Tracheostomy Suctioning Sterile?

[aimessue]

I'm a new LPN and I have a question.

I had a patient who was new to the facility. The day shift nurse told me that he needed to be suctioned frequently through his trach. After discussing his care, she informed me that they do not do suctioning as a sterile procedure. When I went into the patient's room, I discovered that she had been using the same catheter for every suction.

I am not comfortable doing this procedure as non sterile. So, I grabbed a kit and suctioned the way I was taught-sterile.

When I contacted the DON, she informed me that it was not to be done as a sterile procedure. Apparently the RT did not do it as sterile, and that is the way we are to do it.

Is this right?

[NurseLoveJoy88, ASN, RN]

In school we are taught that it is a sterile procedure. With that said the procedure is not really all that sterile, we just don't want to introduce any new bacteria to the patient.

If its his catheter and his own germs on it then it may be ok as long as it is properly stored.

I don't work with trach patients on are regular so it will be interesting to see others thoughts on this.

I just take in consideration that this is not a hospital setting and more of a home like setting for this resident.

Good luck in your new career !

[GilaRRT]

From an infection control standpoint, this should be a sterile procedure.

[hopefulwhoop]

When I worked at a LTC facility, the RT did the trach. suctioning and he did not use sterile technique, but he did use new equipment each time.

[TheCommuter, BSN, RN]

I've worked at several LTC facilities where I have had to perform trach care. LTC facilities love having patients with trachs because this increases their reimbursement rate and profit margin. However, many of these same facilities do not want to pay for the expensive supplies that would enable proper trach care (suction catheters, inner cannulas, outer cannulas, trach ties, sterile trach cleaning kits, etc.).

Since this is a nursing home patient, you are technically supposed to be performing sterile technique on the resident unless you have a physician's order for clean technique. Patients in the home care setting, however, usually have trach care with clean technique.

If a state surveyor walks into the building and asks to observe trach care being performed, they are going to want to see sterile technique being utilized. They are not going to be thrilled to see the nurse reusing the same old suction catheter.

[NurseLoveJoy88, ASN, RN]

OP I would also look at your facilities policy and procedure book as well.

[GreyGull]

When teaching long term trach care, clean technique is sometimes the best expectation. Sterile would be ideal but not practical.

This is going to be facility specific and will depend on the suction catheters available.

For home care and some LTC facilities, multiple use catheters are commonly used. These may be in the form of a sleeved catheter that is used for 24 hours. It is also known for some to reuse what would otherwise be a single use catheter in home care settings because of a limited amount of catheters supplied.

Hospitals (and LTC facilities) will regularly use inline suction catheters which are not necessarily considered sterile since they have been used and may also have seen the circuit opened or disconnected from patient/ventilator or laid on the bedding when moving a patient with it t-pieced onto a trach open to air at one end. No special order is required from a doctor for the type of suction catheter if it is accepted within the P&P of the facility.

Example of an inline multiple use suction catheter.

http://www.northeastcenter.com/equipment_glossary_ballard_style_multiple_use_suction_catheter.htm

Sleeved suction catheter commonly used in home care and LTC.

http://www.medicalsupplydepot.com/Respiratory/Suction-Catheters/Bard-Tracheal-Suction-CathN-Sleeve-Gloveless-Kit.html

Check your facility for a written policy for both nurses and RTs.

[Esme12, ASN, BSN, RN]

I've worked at several LTC facilities where I have had to perform trach care. LTC facilities love having patients with trachs because this increases their reimbursement rate and profit margin. However, many of these same facilities do not want to pay for the expensive supplies that would enable proper trach care (suction catheters, inner cannulas, outer cannulas, trach ties, sterile trach cleaning kits, etc.).

Since this is a nursing home patient, you are technically supposed to be performing sterile technique on the resident unless you have a physician's order for clean technique. Patients in the home care setting, however, usually have trach care with clean technique.

If a state surveyor walks into the building and asks to observe trach care being performed, they are going to want to see sterile technique being utilized. They are not going to be thrilled to see the nurse reusing the same old suction catheter.

Well said......clean technique is great for AT HOME.......not for a facility where cross contamination is rampant. I am suprised somewhat becasue of the new guideline of no reimbursment for hospital acquired infectons......but it is about the dollar spent....

[GreyGull]

not for a facility where cross contamination is rampant. I am suprised somewhat becasue of the new guideline of no reimbursment for hospital acquired infectons......but it is about the dollar spent....

Since the OP was not clear about the type of catheter used, which may have been sleeved or inline, it is difficult to criticize the method.

It has been found, including in our own VAP studies, that multiple use catheters such as inline t-pieces and ventillator adapters are very cost effective especially when it comes to the VAP rate and number of vent days. Probably more of a concern now is the frequency of good oral care on all trach patients rather than clean vs sterile suctioning technique. As long as hospital/SNF personnel follow other precautions for minimizing cross contamination risks, clean technique with a multiple use catheter can be acceptable. However, it will again follow with the specific facility and its accepted P&P.

[Esme12, ASN, BSN, RN]

Since the OP was not clear about the type of catheter used, which may have been sleeved or inline, it is difficult to criticize the method.

It has been found, including in our own VAP studies, that multiple use catheters such as inline t-pieces and ventillator adapters are very cost effective especially when it comes to the VAP rate and number of vent days. Probably more of a concern now is the frequency of good oral care on all trach patients rather than clean vs sterile suctioning technique. As long as hospital/SNF personnel follow other precautions for minimizing cross contamination risks, clean technique with a multiple use catheter can be acceptable. However, it will again follow with the specific facility and its accepted P&P.

Agreed......but she also didn't state the patient was on a vent.....just that he had a trache .......I pictured a single use catheter used multiple times not a multiple use catheter utilized as it is intended...

[TheCommuter, BSN, RN]

Since the OP was not clear about the type of catheter used, which may have been sleeved or inline, it is difficult to criticize the method.

During my time in LTC facilities, I have witnessed the same disposable suction catheter being used for three weeks straight at one particular nursing home. The nursing staff was constantly begging the DON and central supply manager for more trach care supplies, but received responses such as "We'll provide you with stuff tomorrow," or "The supplies are so expensive."

[GreyGull]

Agreed......but she also didn't state the patient was on a vent.....just that he had a trache .......I pictured a single use catheter used multiple times not a multiple use catheter utilized as it is intended...

It doesn't have to be on a ventilator. It used to make me a little queasy in ICU to go from vent to t-piece and back to vent with the same inline suction catheter also especially since the t-piece was open aerosol. Some ICUs, like mine, no longer change those catheters on a daily bases but as needed or sometimes weekly. This includes all of those circuit disconnects.