UNIT FOUR
584
Clinical Skills and Care
Skill 28.7 Performing Endotracheal and Tracheostomy Suctioning
Assessment Steps 1. Verify the health-care provider’s order for endotracheal or tracheostomy suctioning. 2. Assess the patient for the need for suctioning. Auscultate the lungs and listen for moist respirations through the tracheos- tomy. If the patient is on a ventilator, you may hear the pres- sure alarm go off, indicating the need for suctioning. Planning Step 1. Gather needed equipment and supplies: sterile suction cathe- ter kit (which contains gloves, a catheter, and a cup for saline), sterile saline, goggles and a mask or a mask and face shield, a gown if indicated, and an Ambu bag for tracheostomy suctioning. Intervention Steps 1. Follow the Initial Implementation Steps located on the inside front cover. Suctioning an Endotracheal Tube When the Patient Is Connected to a Ventilator 2. Turn the suction on between 100 and 150 mm Hg. 3. Put on the sterile gloves and prepare the sterile suction cath- eter and saline as you did in Skill 28.6, keeping in mind that your nondominant hand is not sterile. 4. Lubricate the suction catheter in the sterile saline by placing the first 3 to 4 inches in the container of sterile saline and placing your thumb over the valve to suction up some of the liquid. 5. Push the button on the ventilator to give 100% oxygen. This gives 100% oxygen to the patient for 2 minutes while you perform suctioning to help prevent hypoxia. 6. Insert the catheter into the endotracheal tube until you meet resistance, which is the carina of the trachea. Safety: Do not apply suction while inserting the catheter to prevent hypoxia. 7. Apply suction with your thumb as you withdraw the cathe- ter. Use a circular motion and rotate the catheter between your thumb and first finger as you withdraw it to ensure that you suction all areas inside the endotracheal tube. 8. Perform suctioning quickly. Safety: Suctioning for longer than 10 to 15 seconds at a time can cause hypoxia. 9. Rinse the suction catheter by placing it in the cup of sterile saline and using your thumb on the valve to create suction. 10. Repeat Steps 5 through 9 as needed to clear the endotra- cheal tube of secretions. Safety: Wait 30 seconds between suc- tioning passes to allow the patient time to rest. Limit the total time to 5 minutes or less. 11. Disconnect the suction catheter from the suction tubing. Hold the catheter in the palm of your dominant hand and remove the glove over the catheter. This contains the cathe- ter for disposal and prevents contamination of the hands. 12. Remove the glove from your nondominant hand and wash or sanitize your hands to prevent cross-contamination. 13. Follow the Ending Implementation Steps located on the inside back cover. For In-Line Suction of an Endotracheal Tube 2. Turn the suction on between 100 and 150 mm Hg. 3. It is unnecessary to use sterile gloves for in-line suction because the suction catheter is contained inside a sterile sleeve, which is connected to the endotracheal tube.
4. Push the button on the ventilator to give 100% oxygen. This gives 100% oxygen to the patient for 2 minutes while you perform suctioning to help prevent hypoxia. 5. Wearing clean gloves, gently insert the suction catheter into the endotracheal tube until you meet resistance. 6. Apply suction by pressing the button over the suction port as you withdraw the catheter. Again, apply suction for no longer than 10 to 15 seconds at a time. Repeat suctioning as needed to clear the endotracheal tube of secretions.
7. Rather than placing the suction catheter in saline to clear it, squeeze a 10-mL plastic container of saline into the port located on the in-line setup. As you insert the saline, apply suction so that it will clear the suction catheter. 8. Follow the Ending Implementation Steps located on the inside back cover. For Suctioning a Tracheostomy When the Patient Is Not Connected to a Ventilator 2. Turn the suction on between 80 and 120 mm Hg. 3. Attach the Ambu bag to 100% oxygen from the piped-in oxygen. 4. Enlist the assistance of another health-care worker. Safety: It is very difficult to attach the Ambu bag to the tracheostomy and squeeze the bag to hyperoxygenate the patient using only one hand because you will be keeping your other hand sterile. 5. Put on the sterile gloves and prepare the sterile suction cath- eter and saline as you did in Skill 28.6, keeping in mind that your nondominant hand is not sterile. 6. Lubricate the suction catheter in the sterile saline as in Step 4 earlier in this skill. 7. Have your assistant attach the Ambu bag to the tracheostomy tubing, give the patient three to five breaths, and then dis- connect it from the tracheostomy tube. If you have no assis- tant, you must do this while keeping your dominant hand sterile and holding the sterile suction catheter.
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