Trach Suctioning

ChicagolandRN · Jan 28, 2004

If you hold the end that is going into the trach first in your sterile dominant hand, you can use your nondominant hand to attach the suction cath to suction. Hope that helps!

TweetiePieRN · Jan 28, 2004

Originally posted by ChicagolandRN
If you hold the end that is going into the trach first in your sterile dominant hand, you can use your nondominant hand to attach the suction cath to suction. Hope that helps!

THANK U SO MUCH FOR RESPONDING! That is exactly what i was looking for!! I have been practicing the whole sterile technique thing and then realized that i totally forgot how to handle the catheter!! Thanks a million and have a GREAT evening!! You saved me from practicing in frustration!!! :D

ChicagolandRN · Jan 28, 2004

No problem...Good luck tomorrow!

gwenith, BSN, RN · Jan 28, 2004

That is unless you use in-line suction catheters ( and we SHOULD use them wherever possible)

Now for extra credit. The suction catheter should be no more that 1/3 the diameter of the tube it is to go down. It should be avanced ONLY just beyond the end of the tracheostomy tube. Hope this helps too!!

ktwlpn, LPN · Jan 29, 2004

I posted this another forum but did not get any feedback....How often are you doing trach care on established(old)trach's? The evening charge and supervisor decided to get an order for benadryl to dry up a fella's secretions-but we have the guy on humidified O2 to liquify and thin those secretions-he has been in our facilty in another unit for several years and this was never a problem.His secretions have been thin and he had a good strong cough ...My stand is that it makes no sense to give him the med---except for staff's convenience.....and I feel that it will cause a problem by depressing his cough...I need some literature to prove either stand...the doc will NOT come off the fence - He just tells me to do "Whatever I feel will make the patient more comfortable but he does NOT WANT calls from the evening staff asking him to re-order the med and bothering him" The evening shift nurse had asked me about this a week or so ago and I did some research and told her later that I felt the benadryl was not needed-so she had the relief evening supervisor call the doc a day or so later to get the order (on a night when that particular nurse was assigened to another floor) I know the trach care is not being done as ordered because I end up with several trach care kits left over at the end of each week....I am suposed to be the charge nurse-how can I do my job when I have people pulling this crap behind my back? I am sure that if I was an RN this would not have happened(the evening nurse is an LPN but the relief supe is an RN) These nurses are clueless about the careplan and the DON will not back me-she tends to side with the squeeky wheel that does to her office first...We have a very small unit with low acuity and all I hear is b*tching and moaning every afternoon... suction the darn trach...It's not like we are being over worked..so do your job...I did NOT ask for this unit-the former charge nurse wanted sa change so I got put there and I just can not make anyone happy.....I used to be happy myself but my attitiude is really suffering-=any tips for a new charge nurse? I tend to be too sensitive and want to please everyone...Just like most other LPN' I don't have any formal management training.....argh..I have 15 residents and always 2 aides on day shift----God forbid I ask them to do anything extra.....or change the bath schedule or assignments..Help!!!

gwenith, BSN, RN · Jan 29, 2004

Okay - you have several problems here so let me start one at a time.

Trach care:- "thickening secretions" You are right it makes absolutely no sense to give a patient something to "thicken their secretions". If loose secretions are an issue then why not swap from a warm bath humidifier to a HME?? (heat moisture exchange unit) HME - sometimes called "Swedish noses" are far more comfortable for the patient and allow greater movement - less "pull" on the trach site - all in all much more comfortable. Their big problems are that they do thicken secretions and that they can become soiled and useless if the patient has a lot of secretions to start with.

Suctioning - don't suction if you can get the patient to huff cough into a tissue. I don't know how "with it " your patient is but if you are able to get them to sit up and cough into a tissue. If they are able to do that then you only need to suction to check the patency of the inner lumen of the tracheostomy- the books vary with this as to how frequently.

Timing of suctioning. Most texts have gone away from a strict time regime with suctioning. The answer is now PRN. However usually a minimum time of 2-3 hourly but this is with acute trachys in ICU.

What you are hitting here is the dearth of information and literature surrounding and supporting long term care of trachy and ventilated patients.

Hey! Perhaps we can get together and write a book then make enough to retire and not have to worry about management??

ktwlpn, LPN · Jan 29, 2004

Due to budget contraints I am sure we will be getting no new equipment any time soon ...We only have portable O2 tanks with humidifiers attached-I was told the fella never drops his sats and the set-up was only to keep his secretions thin and moist so just checking his sats and dc'ing that is an option...The fella is in a vegetative state so that option is out...he can't follow instructions and cough..Yes-let's write that book...Thanks for your input

gwenith, BSN, RN · Jan 30, 2004

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9377917&dopt=Abstract

This is an "inline" HME as used in acute care

http://www.a-msystems.com/pulmonary/filters/hme.aspx

http://www.voicestore.com/pages/faqs/faq6.html

This is the most common one I have used

http://www.qualitymedicalsupplies.com/page/QMS/PROD/RE-ME/SF-570016

Although the price of over $3 per unit looks bad to start with cost that out against what you are using in the way of humidifiers etc to see if it is more cost effective.

HME's also have the added benfit of protecting the staff against infection. Because the HME often has a bacterial filter built in.