Questions involving Trach Care!!! HELP!!! CLEAN TECHNIQUE? WHAT?

[skittlebear]

Okay, I am completely new to trachs. I had a nurse who trained me with this pt (who has been working with him/her for years) teach me all about his trach care. The nurse doesn't use sterile trach care. I was taught in nursing school that every time you should suction a pt, it should be sterile. Am I correct? All of the other nurses don't sterilze as they perform trach care on this pt as well. Also, sometimes they use the catheter to suction the trach and then right in the mouth afterward (and will save to re-use later). Sometimes they even use the tiny yaunker to suction the trach itself and in his mouth after. Isn't that dangerous since it's a yaunker in the trach? Is this not just screaming bacteria, infection, etc. This is a long term trach and it is a home care setting. Is this typical? Am I missing something?

[XB9S, BSN, MSN, EdD, RN, APN]

I would use a new catheter each time I suction, I've been taught, and teach never to reuse a suction catheter. It's a clean procedure rather than sterile but infection prevention would be a priority.

Wouldn't use a Yaunker to suction a trach either.

This is one of the guides that we used, it's taken from the Royal Marsden's Clinical Nursing Procedures

http://www.nursingtimes.net/tracheostomy-care-part-1-using-suction-to-remove-respiratory-secretions-via-a-tracheostomy-tube/1980627.article

[rn438]

I graduated recently, and was taught STERILE technique. I have seen people who have been Nurses or RTs for a long time use clean technique. I would just do what you were taught.

[MissKayRN]

In the hospital setting I absolutely always use a new sterile catheter each time. Since this is a home setting, though, I wonder if this is the same as people reusing straight catheters at home? Since it is their own home/own germs, etc. it may be acceptable? Good question, something I never thought of before.

[Up2nogood RN, RN]

Home care is unique in the fact that that your clients probably gets limited supplies. Doesn't make it right but that's how home care rolls. I've never heard or would put a yaunker into a trach....interesting. As for sterile technique, not necessary in the home as the client is living colonized w his own bacterias....in the hospital he would need sterile teqhnique so as to not introduce new bacteria into his flora. Ah what they don't teach you in school.

ETA: Just an FYI I am not condoning using clean vs sterile technique and in the majority of home cases i've worked i've been able to use a new sxn cath w each sxn, but I have been to homes where caths have been reused in a clean technique and the rate of infection was the same as in sterile technique homes.

[gonzo1, ASN, RN]

I use a new catheter each time. That being said I keep in mind that the only place you can guarantee a completely sterile environment is in an operating room. So be as clean as possible and don't reuse stuff on these pts

[diosa78]

I used to work on a 30 bed trach floor....all trachs all the time :-) Clean technique is used in the home setting and caregivers will use clean technique in the hospital setting as well (it is not reasonable to expect a caregiver to use a new suction catheter every time as you might go through 100+ suction catheters a day...) Nurses should use sterile technique in the hospital setting. If you have a patient with tracheitis that is spewing secretions, it is acceptable to put a yankeur up to the outside of the trach to suction out thick secretions and then use sterile technique with a suction catheter to suction out the rest of the trach.

[merlee]

Home setting is different - but if a suction catheter has been used in the mouth, it should not be reused in the trach.

Suctioning a trach should be as clean as possible - sterile in the hospital. And Yankauer caths are for the mouth.

[Dazglue, ADN, BSN, MSN, RN]

I was taught it should be sterile technique but like someone else posted homecare could be totally different and that's something I don't know much about.

[herowneulogy, BSN, RN]

Chiming in.....I was taught you could go from trach to mouth in terms of suctioning, just not the other way around (mouth to trach).

[joprasklpn]

I work peds home care and we MUST reuse the same cath over and over D/T limited supplies, but they are wiped down with alcohol prep between sx. also the yankauer can be used around the trach for coughed up secretions, but not in it. I have had emergency situations were vomiting has happened and i have used a trach cath back and forth because no time to change to yank. But generally that does not happen often.

[caliotter3]

Clean technique in the home, but you try to be as clean as possible and don't go from the mouth back to the trach with the same catheter. Sterile technique in the hospital. Of course, if the doctor orders sterile technique in the home you follow the doctor's orders. I have seen sterile technique ordered in the home.