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?

[VickyRN, MSN, DNP, RN]

You should follow your facility's or home health agency's policy and procedure and provider's orders on tracheal suctioning. For one home health agency (in which I staff part-time), clean technique is used for tracheal suctioning in the client's home. This particular client has limited monthly supplies due to "bare bones" Medicaid reimbursements. On the other hand, when I am in the hospital on the pediatric floor (for my clinical groups), we always use strict sterile technique while suctioning pediatric patients with tracheostomies. We also use stict sterile technique in tracheal suctioning in a pediatric long-term care facility in which I also accompany students for their clinical experiences.

[kessadawn, BSN, RN]

The staff in my facility suctions using sterile technique, but for homegoing patients and families are taught using clean technique. I never reuse a suction catheter, but I can understand how limited supplies can be at home, and I was also taught to clean and reuse equipment on my preemie that in the hospital setting we would never reuse. Unfortunately, insurance will only pay for so many of each item needed at home, and the out of pocket costs for a family can be ridiculous even when they do reuse. I haven't seen a large amount of infections from suctioning at home, so clean technique and reusing must work out okay.

[BittyBabyGrower, MSN, RN]

Hospital is sterile technique or closed system, home is clean. We show then how to clean the caths for home use also since the insurance companies are so stingy!

[MsbossyRN]

In nursing school I was taught to use sterile technique. At the hospital I work at we are to use clean technique only.