Tracheostomy Suctioning Sterile?

[aimessue]

I'm a new LPN and I have a question.

I had a patient who was new to the facility. The day shift nurse told me that he needed to be suctioned frequently through his trach. After discussing his care, she informed me that they do not do suctioning as a sterile procedure. When I went into the patient's room, I discovered that she had been using the same catheter for every suction.

I am not comfortable doing this procedure as non sterile. So, I grabbed a kit and suctioned the way I was taught-sterile.

When I contacted the DON, she informed me that it was not to be done as a sterile procedure. Apparently the RT did not do it as sterile, and that is the way we are to do it.

Is this right?

[GreyGull]

Forgot this one of Debi. This is how tracheostoma patients prefer to clear their secretions.

That's it for my anti-smoking soapbox. Apologies for sidetracking the thread. But, for those who do smoke, remember these suctioning threads and start checking out your catheter preferences.

[debRN0417]

There are relatively few, and I mean few facilities here that will take a trach patient because of the cost, not only for supplies involved but because of staffing. I can only speak to the facilities I have been involved with, and I guess you could say we're beind the times in a lot of things. Thank you for the information. It is very helpful.

[Oprn54]

Typically in the nursing home setting trach care is a clean procedure, not sterile which is also the case with cathing a resident. You maintain as clean work area as possible, follow your standard precautions. Hospitals - sterile, long term care - clean.

[arabstarRN]

When my father in law was in ICU for almost three weeks after a severe stroke, he had a trach and at first, it was done using a sterile kit each time, however, that didnt last long before they hooked an inline catheter to his ventilator tubing and used that catheter at least once an hour, if not more depending on his needs as he had a lot of secretions. Yes it was his germs, but... my thought was, wouldn't it still breed bacteria? This was in ICU, and it was no different when he was moved to a rehab, where, unfortunately he wasn't able to come off the vent and since he had clearly stated many times he did not want to live that way or go into a nursing home, the family decided to remove the vent and discontinue treatments, place him on hospice and keep him comfortable.

I was taught in nursing school to use sterile techinque for any invasive procedure unless specifically stated it could be a clean procedure (trach care at home being done by patient or the patient's family, etc.), but I have also had nurses tell me, "That is NCLEX world, real world doesn't always work that way." so my best advice is do what you know is right, what will allow you to keep your job without putting your job at risk, what will protect your patients and yourself and what will not put your license on the line (these are in no particular order as they are all important to me). That is what I intend to do at my job that I start soon...

[CapeCodMermaid, RN]

Typically in the nursing home setting trach care is a clean procedure, not sterile which is also the case with cathing a resident. You maintain as clean work area as possible, follow your standard precautions. Hospitals - sterile, long term care - clean.

Hate to disagree but.....there aren't many things we do in LTC that require sterile technique, but catheterizing a resident is definitely a sterile procedure.

[diane227, LPN, RN]

You should use sterile technique. It is the best practice. You don't want to introduce bacteria into the trachea and thus the lungs. Who ever thinks this is a non-sterile procedure is mistaken.

[wannabe2008]

I know this is a really old thread but I still want to say "You can not do a sterile procedure in a non-sterile environment". What you can do is varying imitations of it though. The room, your clothers, the bed and sheets, his clothes, his roommates... are not sterile. Read your facilities Policy and Procedure manual. The manual contains alot of good info on almost anything you will do in a SNF.