tracheostomy tricks of trade

Agnus · Oct 23, 2002

If you are drawing blood you have traumatized the tissues. Most likely because you have suctioned when it was not really needed. New rule of thumb not is not to suction except PRN. That is when the patient cannot clear secretions themselves any other way and the sats are dropping. Blood is not from too deep blood is from trauma and like I said this usually happens from excess suctioning.

I work a lot with trach patients. We usually have a number of them at any given time. The old thing about saline bullets is no longer valid either. Turns out it really has next to zero benefit.

ohbet · Oct 24, 2002

Thanks Agnus

Home Health Columnist / Guide · Oct 24, 2002

Look at this previous post---tons of info and links:

https://allnurses.com/forums/showthread.php?s=&threadid=18893&highlight=tracheostomy

allevi · Oct 24, 2002

I am speaking as both a nurse and a mom of trached child. I have learned many tricks in the last eight years of living with my daughter. I have only dealt with one trached patient, and that was not my favorite, different when it is your own child.

I rarely suction with catheter, just with a small tipped suction to clean out end, very good cough reflex! When you do use cath, never suction past end of trach, that causes tissue damage. Advance cathether to end and withdraw slightly, then apply suction. Personally I also think saline works wonders. Have heard the studies, but a few drops of saline in my daughters trach and she coughs everything out. Saline nebulizer treatments also work well for extra humidity.

My personal preference is also no half strength peroxide to clean around trach either, just causes damage to tissue. Just plain saline or good old soap and water is best. Just my opinion.

Agnus · Oct 24, 2002

allevi

I agree with your comments.

As far as the saline bullets, I'm not saying never use them. When ther is a big ol hard plug they can help. However routine use is not usesful. Sounds like you are using it to trigger a cough reflex.

Patients who do not have a cough reflex and are not able to clear airway may occasionally need deep suction. However, if they can cough it up themselves it is best to let them.

BadBird, BSN, RN · Oct 24, 2002

I like to do chest PT before suctioning, I do use saline if the secretions are dry.

BadBird, BSN, RN · Oct 24, 2002

I like to do chest PT before suctioning, I do use saline if the secretions are dry.

renerian, BSN, RN · Oct 24, 2002

LOL yes find an RT to do it..............LOLL Sorry just joking..........could not resist........

renerian

CaliNurse · Oct 25, 2002

I have worked with trach patient for the last 7 years. When we get nurses who are new to the everyday aspects of trach patients I often open a spare trach up and let them fiddle around with it. You then will get the sense of how deep to go to reach the end of the trach.

If you see blood that is a real sign of trauma. Are you suctioning as you go in? We have comatose patients who do not have a cough reflex and sometimes we need to go deeper. I find that my first few rounds of a 12 hours shift using my saline and suctioning clears them out.

We use 1/2 & 1/2 saline and peroxide for trach care. We have never had a problem with this in the facility. However when I worked home care I did have a few kids that were sensative to it.

Sometimes if there is a lot of dried secretions external to the trach we use a oral care swab for cleaning.

Oh, the other thing that may help you ....... call them trach for now on. Save yourself the time and chart trach to. (Of course check your facilities abbreviation list to make sure you are using theirs :> )

It will grown on you. I wasn't used to the snot for the first year. Now it seems normal to me.

Good Luck,

Cali

whipping girl in 07, RN · Oct 25, 2002

Ewww, no I hate trachs!! The only way I want to suction a trach is if the patient is on a vent with a ballard suction setup. Fortunately our RTs do our trach care so I don't often have to do it unless it's a fresh trach with a lot of secretions and it has to be done more often than RT does it (q8h).

So you're not alone in your dislike.

Also, if I have a patient who is not on a vent with a trach, if they have a good cough reflex I encourage them to cough and hold the yankauer near the trach opening (but not in the opening or touching the opening) to get the secretions.

Oh, yes. Wear eye protection!

micro, RN · Oct 25, 2002

I don't mind suctioning, as far as the nursing aspect of it. I know many people, say secretions, yeck.....even nurses.

Allevi-----thank you for sharing........

I also agree, I have seen studies that say H202 is no longer recommended.

Also that saline is not used just prior to suction.

ohbet: hang in there........nursing is not always glamourous.....

a little bleeding, shows trauma to the tissue.....

too aggressive of suctioning, or too frequent of suctioning.....

a little, is sometimes 'par for the '

but risk is hemorrhage.........

always provide extra oxygenation prior and during suctioning.....

recheck sao2 concentration, pulse ox connections, change connections, etc.

look at patient first, ensure all connections together from patient out.....prior to suctioning.....unless need for suctioning is "obvious"

always ask for assist in changing trach ties, bagging someone, etc. that is not a sign of weakness or less ability.....

it is a sign of good nursing care......

suction only when needed....

no longer to suction (for example: q 4 hours)

micro