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It takes practice. When you do trach suctioning you should make sure that you use an ambu bag with high flow oxygen to pre-oxygenate your patient first. Make sure that if you use those small pink saline containers that you pop the top off away from the patient or you risk having that small tab going into the trachea. Never use a saline that contains a bacteriostatic agent to suction your patient.
Suctioning is a sterile procedure. You will find that when you do it properly you will end up with a clean hand and a dirty hand. Let me try to explain this.
I am right handed. This is the hand I will use to perform the suction procedure.
1. Set up your equipment. Get your ambu bag ready on high flow oxygen.
2. Make sure that your suction canister is set up with tubing and that your suction is set to "continuous".
3. Get your suction kit and open it, maintaining sterile technique.
4. Put the gloves on.
5. With both hands pick up the suction catheter and hold it in your right hand. You are still sterile. Take the catheter out of the little bag and wrap the sterile catheter around your right hand.
6. With your left hand, connect the end of the suction catheter to the suction tubing. Your left hand has just become your dirty hand.
7. Remove the trach collar or vent tube with your left hand. You have to learn to do this with one hand.
8. Then, again using only your left hand, connect your ambu bag to the trach tube and give your patient several deep breaths.
9. Open you little pink saline vials with your left hand by flipping open the top with your left hand. Open away from the patient.
10 Instill the saline down the trach and then give the patient a few deep breaths with the ambu bag using only your left hand.
11. Hold the trach tube (or not) with your left hand and insert the sterile suction tubing into the trachea using only your right hand. This should be done quickly. Do NOT apply suction to the device as you insert it.
12. Quickly withdraw the suction catheter, while applying suction by placing your thumb over the hole at the top of the sterile suction tube. As you withdraw the tube from the trachea, make circular motions with the sterile catheter. You should do this rather quickly because remember you are removing the oxygen in the airway as you perform suction. As you withdraw the catheter, wrap it around your right hand to keep it sterile.
13.. Quickly provide the patient with breaths via the ambu bag on high flow oxygen. This will probably induce coughing.
14. Repeat as needed.
15. To reach into the right main stem, rotate the patients shoulders and head slightly toward their left side. To get into the left, rotate shoulders and head slightly to the right.
Remember: explain the procedure to the patient. Place a clean towel over the patients chest in case they cough it won't get on their gown or linen. Mouth care is essential for these patients.
This appears complicated but I assure you that once you get the steps down you will be able to accomplish the task. If you have small hands and you cannot grip the ambu bag well enough to compress it completely, you will have to position yourself in order to compress it between your hand and another stiff surface. I compress it against my upper abdomen.
If you have a Lippincott Manual it should also have directions there as well.