05 Trach care and suctioning

Question 1

What are indications for a trach?

Answer 1

• Bypass severe recurrent upper airway obstruction i.e., repeated aspiration, anatomic narrowing/stenosis, tracheal malacia, etc.
• Prolonged mechanical ventilation after failure to wean/extubate or if course is protracted (> 5 – 7 days)
• Facial trauma
• Inability to remove secretions from airway
• Head and neck surgery

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Question 2

When are metal trachs used?

Answer 2

• Generally for long term or permanent use for individuals requiring long term airway management.
• Metal trachs are non disposable
• Not used in Pediatrics
• Patients not mechanically ventilated anymore through metal trachs

Question 3

What are risks/complications of trachs?

Answer 3

• Bleeding
• Infection
• Erosion of mucosal lining with granuloma formation
• Compromised breathing
• Plugging with mucous/secretions
• Tracheal esophageal fistula
• Accidental decannulation
• “False pocket” when reinserting tube
• Subcutaneous emphysema/Crepitus

Question 4

What are suctioning indicators?

Answer 4

• Patient request
• Decreased level of consciousness
• Inability to clear secretions due to ineffective, weak cough
• Increased & persistent coughing (even though strong) that doesn’t clear secretions
• Specimen collection from an intubated/trached patient
• ¯ O2 sats
• ­ work of breathing, ­ RR, ­ PIP on ventilator

Question 5

How does Yankauer Suction catheter work?

Answer 5

Used for oral secretions and to clear airway of particulate matter

Question 6

How does the Open Suction Catheter work?

Answer 6

Single use only. Used to orally or nasally suction or with trached patients who are not on ventilator

Question 7

How does Closed Suctioning work?

Answer 7

• Closed suction or “in line” suction catheter. Used for patients on ventilators. Decreased risk of infection - system isn’t opened for suctioning procedures. Kept in sterile sheath
• Clean gloves used

Question 8

How should you go about suctioning?

Answer 8

• Place suction catheter in saline and test suction function
• Insert catheter without suction
• As you reach end of trach tube or feel resistance, pull back slightly and apply suction. Encourage pt to cough.
• Rotate tube and pull out while applying suction – ≤ 10 seconds
• Observe your patient closely and replace oxygen. Allow them to recover 1 – 2 minutes (minimum 1 minute, depends on pt’s toleration of suctioning)
• Rinse catheter in saline
• Repeat procedure if secretions still present (max 3 passes)
• Monitor patient and reapply oxygen