Interment cath and trach suction per pt request limit

Posted
by Rvanurse2012 Rvanurse2012 (New) New

So I recently switched jobs , and I went from acute care ( critical care and step down units) to long

term care but not your usual nursing home patients , these are Pts with mental and physical disabilities and considered young adults -ages 18-50 being oldest. The majority have CP and a few traumatic brain injuries. I have two patients that require prn nurse intervention one being str8 cath as needed per his request and one that has a trach. Requiring suctioning. Let's address first dude ... He will request that you straight cath him numerous times a shift despite timing between last cath times. Request we'll over what I think you would need to cath someone who is not able to urinate without nursing intervention ... Is there a limit to this the order states as needed within no limits and I have asked staff and they say they just do it when ever and how many ever times he request... Now here's the trach dudes story .... He request suctioning numerous times a shift. He request prior to neb tx , then after and then will request again in between the last neb and then again prior to ha neb and after and then again .. Each suctioning you hardly get anything but a scant amount of clear secretions , he wants you to hold the suction catheter down until he nods to pull it out. Is there a limit to this and how can I approach the fact that this seems to me as a behavior problem almost a stimulation type thing because he is a quad that doesn't feel anything from shoulders down. Any suggestions ???

Edited by Esme12
TOS/NO TEXT SPEAK

As far as the patient requesting frequent trach suctioning, I've also had patients do this. They are awake, usually very anxious and often times long term/permanent trachs.

I try to explain to them that when I start to get blood-tinged/bloody secretions back, I am actually causing trauma and irritation to their airway by the too frequent suctioning.

From what I've observed (especially with para/quads) is that they have so little control of their lives they will attempt to control any aspect that they are able to, such as frequency of suctioning.

With the cath patient, are you getting a decent amount of UO each time he's cathed per his request?

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

For the first patient I would recommend seeking information on why he feels the need to be straight cathed so often. Is he feeling like his bladder is full? If so, he may need a urinary work up, UA, urine culture, and if necessary, urology referral. With needing intermittent catheterization, he is certainly at risk for UTI. If it's not that, I hate to ask if you think it may be sexual? How old is he?

Oh forgot to add this In a 8 hour shift ... And the cath pt .. it's not even but an hour later he wants you to cath him again and then you don't get but maybe 100 ml max. Then the pt complains about urgency says frequency etc and in thinking let me run a cath down me 10 times a day and see how many infections I get It's almost uncomfortable because I know that there is no way there is a need for that many caths and suctioning especially when you get not only 100ml if that and then with trach pt you get scant amount of sputum clear at that and clear lung fields X5 pre and post suction

The cath pt maybe the first time and after no it's 100 ml max the guy is in his mid 20's

I also feel like the with the trach patient its a controlling behavior because he tries to tell me how long to hold it down in his trachea how to suction wants you to beat on his chest ( cheats pt ) to the point I tell him I can not hit any harder do to the fear of causing a bruise then when you are suctioning him it's almost like he is enjoying it making a gag like gesture , eyes rolling back In his head. Weird I know but then I'm almost scared to say something because I do to want managemr or the doctor to think I'm that nurse that is lazy because I am not I'm concerned I'm literally

tearing the lining of his trachea due to over suctioning ... The trach patient and the cath pt almost fight for attention ringing there call lights in sequence one behind the other asking for something simple to get you in room the. Requesting you to close door then asking for there prospective routine nursing tx. almost as it is secretive or there ashamed of it because they know there being obsessed

I also feel like the with the trach patient its a controlling behavior because he tries to tell me how long to hold it down in his trachea how to suction wants you to beat on his chest ( cheats pt ) to the point I tell him I can not hit any harder do to the fear of causing a bruise then when you are suctioning him it's almost like he is enjoying it making a gag like gesture , eyes rolling back In his head. Weird I know but then I'm almost scared to say something because I do to want managemr or the doctor to think I'm that nurse that is lazy because I am not I'm concerned I'm literally

tearing the lining of his trachea due to over suctioning ... The trach patient and the cath pt almost fight for attention ringing there call lights in sequence one behind the other asking for something simple to get you in room the. Requesting you to close door then asking for there prospective routine nursing tx. almost as it is secretive or there ashamed of it because they know there being obsessed

I've seen the "almost enjoying it" thing too.....I think it's attention seeking on the patient's part. Trust me, I've been on a ventilator and suctioned (while aware of it) and it feels like you're being suffocated. I don't understand how anyone could ever get used to or derive pleasure from that.

I've also noticed that many with chronic illnesses, trachs and paraplegics/quadreplegic can be very anxious (rightfully so) and be call light abusers.

Ty I am glad I'm not only one that his experienced this I thought for sure I was possibly being over dramatic but now I see this is a lot of Pysch nursing

-Dustin

Good luck and hang in there. You are probably going to have to set limits with these patients, in a firm but respectful manner, of course.

Although I feel for them and try to understand their perspective, patients like these do grate on your nerves. Some people, ill or not, are just manipulative of others.

Example.....just remembered this patient :cautious: Said patient was a quadraplegic who had a blow type call light. However, instead of using it, pt would make this weird, squirrel-call sounding noise with their mouth/cheek EVERY SINGLE TIME someone passed by their room.

Got old REALLY quickly.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

The cath pt maybe the first time and after no it's 100 ml max the guy is in his mid 20's

My only other thought....with being cathed that much there is a good chance he has a UTI. Check for infection before assuming he is in it for control or pleasure.

Some patients who are chronically ill will manipulate staff...they are lonesome and afraid. Set limits and reassurance that they are heard and won't be forgotten.

Of course I have already checked for infection that was first intervention done

-Dustin