UNIT 4 CHAPTER 25 TRACHEOSTOMY THERAPY & OXYGEN THERAPY Flashcards
TRACHESTOMY SUCTIONING
Suctioning the Artificial Airway
* Assess the need for suctioning.
* Wash hands. Don protective eyewear. Maintain Standard Precautions.
* Explain to the patient that sensations such as shortness of breath and coughing are to be expected but that any discomfort will be very brief.
* Check the suction source. Occlude the suction source, and adjust the pressure dial to between 80 and 120 mm Hg to prevent hypoxemia and trauma to the mucosa.
* Set up a sterile field.
* Preoxygenate the patient with 100% oxygen for 30 seconds to 3 minutes (at least three hyperinflations) to prevent hypoxemia. Synchronize hyperinflations with inhalation.
* Quickly insert the suction catheter until resistance is met. Do not apply suction during insertion.
* Routine instillation of normal saline is not supported. Gas exchange is impaired due to hypoxia and there is an increased risk for infection.
* Withdraw the catheter 0.4 to 0.8 inch (1 to 2 cm), and begin to apply suction. Apply continuous suction and use a twirling motion of the catheter during withdrawal to avoid impairing tissue integrity. Never suction for longer than a total of 10 to 15 seconds.
* Hyperoxygenate for 1 to 5 minutes or until the patient’s baseline heart rate and oxygen saturation are within normal limits.
* Repeat as needed for up to three total suction passes.
* Document secretion characteristics and patient responses.
TRACHEOSTOMY CARE/ MASK CHANGE
Tracheostomy Care
* Assemble the necessary equipment and maintain Standard Precautions.
* Suction the tracheostomy tube if necessary.
* Remove old dressings and excess secretions.
* Set up a sterile field.
* Remove and clean the inner cannula. Use half-strength hydrogen peroxide (if ordered) to clean the cannula and sterile saline to rinse it. If the inner cannula is disposable, remove the cannula and replace it with a new one.
* Clean the stoma site and then the tracheostomy plate with half- strength hydrogen peroxide followed by sterile saline. Ensure that none of the solutions enters the tracheostomy.
* Change tracheostomy ties if they are soiled. Secure new ties in place before removing soiled ones to prevent accidental decannulation. If a knot is needed, tie a square knot that is visible on the side of the neck. Only one finger should be able to be placed between the tie tape and the neck.
* Document the type and amount of secretions and the general condition of the stoma and surrounding skin tissue integrity. Document the patient’s response to the procedure.
