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Complete Tracheostomy Care - Part 1 of 3

Posted by admin - 11/06/08 at 08:06 am

Suctioning a Tracheostomy Tube

Purpose

To remove mucus from your child’s tracheostomy tube and windpipe, and to allow easier breathing. Mucus is the body’s normal method of cleaning the airway. During the first few weeks after a tracheotomy, your child may form a large amount of mucus because of the surgery on the airway, and the tissue’s normal response to the new tube. In many children, the amount of mucus should decrease over time.

When to Suction

You should learn your child’s breathing pattern so that you know what you see, feel, and hear when he or she needs suctioning. Signs which may indicate the need to suction may include:

• Rattling mucus not cleared with coughing
• Fast rattling
• Bubbles of mucus at tracheostomy opening

Advanced signs that your child need to suction may include:

• Frightened look
• Flared nostrils
• Restlessness
• Pale or bluish color (over skin, nails, mouth)
• Clammy skin
• Fast, noisy, hard breathing
• Dry, whistling sound

Supplies Needed

You will need the following supplies for suctioning your child’s tracheostomy tube:

• Saline bottles or disposable vials - side effects may occur with saline use, only instill saline when secretions are thick or blood tinged. These side effects include lower oxygen levels, changes in heart rate, or infection.
• Suction machine - pressure gauges vary with suction machines; check with your equipment company about setting the pressure limit.
• Suction catheter - the ideal size suction catheter is 1/2 the opening of the tracheostomy tube. You may need to adjust the size if the mucus is thick.
• Eye dropper / syringe - if using bottles of saline.
• Paper cups
• Breathing bag - with optional tracheostomy adapter for metal trach tube.
• Tissue
• Gloves - optional, suctioning is a clean procedure at home.
• Rinse water - If rinsing catheters in water instead of saline.

How to Suction

Here are the steps you need to take when suctioning a tracheostomy tube:

• Wash and dry hands
• Set up equipment
• Pour rinse water into paper cup
• Connect suction catheter to suction machine tubing
• Turn on suction machine
• Place tip of suction catheter into water to moisten it and test to see if suction machine works
• Put small drops of normal saline into tracheostomy tube. You do not have to use normal saline if mucus is thin and loose.
• Using a tissue, wipe away any mucus which is coughed out
• Ask your child to take three deep breaths or with a breathing bag, give the child 3-5 breaths
• Using the obturator as a guide, measure how far to insert the suction catheter. Many catheters have markings on them to make measuring easier.
• Without applying suction pressure, gently insert the suction catheter into the tracheostomy tube just past the end of the tracheostomy tube. Deeper suctioning may be needed and can be done safely if your child has a poor cough or is not clearing the mucus from the airway. Your nurse will review when and how to use deeper suctioning.
• Put your thumb over the opening of the suction catheter to create a vacuum.
• Use a gentle circular motion while removing the suction catheter so that the mucus is removed well from all areas. This step should take 5-10 seconds.
• Rinse the suction catheter
• Watch your child’s color and breathing effort
• Let the child catch his breath or repeat bag breathing between suctioning attempts
• Repeat suctioning until your child’s respiration’s sound clear and the suction catheter returns with little or no mucus. Limit the passes of the suction catheter to 3 times whenever possible to prevent tissue trauma.
• Dispose of suctioning supplies and turn off suction machine
• Wash and dry hands

Tips on Suctioning a Tracheostomy Tube

If there are bloody streaks in the mucus, try using saline drops with suctioning. More time on the mist machine may also help decrease blood in the mucus. If the blood in the mucus does not get better within 24-48 hours, notify your doctor. If you see bright red blood your child needs to be seen right away by your doctor.

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This entry was posted on Wednesday, June 11th, 2008 at 8:50 am and is filed under NBN Respiratory, Newborn Nurses, Uncategorized. The entry is tagged under respiratory, trach. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.