saline and blocking the thumb port to activate the suction.
    • 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.
  5. Once the procedure is done, you may hyperoxygenate the client again.
  6. Remove the bath towel, cloth, or disposable drape.
  7. Reposition your client.
  8. Clean up the suppiles.
  9. Remove the gloves, face shield, or mask.
  10. Perform hand hygiene.
REPORTING & DOCUMENTATION
Document:
  • the date and time of the procedure
  • any abnormal observations, including bloody sputum, abnormal heart rate and breathing, and a decrease in oxygen saturation after suctioning has been performed

Summary

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 in the neck and trachea into the tracheal lumen. Tracheostomy tubes are used to bypass an upper airway obstruction; prevent aspiration; and enable easier suction of tracheal secretions, which can block the normal airflow and lead to an insufficient oxygen supply. Tracheostomy suctioning should only be performed by a trained healthcare provider, to minimize possible injury to the trachea or bronchi, which can lead to complications such as bleeding, or infection.