Assessment:
Assess breathing pattern. Listen to the breath sounds. Observe for infection. Observe for hypoxia. Assess the needs of the patient with a tracheostomy for suctioning and cleaning.
Planning:
Wash your hands. Obtain the necessary equipment, as follows: Tracheostomy tube, mask, sterile gloves, self-inflating breathing bag, sterile water, sterile suction catheter, sterile syringe, normal saline if saline is to be instilled, sterile gauze squares, eye protection, portable suction machine and suction trap, if a spectrum specimen is needed.
Implementation:
Identify the patient. Provide privacy. Explain the procedure. Establish a way communicating with a tracheostomy patient. Test the suction apparatus. Place the patient on supine or in Mid-fowler’s position. Turn the patients head slightly toward you. Place the unconscious patient in the lateral position facing you. Put an eye protection and mask. Prepare 5ml sterile saline in a syringe. Open the sterile suction set, and prepare the equipment. Place the drape from the kit or a clean towel over the patient’s chest. Most kits contain a pocket of solution, sterile gloves, the sterile suction catheter and sterile gauzesquares. If the kit contains all this equipment, first put on gloves. Pour the saline into the basin. Hold the catheter in your dominant hand. And use the non-dominant hand to hold the suction taking to control the suction and to handle any after unsterile object. The non-dominant hand is now contaminated and cannot touch the catheter. The second person attaches the breathing bag to the oxygen source and prepares to ventilate the patient. The second person attaches the breathing bag to the tracheostomy tube and provides three deep breaths coordinated with the patients breathing pattern. Instill the normal saline into the tracheostomy. Control the suction with your unsterile gloved hand while suctioning with your sterile hand. Insert the catheter 4 to 5 inches into the tracheostomy without occluding the part on the suctioning catheters. Apply the suction by closing the system. This is done placing you thumb over the post or side opening at the base of the catheter. Apply suction for only 10 seconds. Withdraw the catheter, rotating it gently while you continue suctioning. Rinse the catheter with sterile water or normal saline. The second person provides ventilation immediately after the suction catheter is removed. Observe the patient for dyspnea after the suction catheter is removed. If hypoxia occurs, immediately provides additional deep breaths of oxygen. Turn off the suction and listen for clear breath sounds. If breathing is not clear, repeat suctioning method. If breathing sounds clear, uses the breathing bag to provide 3 or 4 deep breaths of oxygen Disconnect the catheter from the suction tubing. Grasp the cuff of the sterile glove, and pull the glove down over the used catheter. Discard all disposable equipment. Wash your hands and provide oral hygiene.
Evaluation:
Evaluate using the following criteria: tracheostomy tube in place, respiratory rate and depth normal, breath sounds clear and patient resting comfortably.
Documentation:
Record the procedure and observation on the patients chart. Amount and description of secretions and patient’s response to the procedure.
