Quote from Zumalog:
'When we went in room to do trach care--this resident kept telling us to go 'deeper' and wanted to be suctioned 5-10 times at once!!! I refused and this resident became very angry and told us to leave room.
When I discussed this with nursing staff they said they always suction this resident this way. It is what she wants. I know there is some sexual thing about being stimulated by lack of 02--one of the nurses said that this resident seems to enjoy when we suction her "deep and long". '
The Pulmonary nurse side of me makes me HAVE to respond here:
Concerns I have here are:
1. Nursing staff always suctioning patient this way; It's what SHE wants.---Long suctioning not good for the patient.
2. Lack of preparation by the staff to inform you and student in how THEY always suction the pattient.-----They set you and student up for failure.
As I say to my kids: Just because you want something, doesn't mean you have to get it.
I've cared for hundreds of respiratory/vent dependent patients in the past 25 years. Have gone AGAINST standard practice in a few situations after discussions with doctors and patients with patient fully aware of risks and side effects, because standard practice was not effective or meeting patient needs for THIS PARTICULAR PATIENT.
How this could have been handled differently:
1. Any time one deviates from usual standards of practice; DOCUMENT, DOCUMENT, DOCUMENT!!!!
That's the PURPOSE of care plans
----to document what and why you are performing a task. The fact that the nursing staff was suctioning this patient multiple times, going deeper than usual AND RATIONALE for performing this should have been on the care plan.
2. I would have gone out and BLASTED, professionally of course, the nursing staff for setting you up. Also, discussed with unit manager.
3. This was a golden teaching moment. After you cooled down and student stoped being bewildered/upset, I would have gone back and sat down with the patient to discuss WHY she feels the need for deep suctioning. After seeing PATIENTS viewpoint, explained why you acted the way you did as unprepared by staff.
4. If this is a long term client, you are most likely not going to change her behavior/request for suctioning this way.
5. I've had patients request this before--the few who did this have stated a feeling that somethings still down there.
Adequate hydation, gentle chest vibration and percussion, turning side to side, deep breathing with encouragement to cough THEN suctioning, often helped to move mucous upward with decreased need for porlonged suctioning. These could all be offered to the patient.
6. Hope you get a chance to go back again. If you can, meet with patient beforehand, explain staff didn't inform, discuss situation if she's open. If not, can you agree on so many passes beforehand and have same student again suction patient.
This can be win-win for both sides.
Never heard of sexual effects but some few patients do enjoy hypozic buzz. If return not possible, at least hope you had a chance to explore concerns with students.
Here are some good sites with rationale for your concerns. Let us know outcome.
Tracheal Suctioning of Adults with an Artificial Airway ...
File Format: PDF/Adobe Acrobat -
... the risk of trauma, hypoxia and other side effects ... that patients who are subjected to frequent suctioning episodes are also at risk of tracheal ...
STANDARDS OF NURSING CARE FOR ADULT PATIENTS WITH
PULMONARY DYSFUNCTION by American Thoracic Society/American Lung Assoc.
*** England--Royal College of Nursing :Tracheostomy care*** FANTASTIC!
Rehabilitation After Laryngectomy: A Practical Approach and Guidelines For Patients
Preoxygenation for tracheal suctioning in intubated, ventilated newborn infants