Nursing Judgement and Suction

[weirdRN, RN]

I have a resident who has an order to clean trach and suction Q Day. The resident did not need suctioned at any time while I was on shift. No SOB no Dyspnea, Sats in the 90's. I changed the trach dressing but left the trach itself alone because the woman was breathing well and in NO Distress. In Fact, she was SLEEPING when I checked on her the last time at 2:40 PM.

The Nurse before me had suctioned and cleaned the trach at 2AM. The report to the ADON was that the trach was "Filthy" and that the woman had to be suctioned as soon as the afternoon nurse came on. The family's complaint was that the resident did not recieve as good care on one wing of our facility as she did on the other one. I asked the ADON if the woman had had a trach and PEG when she was on the other wing, and of course the answer was no.

My nursing judgement said that the woman did not need suctioned and the trach was not junky enough to warrant the distress that suctioning and cleanning would put her in. The MD order is Q Day and PRN, not Q Shift.

Was I wrong?

[Antikigirl, ASN, RN]

I would have documented fully that the condition of the trache was fine, and would have caused undo stress on the patient at that time to clean when it wasn't needed, and that I told the next shift nurse of that fact so she could clean it when needed. That shows my side of the story and in documentation!

Also, sometimes I will do it anyway because even though it looks clean, bacteria still builds up and can be a hazzard for them. I premedicate patients before I do this to keep anxiety an comfort levels on an even note, have all my stuff ready...do it as quickly but efficiently as possible and get it back in. My mindset is one of not allowing bacteria build up whenever possible.

Also, it only takes one second to dirty a trache! One big respiratory secretion getting stuck in there is all it takes..and that stuff drys like brick quickly! I find that they get severely soiled after waking...when their secretions have added up and now the pt is alert enough to cough or try to expell them! SO, chances are it was clean on your shift, and quickly soiled on the next...but what patients family will know or care? CYA by documentation!

[weirdRN, RN]

Oh, Okay..... So like the COPD patient who expectorates copious secretions on waking in AM, that was what most likely happened with this woman when she woke up. oKay that makes sense to me. SO the trach most likely was soiled and the nurse probably did have to suction her.

I was pretty upset when the ADON called me this morning and told me that I was wrong for not suctioning this woman. I see now that while I may not have been wrong, I wasn't right either.

Thanks for the learning.:)

[leslie :-D]

just think of all those secretions pooling while she sleeps.

once she awakens, out come those secretions.

it does get quite junky and can soil in a minute's time....esp if she's receiving humidified o2.

leslie

[Ohmygosh]

Oh, Okay..... So like the COPD patient who expectorates copious secretions on waking in AM, that was what most likely happened with this woman when she woke up. oKay that makes sense to me. SO the trach most likely was soiled and the nurse probably did have to suction her.

I was pretty upset when the ADON called me this morning and told me that I was wrong for not suctioning this woman. I see now that while I may not have been wrong, I wasn't right either.

Thanks for the learning.:)

:yelclap: :yelclap: :yelclap: