Deep Suction for comfort with trach at end of life?

CamillusRN, BSN · Apr 10, 2015

I work mainly in the ER, but during nursing school the clinical preceptors for my hospice care rotation stated that they pretty much avoid deep suctioning altogether since it stimulates an increase in secretions and worsens the patient's condition while doing little or no palliative good.

Alex Egan, LPN, EMT-B · Apr 10, 2015

My thought would be that comfort care usually means not adding invasive care. If the person has a long standing tracheostomy and has been deep suctioned for years, than its a normal part of their care. I would say that not doing it would be similar to turning off a chronic COPDers O2 or refusing them a cpap they have used for years simply because they are comfort care.

Red Kryptonite · Apr 10, 2015

Patient's pain and air hunger is well controlled with MSIR and Ativan and is "brain dead" according to doc's.

Wait....what?!

RNNPICU, BSN, RN · Apr 10, 2015

For trachs, there really should be no such thing as deep suctioning. Each trach has a specific length. When suctioning, you are just clearing past the tip of the trach. Suctioning a trach is definitely for comfort as this IS their airway and should be clear to help them breath easier. Suction the trach, clear the secretions to give them comfort. You should never be suctioning a trach to the point of causing discomfort. If you are eliciting a cough though, your patient may not be "brain dead"

dirtyhippiegirl, BSN, RN · Apr 10, 2015

Are you talking about suction q4h or q2h standing orders regardless (I have seen these) or just suctioning PRN? Does he look comfortable but sound like crap?

ixchel · Apr 10, 2015

If the patient is brain dead, how are they not on a vent?

My limited experience with trachs, those who have them actually experience increased comfort when they are suctioned PRN.

ICUNurseStat · Apr 10, 2015

If the patient has a trach but is not on a vent they are not brain dead. People who have progressed to brain death are unable to breathe independently. Perhaps this patient is actually in a persistent vegetative state. With regard to suctioning, does it appear to make the patient more or less comfortable when you do it? That's really the question you need to answer.

BryceBehrens · Apr 11, 2015

I should have been more clear "brain dead" was just what the doc said. Glasgow scale is 4 - but this is of no consequence. Patient is on comfort care and 3 weeks into no food and only g-tube flushea for patensy.

Before this change in plan of care we would regularly do deep suction prn.

Deep suction is only indicated due to other nurses hearing crackles upon auscultation.

I mi personally don't feel like if the hospice client doesn't appear to be in pain or discomfort we should do additional intervention. That's where the disagreement is stemming between the nurses providing care.

Alex Egan, LPN, EMT-B · Apr 11, 2015

My policy on suctioning is if I can't hear it with my unassisted ear, I generally won't go after it. If he's not having a measurable amount secretions, then suctioning of any kind wouldn't be needed regardless of if he is comfort care or not.

anon456, BSN, RN · Apr 11, 2015

Sometimes deeper suctioning is needed to clear a plug that's below the trach in a patient who is too weak to cough it up into the trach. In normal circumstances, though, it should not be regularly used, as stated above already.

As nurses our first job is to avoid harming a patient. IMO deep suctioning on a regular basis does harm the patient by injuring the airway and risking a vagal response. Comfort or not, if does harm, we should not be doing it.

If the suctioning is part of regular trach care, then it should be done no matter if the patient is hospice or not. Suctioning to clear the airway is our job.

sistrmoon, BSN, RN · Apr 11, 2015

Our protocol comfort care orders say "no invasive procedures." It seems like if the patient was struggling to clear it or breathe, you would. I have been told suctioning a non trach patient at end of life can increase secretions.