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

[Misstika]

Hi everyone....

I'm a graduate nurse currently working. In nursing school, we weren't thoroughly taught trach care. I'm not too comfortable when I'm placed on the trach unit. (Which is often) My training in that area was minimal. I've watched a professor deep suction a patient, but I never done it myself. Has anyone else experience a similar situation? I was basically just placed in a situation that makes me uncomfortable. As a new nurse, how did you become more comfortable caring for trach patients? What tips do you have for caring for trach patients?

Thanks

[RNNPICU, BSN, RN]

Alos, look at your policy and procedure guideliness or some places call them practice guidelines. This may help you think about what you need and what you should know about caring for that patient population.

[atehortuak37]

I asked Respiratory to show me how to do it,I don't often get trach patients but when they are who I call, they are more than happy to show me. I am also a new grad.

[Jewelsforme]

I had a daughter with a trach. I hope it's ok to post about this. Trach suctioning I could do without breaking sterile tech in my sleep, and did as she was a "wet" trach and sometimes the nurses called out sick. For some training on our MedSurg floor, I bought a big teddy bear and popped a hole in its neck. I put a trach tube in and tied it on. I set up the room for suctioning the teddy bear. Boy, did that help any nurse who felt trepidation suctioning. Remember sterility and being gentle. Get an order for sterile water drops (gtts x 1-3 or whatever loosens up the secretions). The catheter goes in way easier if it's lubed up with sterile water, too. After you are all ready, then instill the gtts to help loosen secretions up. The one issue I had with learning in school and on the floor is that schools and RT will always insist on going in to suction when the patient is inhaling. This is counterproductive. I always notice less stress and optimum suctioning by waiting until the patient takes a deep (or normal) breath (they will have maximum sats), then insert (without covering the suction with your thumb) when their first begin exhalation. This way you are not cutting off their inspiration and they are working "with you" when you do cover the hole with your thumb as they continue exhaling. The secretions will now be flowing outward toward you and the suction catheter. Close off the hole with your thumb and don't go past the feel of the clogged spot. (Deep suctioning not only hurts, but can cause bleeding and scar tissue.) Then when you "hear" and feel the suction has caught the gtts you instilled as well as any secretions, gently spiral the catheter in between your fingers as you exit up and out from the trach. Practice on a teddy bear. Keep doing the procedure on Ted E. Bear patient as well as in your head until you can see when to insert, when to close off the thumb hole, gently spiral when pulling up. Clean the catheter with the sterile water and wait. You may need to suction again or insert a couple more drops if the secretions are sticky. The patient needs help to get this "gunk" out. Very best wishes to you and don't shoot me anyone. I learned this a very hard way on my own baby, thousands of times. It's also why I went into nursing. And if the mom or parent is there, ask him/her if there is a special technique you can use for that specific patient. They will really appreciate your asking and you will learn a lot. I'm so glad you even asked.

[Misstika]

Thank you for your thorough response í ½í¸Š The fact that suctioning is a sterile technique is the main reason why I want practice. I will keep all your tips in mind.

[Misstika]

Thank you for your thorough response :) The fact that suctioning is a sterile technique is the main reason why I want practice. I will keep all your tips in mind.

[Misstika]

I talked to the respiratory therapist today. She was so helpful and nice. She gave me some tips and let me watch her today. I told her that I never asked her because she always seemed busy. She said she's always willing to help.

[guest940422]

If the patient can survive the wait, it is better to leave a task undone, than to attempt something you don't know how to do.

If the patient coughs (unless they are paralysed) you suctioned too deep

don't ever stand in front of a trach

always have one hand holding the trach when the ties are being changed

the splash guard is your friend... friends don't leave friends behind

all my experience is with infant/pedi trachs so not many inner cannulas we changed ties daily, trach care q shift and prn

There will be old schoolers insisting you can dump sterile saline down the tube to loosen a plug and suction..... mountains of evidence shows this just causes infections, damages lung tissue, and leaves plugs/secretions in place if you can't suction it out change the trach

don't ever stand in front of a trach

hemostats are your friend when you are trying to thread the velcro from the collar through the little eyelet on the flange

When you clean, don't ever use the same item (gauze, qtip...) twice, always start at the stoma and wipe out (like you are moving the bacteria away from the stoma)

only one finger should fit under the collar, they stretch out so if it's close to being changed you might need to tighten it, get someone to hold the trach in place while you tighten it

don't ever stand in front of a trach

make sure you have a spare trach, and trach a half size smaller, lube, a stylet, and a mask that fits the patient within arms reach of the bedside (or hanging in a bag at the bedside) as part of your safety checks. The smaller trach thing could be a pedi thing, but if they pull out their trach you want a sterile back up and a stylet where you can reach it, it is also a terrible time to have to find a packet of KY, if you can't get it back in (or the smaller one) you can always cover the trach and give manual breaths with the ambu bag and mask until ENT or the code team gets there.

Make sure your suction is working (and not on intermittent trust me happens all the time) when you walk in, make sure your ambu bag is connected to the wall already and check to make sure it is working and on oxygen

dont ever stand in front of a trach

Hope this helps, next comes the part where everyone disagrees with me....

[NotReady4PrimeTime, RN]

Hope this helps, next comes the part where everyone disagrees with me....

Nope. Not me. I've worked with dozens of trached patients and I concur with everything you've said, right down to the "sterile saline loosens plugs" part.

I could, however, expand on the pedi trach part. Some kids have NO functional airway and are very difficult to bag from above. It's essential that you know ahead of time if this is going to be the case, because if that kid's accidentally decannulated you'll need to do CPR until the code team arrives.

And you forgot to mention don't ever stand in front of a trach.

[Forest2]

Get yourself educated right quick( buy a book, take an online course, read and study). You can't depend on some institution to give you the training you need. That's my tip.

Nurses must be proactive in their own education.