Endotracheal and Tracheostomy Suctioning & Reinsertion Medical Directive

Question 1

Endotracheal and Tracheostomy Suctioning & Reinsertion Medical Directive

Answer 1

A Primary Care Paramedic may provide the treatment prescribed in this Medical Directive if authorized.

Question 2

Indications

Answer 2

Patient with endotracheal or tracheostomy tube
AND
Airway obstruction or increased secretions.

Question 3

Conditions - Suctioning

Answer 3

Age: N/A
LOA: N/A
HR: N/A
RR: N/A
SBP: N/A
Other: N/A

Question 4

Conditions - Emergency tracheostomy reinsertion

Answer 4

Age: N/A
LOA: N/A
HR: N/A
RR: N/A
SBP: N/A
Other: Patient with an existing tracheostomy where the inner and/or outer cannula(s) have been removed from the airway AND
Respiratory distress AND
Inability to adequately ventilate AND
Paramedics are presented with a tracheostomy cannula for the identified patient.

Question 5

Contraindications - Suctioning

Answer 5

N/A

Question 6

Contraindications - Emergency tracheostomy reinsertion

Answer 6

Inability to landmark or visualize

Question 7

Treatment

Answer 7

Consider suctioning

Consider emergency tracheostomy reinsertion

Question 8

Consider suctioning

Answer 8

Age: < 1 year
Dose: Suction at 60-100 mmHg
Max. single dose: 10 seconds
Dosing interval: 1 minute
Max. # of doses: N/A

Age: ≥ 1 year to <12 years
Dose: Suction at 100-120 mmHg
Max. single dose: 10 seconds
Dosing interval: 1 minute
Max. # of doses: N/A

Age: ≥ 12 years
Dose: Suction at 100-150 mmHg
Max. single dose: 10 seconds
Dosing interval: 1 minute
Max. # of doses: N/A

Question 9

Consider emergency tracheostomy reinsertion

Answer 9

The maximum number of attempts is 2.

Question 10

Clinical Considerations

Answer 10

Suctioning:
Pre-oxygenate with 100% oxygen.
In an alert patient, whenever possible, have patient cough to clear airway prior to suctioning.

Emergency tracheostomy reinsertion:
A reinsertion attempt is defined as the insertion of the cannula into the tracheostomy.
A new replacement inner or outer cannula is preferred over cleaning and reusing an existing one.
Utilize a family member or caregiver who is available and knowledgeable to replace the tracheostomy cannula.