As you advance the catheter you meet resistance and the client begins to cough

The tracheostomy effects the normal functions of the upper airway including secretion management and humification due to impaired cough reflex, increased mucous production and impaired actions of the cilia.  Tracheal suctioning is one strategy to assist in secretion management for individuals with tracheostomy.  Suctioning is an important part of care for both the individual with tracheostomy as well as laryngectomy.  

Tracheal suctioning is performed to remove secretions from the tracheostomy tube and airway in order to maintain a patent airway and avoid tracheostomy tube blockages.   The amount of secretions varies by patient as does the amount of suctioning needs.  Some individuals are able to project mucous out of the tracheostomy tube by coughing.  Once an individual can tolerate a speaking valve or cap, they may be able to cough secretions around the tracheostomy tube, through the upper airway and out of the mouth.  The ability to forcibly cough secretions through the upper airway is one indicator for readiness of decannulation.  

Suctioning is a lifesaving procedure requiring timely and precise methodology. If done appropriately with caution, it decreases the risk of infection, pooling of secretions, and prolonged hypoxia.  Suctioning of the airways should be performed by skilled personnel with appropriate preparation to prevent  

When to perform tracheal suctioning

The Clinical Consensus Guidelines indicates that the stoma and tracheostomy tube should be suctioned when there is evidence of visual or audible secretions in the airway, suspected airway obstruction, and when the tube is changed or the cuff deflated (Mitchell, 2013).  Indications include noisy or moist respirations, prolonged expiratory breath sounds, increased respiratory effort, oxygen desaturations, restlessness, increased coughing or reduced effectiveness of coughing, increased use of accessory muscles and patient request.  Signs of airway obstruction include hypoxia and cardiovascular changes.   Easy passage of a suction catheter and removal of secretions confirms proper placement and patency of the tracheostomy tube.

There is no clear consensus on how frequently an individual should be suctioned.   It is patient dependent on the amount of secretions and their ability to clear the secretions independently.   Airway patency can be checked by attempting suctioning at least every 8 hours.

The inability to pass a suction catheter indicates the airway is not patent Failure to pass a suction catheter may indicate that the tube is blocked or displaced and should prompt assessment by an appropriately trained individual. This is a red flag and requires quick attention. × Dismiss alert

There are no absolute contraindications to suctioning.  Risks are associated with suctioning and should be weighed with specific individual patient needs.  

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  14 Modules

  Adult Tracheostomy Care Webinar: Home Edition

  
  katrina-cambigue

  Adult Tracheostomy Care: Home Edition Webinar 20% off!  Now available! AARC CEU- 1.0 contact hours Adult Tracheostomy Care: Home Edition is a 1 hour recorded webinar which provides information about performing tracheostomy care for adult patients in the home environment. Learn about suctioning, inner cannulas (disposable vs non-disposable), tracheostomy tube cleaning (if indicated), stoma care, cuff management, humidification and communication with the interdisciplinary team.  Education is a main role of respiratory therapist in the home environment.  Videos are used to aide in learner comprehension of tracheostomy care.  A sample interdisciplinary communication form will be provided as well as home care guideline samples. Webinar objectives

  • Identify the indications for and complications of a tracheostomy
  • Note the differences and limitations of tracheostomy care at home versus acute care
  • Demonstrate how to perform trach care (inner cannula changes, site care, cuff management, suctioning)
  • Identify the steps for tracheostomy tube changes
  • Discuss patient/family education for humidification, oxygen, nebulizers, and mechanical ventilation with trachs.
  Instructor:  Katrina Cambigue BS, RCP, RRT-ACCS Katrina is a respiratory therapist at Kaiser Santa Rosa Pulmonary Rehab as well and a clinical instructor at Napa Valley Community College.

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  15 Modules

  Tracheostomy Tubes Webinar: Comparisons and Choices is a 2 hour recorded course that is all about different types of tracheostomy tubes and how to choose the most appropriate tracheostomy tube for your patient.  Even those working with trach tubes for years will likely learn something new in this detail oriented course on trach tubes.  In this course, the risk of inappropriate tracheostomy tubes based on the size and length will be provided. The course will also provide information on different trach tube materials, size, length, cuff type, cuff vs cuffless, single vs double cannula, fenestrated, subglottic suctioning and custom tubes.  The Tracheostomy Tubes Webinar will provide information on  patient candidacy for the types of tubes.  Course is for physicians, respiratory therapists, nurses, nurse practitioners, physician assistants, speech-language pathologists, and any clinician caring for patients with tracheostomy. Course Format: Video Powerpoint with author narration and video samples Presenter: Mona Lisa Baxter BA, RRT, RRT-ACCS Mona is an Adult Critical Care Respiratory Therapist with extensive background in teaching and presenting respiratory topics, currently contracting with Legacy Mt. Hood Hospital in Graham Oregon. Application for continuing education credit has been made to AARC for 1 CRCE. Course Certificate is provided upon completion. Which of the following is the best indicator for suctioning a client?

  A pressure change on the ventilator, specifically peak inspiratory pressure (PIP), is a classic indicator that your patient may need suctioning.

  What is the primary indication for tracheal suctioning?

  Suctioning is performed when the patient is unable to effectively move secretions from the respiratory tract. This may occur with excessive production of secretions or ineffective clearance, which leads to the accumulation of secretions in the upper and lower respiratory tract.

  Which action should the nurse take when caring for a client with a tracheostomy?

  Perform hand hygiene, apply non-sterile gloves. Suction the oropharynx if indicated to remove any pooled secretions before cuff deflation to minimize risk of aspiration. Perform routine tracheostomy tube suction procedure.

  Which is the best method for the nurse to use when evaluating the effectiveness of tracheal suctioning?

  Assessment. ETT suction should be based on a clinical assessment of the infant. The inspired gas is warmed and humidified (therefore decreasing the amount of secretions drying and occluding the airway). Auscultate with stethoscope before and after ETT suction to evaluate necessity and effectiveness of the procedure.