As a new nurse, how was your first experience with trach patients?

sallyrnrrt, ADN, RN · Feb 8, 2018

My ancient diploma RN program, prepared me well, unfortunate today's nursing programs, lack that intensive clinical component

Misstika · Feb 8, 2018

Yes these programs now really do lack substantial knowledge thats needed in the field. My program was accelerated. There's alot of things that were just slightly touched instead of in depth learning.

sevensonnets · Feb 8, 2018

Like Sally, my ancient (though BSN) program taught me great clinical skills. If you need to learn trach care and suctioning, admit that to your manager and observe an experienced nurse a few times. Observe, ask questions and learn, then try it with supervision.

Misstika · Feb 8, 2018

I've personally spoke with the administrator about how I felt. Thats exactly what I want to do. I put emphasis on having the opportunity to suction but have someone give feedback/tips. That never happens when I train. As I said earlier, my training in that area was minimal. Its sad because some nurses feel like me wanting to give proper care is not being a "confident" nurse.

Buckeye.nurse · Feb 11, 2018

I agree with other posters who suggested observing a more experienced nurse. Is there a charge RN who could assist you the first time or two? Don't discount respiratory therapy as a resource in this area as well. In my facility, they routinely suction trach'd patients during rounds, and have a schedule for changing the trach ties. Most RTs would be more than happy to give you suctioning pointers. They can also give you a quick walk-through on the heating/humidifying 02 set up for the trach.

Also, take a look at your policy/procedure on trach care. It should have some good basic information like how often to change/clean the inner cannula, frequency of site care, etc. My employer links many of our policies to Mosby's nursing skills. Mosby gives a great step by step run through on procedures. I've pulled up the Mosby skill for a task more than a few times when precepting a new nurse to refresh both of us and make sure I am teaching skills the right way.

Hopefully some of this helps you!

Kitiger, RN · Feb 11, 2018

Ask if you can shadow a respiratory therapist for a day. You will learn a ton!

Misstika · Feb 12, 2018

I am unsure about how open the RT would be giving me pointers. All I can do is ask. When she do trach cares, she seem to always be in a rush. Our facility want the trach sites cleaned and inner cannula changed daily. Also trach ties changed weekly. I work days, therefore when I'm on that unit, its my responsibility. I'm comfortable doing those cares. There's a couple trach patients that has thick secretions and sometimes have issues removing them. Therefore I need to practice suctioning. I literally started reading my MedSurg book again. I will look at Mosby's nursing skills next. Is the main issue is not suctioning too deep and too long? I've purchased a pulse ox to monitor them just in case.

Kitiger, RN · Feb 12, 2018

If you don't have an order specifying how deep to suction a patient, measure one of his old trachs or ask the respiratory therapist how long the trach is. You want the suction cath to go all the way to the end of the trach without coming out the tip of the trach. If he has an inner cannula, measure that.

Ideally, you will be using suction caths with the length in cm printed on the outside of the cath. In the home, when the cath does not have markings, we measure a piece of tape, mark the correct depth, and attach the tape to the suction machine. Obviously, you wouldn't let the sterile cath touch this tape.

Hold your breath while suctioning. If YOU get out of breath, I guarantee that your patient is out of breath, since you're pulling air out of him.

It's OK to use suction going in and out of the trach, since you will not be going past the tip of the trach. If you were deep suctioning, you would insert the cath without suction, using suction as you pulled the cath out. (Suction would tend to grab the wall of the trachea as you were pushing the cath in, thus poking the cath into the wall of the trachea.)

Misstika · Feb 12, 2018

Thank you very much for the tips. I will remember to use the inner cannula as a guide for how far to go. I heard the trick about holding your breath when suctioning before. I forgot all about that until you reminded me. I will do that too.

Thanks :)

Bubbly26, BSN, RN · Feb 12, 2018

I work on an oncology ENT floor and I suction patients almost daily. It gets better with practice. Ask an experienced nurse if you could watch them suction a patient. It also depends on the type of trach the patient have. If they have a lary tube, then little suction is needed like q6 hour suction. If they have a Shiley, for instance, then you would suction more frequently. Like q2 to a4 hours if they have thick secretions.

Good luck!

P.S. Don't stand right in front of the patient when you shadow the nurse as they suction the patient. Step to the side or you will regret it. I know from experience.

Misstika · Feb 12, 2018

Thanks for the comment :) I spoke with several people and now I will be retrained on that unit. Its a good thing, but it really depends on which nurses I'm paired with. Everyone isn't as open to training me as I thought. I was very upset to hear that people believe that I'm not confident when I specifically asked to be trained doing things I never done before. I just graduated in December.

The majority of trach patients has the Shiley tracheostomy. Therefore I will put emphasis on suctioning my first day training again. There's only one patient with a larytube. I find that type very interesting. She can talk a little bit but mostly communicate needs by writing on her dry erase board.

I learned in my clinicals about standing to the side. Secretions literally flew across the room. I needed that reminder though.