Suctioning

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Specializes in ER (new), Respitory/Med Surg floor.

Hey everyone! I recentely had a pt with a trache who had very thick mucous. This same pt a week prior to her recent admission to my hospital was coughing out through her trache lots of white mucous but not as thick. Her sats were 87% on a 65% trache collar and over several days the trache collar increased to 75%. Well anyway for my shift despite suctioning and even using saline bullets down the trache to loosen the mucous got quite a bit mucous but the pt's stats were still low and getting cyanotic. I got respitory and they suctioned quite a bit and got lots of mucous out then her sats went up instantly.

My question is that I was taught to NEVER suction a pt beyound low suction. Inorder to get the mucous out Respitory used it in medium suction almost to high. It worked. I just needed to know is this common practice and should be done? I would think if I really feel its a plug to do it but you don't know all the time. I don't want to ruin the trachea but I want the pt to breath!

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Specializes in Med/Surg, Ortho.

So when in doubt, why not get RT to help with suction? They are there for resource and backup if you need it. Let them inservice you a little when they are doing it so you will be aware of technique you are unfamiliar with.

We have to learn from each other, and anyone not willing to walk/talk you through a situation like that to further your knowledge needs to move on and get another job.

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Specializes in ER (new), Respitory/Med Surg floor.
So when in doubt, why not get RT to help with suction? They are there for resource and backup if you need it. Let them inservice you a little when they are doing it so you will be aware of technique you are unfamiliar with.

We have to learn from each other, and anyone not willing to walk/talk you through a situation like that to further your knowledge needs to move on and get another job.

Yea that one respitory therapist, just this one I know great resp therapists that I have fun with and do our job, but doesn't help myself or the pt. I had him up there several times and he didn't suction. I just wanted to know from more experience nurses if suctioning at a medium level sometimes they do it if it is right? The pt did hiccup after the suctioning then was alright and the sats went up. I will ask the other respitory therapists this as well but even if they tell me it's ok since it was obviously done is that correct by nursing standards?

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I have suctioned trachs at medium to high suction to loosen thick plugs. I have my pt. deep breath prior to the procedure, put the saline down the trach and give it a bit of time to loosen up the plug. Then I go down with the cannula for about 30 seconds to work the plug out. Give the pt more O2 and some time to catch up with himself, then repeat suctioning the same way. If there is no loosening of the plug at that point let the pt. rest and call RT.

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Remember ABCs...airway always comes first. If there's a plug and (s)he can't breath, suctioning on low vs high really isn't the issue.

~L

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Specializes in MICU, SICU, CICU.

In my experience working on a pulmonary unit with a large number of trached patients, we usually keep the suction no higher than 120 mm suction. The RTs on my unit have told us that suctioning at higher levels of suction is damaging to the trachea and actually increases their suctioning needs by increasing the amount of secretions in response to tracheal injury.

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