when to suction?

I work in a sub acute hospital and all of our pts are on trach. I know that the dr orders to suction q2-3 but some are PRN. I jst use my judgement. My reasoning is there is no need to suction when there isn't a lot of mucous cus you can irritate it when you suction frequently. That's just me. But I do have pts who need suctioning every hour.

I think a gentle, non-threatening, non judgmental way to ask the mom why would be best. I cannot imagine being a mother with a vent dependent child. Has the mom cared for her a long time? Maybe mom knows best?

Somehow say that in school or with other vent patients you have always been told to suction based on the saturation levels or lung sounds, not just to do it routinely every 2 - 3 hours. What does the mom know (that you don't know) about her daughter's health. What has happened in the past when she wasn't suctioned every 2 - 3 hours?

Maybe do this a few weeks AFTER you have established a relationship with the mom and daughter and have gone ahead and suctioned as the mom asked?

The mom said another nurse that works on the case would do that. I asked why and she didn't know. I told her, I didn't understand auctioning her when there's no need. It can cause irritation & it disturbs her whole she's trying to sleep. She doesn't get any rest during the day because the mom always want u doing something with her. If not, then she says her daughter isn't being taken care of.

The mom may also want you to make sure the trach is patent and in place. If you go online and look at all the adverse events related to this you might understand the mother's reasoning for being a little paranoid. Even working in a hospital with the Code and Rapid Response teams, I am sickened at the number of times a child's trach is plugged or is dislodged and goes unnoticed until the child is found dead or nearly dead. Usually the fault can lead directly back to the nurse. This is not just one hospital either.

Sometimes the trach can get build-up inside and the hole gets narrower and narrower from dried build up until it becomes a crisis. You can suction frequently without harming the tissue below the trach. Just only go as deep as the trach is long and not any deeper.

what does the 485 say?

does pt. have a pulmonologist?

how does pt. tolerate suction?

would be nice to get everyone on the same page

in the meantime,as said above, don't deep suction routinely

(is there even an order for deep suction)