I need some advice on suctioning trachs

caliotter3 · Mar 13, 2010

In home care you can't be throwing away catheters and a lot of other supplies. Each case usually determines how long a catheter is used. Changed daily, changed each shift, changed PRN are the usual frequencies. As long as efforts are made to keep the catheter clean and the patient does not develop infection, these frequencies can usually work. One patient only wanted sheathed catheters which were not provided by the supply company. He paid for them out of pocket and made the nurses keep using the same catheter until it was demolished and all pretenses of infection control were gone. No education concerning this matter got him to budge. And yes, he was hospitalized for pneumonia, but kept on with the way he wanted it done. Document the patient wishes and move on, the reaction from the agency supervisors.

ArwenEvenstar · Mar 13, 2010

Yeah, things are different in the home! I also was shocked by this when I first made the switch from the hospital to the home care setting. It is very common to use "disposable/one-time use" supplies over and over again. Other items are boiled or otherwise cleaned (usually in a vinegar and water solution) and are re-used until they fall apart (such as nebulizer pieces, some vent circuit parts, etc). Remember, in the home, there are a lot less germs than the hospital. So it is not quite so horrifying to re-use stuff or clean it compared to the hospital setting.

I worked a vent dependent trach peds case for over 4 years. Believe it or not, they suctioned the child on the way IN to the trach, not on the way out! You would think the child would have suffered oxygen deprivation by suctioning on the way into the trach, but they did not. The family, for whatever reason, had always done it this way and suctioning this way seemed to get the best results also. I'd try suctioning the proper way, and usually wouldn't get much out! (Strange...) So, we nurses went with it, and suctioned the family's way. On this case, the suction catheter was changed every 24 hours. This child was suctioned very frequently, so that cath was used many times in a 24 hour period.

kids · Mar 13, 2010

Peds Pvt duty was my thing for many years.

If you haven't already seen it this site http://www.tracheostomy.com/ can be a HUGE resource for reconciling hospital -vs- home. I know of 2 nation-wide companies who incorporate it into their training of new nurses on peds with trachs.

Blackcat99 · Mar 14, 2010

Thanks all for your great advice and tips.:redpinkhe Yes, I think I am going to suction like Mom does it. Mom said to suction every 2 hours. She suctions on the way in and on the way out. The important thing is that she is getting good results while I am getting hardly anything. This child sometimes needs to be suctioned every 30-60minutes.Mom said that she thinks he is coming down with something. I am concerned because I heard it is not good to suction frequently.I heard that the more you suction the more secretions will be produced. But what to do? If I don't suction his sats go down. I am also concerned that if I don't suction frequently he will get all plugged up. I love the Aaron's tracheotomy site. It's very helpful.

tewdles, RN · Mar 15, 2010

Just remember to suction only on the way out, no longer than you can comfortably hold your own breath without taking a deep breath first.

Good luck!

ArwenEvenstar · Mar 15, 2010

Hmmm....just an observation. On the trach peds case I worked (mentioned in my other post), the family suctioned on the way IN to the trach. And Blackcat99 says on her case, the family also suctions on the way IN the trach. Two families both doing it wrong! Whats up with that? When a child is discharged home with a new trach, who is responsible for teaching? The hospital prior to discharge? A home care agency on the case? You'd think the importance of not suctioning on the way in would be emphasized due to risking oxygen deprivation. Of course, families will ultimately do whatever they want no matter what they are taught!

I also find it interesting that on both these mentioned cases (mine and Blackcat99), the families would get good results suctioning their "wrong" way, and when we suctioned the "right" way we got poor results! Maybe the children's trachial/resp systems just adapted to the wrong way over time, and now the wrong way is the only way to get proper results??

I worked another case where the mother had some rather bizarre ways of administering peg tube meds. Yet, her strange ways worked well (better than the "proper" way!). The agency actually put in the careplan the specific directions for administering peg tube meds the mom's way...

Blackcat99 · Mar 15, 2010

I sure can't argue with Mom's success. When I just suction on the way out, hardly anything ever comes out. Mom does suction both in and out and she gets great results. I am going to do it Mom's way because it is very effective.

So I quess it doesn't always pay "to go by the book."

allnurses Guide · Mar 17, 2010

Got an adult patient who wants us to suction on the way in and all the way out. Has had a trach for 30yrs. so I guess that's worked out pretty well ---

It's interesting to me, every patient seems to have a unique way they like things done, based on their experience. I once worked in a home with a new nurse- the patient's 65yr. old husband was trying to teach her how suction without too much success, finally grabs the suction catheter from the nurse, starts to suction and exclaims,

"Look! It's just like a Roto-Rooter, OK?" :lol2:

iwanna · Mar 17, 2010

I have had two trachs, one in 90, and again in 94. No, make that three, had another one briefly in 96. Anyways, to the best of my memory, I believe that I suctioned out. And, when I felt a plug, a shot of NSS, before suctioning got rid of the plug.

They frequently change the way we do things in the medical field, anyways. Perhaps, it is better the patient's way. If someone did it "their way" for 30 years with no complications, then I would agree with them. If the patient is lucid, I would trust them. It may go against current rationale, but like I said things always change in the medical field.

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For me, I had no problems with suctioning on the way out. That is the way I was taught, and I had no problems with it. But, every patient is different.

aubreysmommy · Mar 19, 2010

I also suction my client on the way in and out. She is 10, has had a trach since 4wks old and suffers NO O2 deprivation. Like others said, I think that each patient will respond differently and in their home you just do what works (as long as you are not harming them).

Blackcat99 · Mar 19, 2010

Thanks all so very much. I am getting better results. Sometimes I can get a lot out. Other times, I can hardly get anything. So I guess I just have to keep suctioning until the sats go up. Yes, it is just like a roto-rooter. That's for sure.