Tracheostomy Care/ Suctioning Documentation

[Archana Shrestha, BSN, RN]

Tracheostomy suctioning can be performed with an open or closed technique. Open suctioning requires disconnection of the patient from the oxygen source, whereas closed suctioning uses an inline suctioning catheter that does not require disconnection. 

Indications include:

1. Problems in patency and integrity of tracheostomy/ Airway.

2. Decreased oxygen saturation and/or abnormal Arterial blood gas values

3. Visible secretions in the airway

4. Inability to generate a spontaneous cough by patient

5. Acute respiratory distress

6. Suspected aspiration of gastric or upper-airway secretions

7. Obtain a sputum specimen.

Assessment of the stoma:

The stoma should be free from redness and drainage. Hyperoxygenation using a bag mask valve attached to an oxygen source may be required before and during the open suctioning procedure based on the patient's oxygenation status. Assess lung sounds, heart rate and rhythm, and pulse oximetry.

Steps:

1. Gather supplies: sterile gloves, trach suction kit, mask with face shield, gown, goggles, pulse oximetry, and bag-valve device. If required, request assistance from a second nurse for preoxygenation of the patient before suction passes. Verify that there are a backup tracheostomy and bag valve device available at the bedside.

2. Perform hand hygiene and check for transmission-based precautions.

3. Introduce yourself, your role, the purpose of your visit, and approximate the time it will take.

4. Confirm patient ID using two patient identifiers (e.g., name and date of birth), explain the process to the patient, and ask if they have any questions. Listen and attend to patient cues. Ensure the patient's privacy and dignity.

5. Raise the head of the bed to waist level. Place the patient in a semi-Fowler's position and apply the pulse oximeter for monitoring during the procedure.

6. Turn on the suction. Set the suction gauge to the appropriate setting based on the age of the patient. Perform hand hygiene

7. Don appropriate PPE (gown and mask). Open the suction catheter package facing away from you to maintain sterility.

8. Don the sterile gloves from the kit.

9. Remove the sterile fluid [check the expiration date]. Open the sterile container used for flushing the catheter and place it back into the kit. Pour the sterile fluid into the sterile container using the sterile technique. Remove the suction catheter from the packaging. Ensure the catheter size is not greater than half of the inner diameter of the tracheostomy tube.

10. Keep the catheter sterile by holding it with your dominant hand and attaching it to the suction tubing with your non-dominant hand. Note that your non-dominant hand is no longer sterile.

11. Test the suction and lubricate the sterile catheter by using your sterile hand to dip the end into the sterile saline while occluding the thumb control.

12. Ask an assistant to preoxygenate the patient with 100% oxygen for 30 to 60 seconds using a handheld bag valve mask (Ambu bag) per agency protocol. Alternatively, ask the patient to take two or three deep breaths if able.

13. Insert the catheter into the patient's tracheostomy tube using your sterile hand without applying suction. [Do not force the catheter].

14. Keep the dominant (sterile) hand at least one inch from the end of the trach tube. To apply suction, place your non-dominant thumb over the control valve. Withdraw the catheter while continually rotating it between your fingers to suction all sides of the tracheostomy tube. Do not suction for longer than 15 seconds to prevent hypoxia.

15. Follow agency policy regarding the use of intermittent or continuous suctioning. Do not contaminate the catheter as you remove it from the trach tube. Suction sterile saline each time the suction catheter is removed to flush the catheter and suction tubing of secretions.

16. Assess the patient's response to suctioning; hyperoxygenation may be required. If dysrhythmia or bradycardia occurs, stop the procedure. Allow the patient to rest. After the patient's pulse oximetry returns to baseline, a second suctioning pass can be initiated if clinically indicated. Encourage the patient to cough and a deep breaths to remove secretions between suctioning passes. [Do not insert the suction catheter more than two times. If the patient's respiratory status does not improve or it worsens, call for emergency assistance].

17. Reattach the preexisting oxygen delivery device to the patient with your noncontaminated hand. Evaluate the effectiveness of the procedure and the patient's respiratory status. Assess the patency of the airway and pulse oximetry.

18. Remove the catheter from the tubing and then remove gloves while holding the catheter inside the glove. Perform hand hygiene. Turn off the suction. Perform proper hand hygiene and don clean gloves.

19. Reassess lung sounds, heart rate and rhythm, and pulse oximetry for improvement. Perform patient oral care. Remove gloves and perform proper hand hygiene. Assist the patient to a comfortable position, ask if they have any questions, and thank them for their time.

Ensure safety measures when leaving the room:

CALL LIGHT: Within reach

BED: Low and locked (in the lowest position and with brakes on)

SIDE RAILS: Secured

TABLE: Within reach

ROOM: Risk-free for falls (scan room and clear any obstacles)

Perform hand hygiene.

Document the procedure and related assessment findings. Report any concerns according to agency policy.

Example for documentation of the procedure:

Example 1: Mucus present at the entrance to a tracheostomy tube. Hyperoxygenation was provided for 30 seconds before and after suctioning using a bag valve mask with FiO2 100%. The patient's pulse oximetry remained at 92-96% during suctioning. A moderate amount of thick, white mucus without odor was suctioned. Post-procedure: HR 78, RR 18, O2 sat 96%, and lung sounds clear throughout all lobes. The patient tolerated the procedure without discomfort.

Example 2: Mucus present at the entrance to a tracheostomy tube. Hyperoxygenation was provided for 30 seconds before and after suctioning using a bag valve mask with FiO2 100%. During the first suctioning pass, the ECG demonstrated bradycardia, with HR dropping into the 50s. Suctioning was stopped. The trach tube was reattached to the mechanical ventilator, and emergency assistance was requested from the respiratory therapist. A moderate amount of thick, white mucus without odor was suctioned. Post-procedure, HR 78, RR 18, O2 sat 96%, and lung sounds clear throughout all lobes.

https://med.libretexts.org/Bookshelves/Nursing/Nursing_Skills_(OpenRN)/22%3A_Tracheostomy_Care_and_Suctioning/22.05%3A_Checklist_for_Tracheostomy_Suctioning_and_Sample_Documentation

[DLS_PMHNP, MSN, RN, NP]

Don't forget to chart the sputum:

1. consistency (viscous vs. watery)

2. color

3. any odors?

4. amount

How did pt tolerate the procedure? What were the O2 sats before and after suctioning? How much 02 are they on? How many times did you suction them? (In real life, it usually takes more than one time to get all of the secretions).

Etc, etc.

Good luck.

[Daytonite, BSN, RN]

(From nurse's 5-minute clinical consult: procedures, pages 503 and 509) document:

• Date and time.
• Type of technique used (aseptic or sterile) and all procedures performed.
• Amount, color, consistency, and any odor of the secretions.
• The appearance of the stoma and the condition of the skin.
• Record any changes made to the trach tube, inner cannula, or trach ties.
• Record the duration of any cuff deflation.
• Record the amount of cuff inflation.
• Note any ability of the patient to speak.
• Record respiratory status and breath sounds.
• Document any patient teaching that you did.