Trach suction vs. O2 depletion

  1. Have a question for you all out there. I recently was subbing for my coordinator at LPN program I work for--the resident we had to take care of is an old trach patient. The resident is alert and oriented. The student was to do trach care and suction her prn.

    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".

    This seems too sick for me--besides the fact that her lungs are clear and you don't get much mucus when you do suction. What do you guys think??? Has anyone ever heard of such a thing?
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  2. 7 Comments

  3. by   sunnygirl272
    the sexual thing w/ O2 deprivation is that orgasms are supposedly intensified by the hypoxia...doubt this woman is getting off with the long deep suction unless there is other things going on at the same time...
  4. by   pebbles
    Gross!

    This resident needs to be told that you can irritate and even damage her respiratcory tracts by suctioning too vigorously. You'd be liable for any damage that did occur - short tern or long term.....
  5. by   NurseDennie
    I dunno about the sexual thing.... I can't imagine that anoxia alone is sexy. But on the other hand, we do a lot of stuff that kills brain cells and seem to enjoy it. Maybe she gets a "buzz."

    But I always read that three times only, three seconds each time. They lose brain cells every time you have to suction.

    I think she should be doing DB/C and other than that, I don't know!

    Love

    Dennie
  6. by   NRSKarenRN
    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 ...
    www.joannabriggs.edu.au/bpsuc.pdf


    STANDARDS OF NURSING CARE FOR ADULT PATIENTS WITH
    PULMONARY DYSFUNCTION by American Thoracic Society/American Lung Assoc.
    http://www.thoracic.org/adobe/statem...unction1-6.pdf


    *** England--Royal College of Nursing :Tracheostomy care*** FANTASTIC!
    http://www.nursing-standard.co.uk/ar...s/p4552w42.pdf


    Rehabilitation After Laryngectomy: A Practical Approach and Guidelines For Patients
    http://www.principalhealthnews.com/a...well/102243554

    --------------------------------
    For neonates---
    Preoxygenation for tracheal suctioning in intubated, ventilated newborn infants
    http://www.nichd.nih.gov/cochrane/pr.../pritchard.HTM
    Last edit by NRSKarenRN on Jul 22, '02
  7. by   stevierae
    We were always taught to HYPERVENTILATE the patient before doing ANY suctioning to PREVENT hypoxia. Maybe if you do thatroutinely, she won't GET the hypoxic sexual side effect (for lack of a better word) and will stop requesting this "service."
  8. by   micro
    NRSKarenRN

    You said it better than I could even begin to. Ignorance on the part of staff and believing one of the "suctioning myths" floating around out there. do not mean any disrespect to anyone here, but i have heard this one for many years.............

    Have found yes, that some patients do like to be suctioned quite frequently........when not needed. I think the furthest thing from their mind is any kind of sexual pleasure.....

    and please disregard anything as factual that micro types below.....
    because it is only purely nursing conjecture....
    possibly a security need......
    a fixation on the ventilator and the need of being suctioned.....
    anxiety.........
    a way to get staff's attention.............
    BUT THE ABOVE DO NOT MEAN THAT I AM INSULTING THE PATIENT OR RESIDENT IN ANY WAY..........
    to be on the other end of this nightmare...........well, this is probably a coping mechanism.....maybe not the most healthy, but a coping mechanism no less.......

    but it does not disclude that the patient can feel the need and rightfully so to be suctioned, but is not symptomatic of this action........
    it is a tough call and ability to educate the patient that is experiencing such..........that they are okay.....
    you try fighting for air, not being able to breathe without a ventilator....then they start weaning you on a trach collar.....
    and they(meaning us nurses, etc) tell us how good we are doing..........and we feel like we can't breathe......SUCTION ME!!!!!!!!!!!!!

    suctioning is a necessary nursing action..........but you need to not overly suction.....
    it does damage tissue.....
    can cause bleeding and hemorrhage.........
    it does deplete the O2 level.........
    you must hyperventilate, hyperoxygenate the patient before suctioning and monitor.........


    for a patient now resident.......that stays with a longterm trach...........what a life this person must face.......
    with physical demands.....
    and mental changes.........
    and ....................

    nursing is not an easy place to be.....
    but it is a rewarding one.............

    it is nice to feel good when the day is done!!!!!!!!!
  9. by   stevierae
    Another question--you said she was an old trach patient--meaning, she's had the trach for a long time, correct? Sooooo--why can't she suction herself? If she was at home, she would, correct?

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