Ughhh, trachs. My nemesis. I graduated almost 2 years ago, and work in one of the bigger hospitals in Dallas. I work on a very busy med-surg floor (I know, they are all busy, but ours can tend to turn into "ICU light"). My worst night was a couple of weeks after finishing orientation, and already had a full load of heavy patients. I got an admission, and this guy was THE WORST trach patient I've had. It was my first trach, he spoke only spanish (although I don't remember him ever really responding) and had terrible, projectile, secretions. It being my first trach, I was petrified, and thought I was gonna do something to kill him. It was the night that all new nurses have at some point. I was drowning, and I knew it. After I went into the med room and melted down, I pulled myself together, and got the charge nurse (who is now me
) to help me.
Anyway, we are lucky in that we have an ENT floor, and most trachs end up there. For the last couple months, tho, we have had at least one, and usually two trach patients (one of which is a DNR now).
I am much more comfortable managing and suctioning trachs now, as I've had each of these patients many times.
It seems like when you ask people for advice, everyone gives you a different answer. How often to suction? I've been told if a patient is satting well, don't suction. I've been told to do it if it sounds like they have a lot of secretions.
How many people go in until they feel resistance, and how many only go about the lenth of the trach, or an inch or so longer? I never go until I feel resistance. I've seen nurses and RT go deep and frequently enough that the secretions are pink, which I suspect is blood.