Burton Sneak Preview

Chapter 28

Respiratory Care

585

Skill 28.7 (continued) 8. Insert the catheter into the tracheostomy tube until you meet resistance, which is at the carina of the trachea. Safety: Do not apply suction while inserting the catheter to prevent hypoxia. 9. 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 tracheostomy tube. 10. Lift your thumb off the valve after a few seconds and then return it to the valve. This helps prevent the suction cath- eter from sticking against tracheal tissue and causing trauma to it. 11. Perform suctioning quickly. Safety: Suctioning for longer than 10 to 15 seconds at a time can cause hypoxia. 12. Rinse the suction catheter by placing it in the cup of sterile saline and using your thumb on the valve to create suction. 13. Repeat Steps 7 to 12 as needed to clear the tracheostomy tube of secretions. Wait at least 30 seconds between suction- ings to allow the patient to breathe easily. Reoxygenate with the Ambu bag between suctionings. Avoid suction- ing for more than a total of 5 minutes to prevent fatigue, trauma, and hypoxia. Safety: It is a good idea to hold your breath while you are suctioning a patient with a tracheostomy because this will remind you that the patient cannot breathe while the suction catheter is in the tracheostomy.

14. 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. 15. Remove the glove from your nondominant hand and wash or sanitize your hands to prevent cross-contamination. 16. Follow the Ending Implementation Steps located on the inside back cover. Evaluation Steps 1. Evaluate the patient’s ease of respirations after suctioning. Is the ventilator working properly without pressure alarms? Can the patient with a tracheostomy breathe without mucus bub- bling or rattling? 2. Determine how the patient tolerated the procedure. Were they frightened? Anxious? Did they complain of fatigue or dis- comfort afterward?

Sample Documentation

10/11/28 2010 Respirations moist with rattling noted in trach. Suctioned for mod amt of light yellow mucus. Coughed repeatedly during procedure and c/o fatigue after suctioning complete. Resp quiet and even at 22/min. _________________________________________________ Nurse’s signature and credentials

Sample of Electronic Documentation

Pt Sel

Log Off

Logged in: Hiam, Judith

Documenting in current time and date

Patient Charting Vital Signs Order Entry Order Review Patient Teaching Patient CARD Patient Data M.A.R Care Plans Reports

Page 1

To Begin: Double-Click the Report Admission History Care Plans Discharge Plan Discharge Summary/ Instructions MAR Nurse's Notes Patient Card Patient Teaching Vitals/ I & O

Nurse’s Notes

Scenario #: None

Nurse: Judith Hiam Number: N2 Judith

Patient: JH Number: 45

Printed: mm/dd/yyyy 21:41

Physical Assessment Phase:0 Respiratory Treatments Respiratory Treatments and Care Notes mmddyyyy 21:30 Judith Hiam

Resp moist with rattling noted in trache. Suctioned for sm amt thick, white, odorless secretions. 8mm disposable inner cannula replaced. Pulse ox 90% on room air. Trache collar replaced per order with oxygen at 2L/min. No gagging during procedure. Resp nonlabored. See VS record.

Patient Response mmddyyyy 21:40 Judith Hiam

Respiratory Treatments and Care mmddyyyy 21:40 Judith Hiam

Breath sounds clearing

Humidified air per orders

mmddyyyy 21:40 Judith Hiam

Reports breathing easier

Trach care per orders

mmddyyyy 21:40 Judith Hiam

Compliant with treatment regimen

Suction per orders and PRN

mmddyyyy 21:40 Judith Hiam

High Fowler’s position

mmddyyyy 21:40 Judith Hiam

Teach rationale for nursing interventions