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Tracheostomy Suctioning
Tracheostomy Tubes
Maintain airway ______
Provide access for removal of ______
Prevent ______when LOC decreased
Provide access for mechanical ______
Oral Airway
Emergency airway
- Quick
- Easy
Used with general anesthesia and short term vent patients
Discomfort and gagging common
Accidental ______is more common
Oral hygiene is difficult
Nasal Airways
More difficult to insert
Better tube stability and oral hygiene
Better tolerated
May cause ______of nasal septum and external meatus
May block sinuses or eustachian tubes
Tracheal Airways
The most efficient artificial airway
Device of choice for airway obstruction or trauma
Most comfortable airway
Allows oral feedings
Requires surgery
Indicated for the prolonged (>10 days) artificial airway
Complications include hemorrhage, scarring, ______
Trach components
Neck plate (flange)
Outer cannula
Trach ties
Cuff
- ______mmHg
- Inflated
- Deflated
Trach components
Outer Cannula
Inner Cannula
______
Trach types
Metal
Plastic
Single vs Double lumen
Fenestrated
Passy-muir
Placement
Above the carina at the level of the 2nd, 3rd tracheal rings
- Improper – against posterior wall of trachea
- Complication: perforation of esophagus
Emergency Bedside Supplies
Spare trach tube of same size and kind
Spare suction kit
Ambu-bag to manually ventilate patient
Sterile gauze
Airway/Trach Assessment
Patent Airway??
- Excess secretions
- Diminished airflow/breath sounds
- Wheezes, crackles
- Change in vitals
- BP, O2 sat
- Change in behavior
- LOC, restlessness, anxiety
Soiled dressing/ties
Oropharyngeal Suctioning
Yankaur or tonsillar tip used
May be delegated to ______
Clean gloves
Be gentle
Keep O2 source close
Encourage patient to cough
Rinse with water
May reuse if stored in clean dry area
Document assessment findings pre and post procedure
Trach suctioning
Gather equipment
- Suction kit
- Suction source
- Sterile saline
- Stethoscope
Trach Suction
Adjust wall suction to ______mmHg
Place connecting tubing in accessible secure place
Open saline, open suction kit
Set up basin and pour solution
______
Don sterile gloves
Connect sterile catheter to tubing
Test suction
Hyperoxygenate
Insert tube until resistance
- Insert only during inhalation
- Do not insert during swallowing
- Do not apply suction while inserting
Apply suction and rotate tube while withdrawing catheter from airway (no more than 10 sec)
______
Rinse catheter at every pass
Auscultate lungs
Document procedure and client response
In-line Suctioning
Mechanically ventilated patients
Should not be delegated to assistive personnel
Clean gloves
Documentation
Gurgling present on inspiration. O2 sats 90%. Procedure explained and patient positioned in Semi-fowlers. Trach suctioned with yellow, thick returns. Heavy, dry, yellow crusted drainage around stoma, trach plate and on old dressing. Trach site cleaned and dressing changed. Trach ties replaced. Patient tolerated procedure well with no complaints. Lungs clear. O2 sats 92%.------M. Smith, RN
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