Tracheostomy Suctioning

Pre-procedure for tracheostomy care

Involves passing a suction catheter though a tracheostomy and
applying suction to clear tracheobronchial secretions and maintain a
patent airway.
Only when clinically indicated
Open or closed technique
 Indications

1. Visible secretions in the airway

2. Need to maintain the patency and integrity of the
artificial airway
3. Coarse crackles over the trachea
4. Deterioration of the oxygen saturation level, arterial
blood gas values, or both
5. Inability to generate an effective spontaneous cough
6. Acute respiratory distress
7. Suspected aspiration of gastric or upper airway
secretions
8. Need to obtain a sputum specimen to identify infection
or for cytology
Contraindications

There are no absolute contraindications to

tracheal suctioning as problems are usually
short lived and related to the baseline
stability of the patient.
 Complications

decreased lung compliance

decreased functional residual capacity
hypoxemia
tissue trauma
bronchospasm
colonization of the lower airway
increased intracranial pressure
hypertension
hypotension
cardiac arrhythmias
Important to remember
Too frequent suctioning may cause irritation of mucous
membranes and increase secretions.
A suction attempt should last = <10-15 seconds.
There should be second intervals between each suction
(non-respiratory or O2 dependent)
Limit suctioning to 5 minutes in total
Applying suction for too long may cause increased
secretions &/or decrease the client’s oxygen demand
Equipment
Oxygen source & Suction catheter
tubing

Suction
Stethoscope
apparatus with
collection
container

Handheld
Oral suction resuscitation
device bag

Suction tubing
Equipment

Gloves Disinfectant
pad

Sterile solution Spare

tracheostomy
Sterile solution tubes
container

V/S monitoring Obturator

equipment
Equipment
Optional:
sterile gloves
suction catheter kit (includes a sterile suction catheter,
sterile gloves, and disposable sterile solution container)
gown
mask
goggles
mask with face shield
pulse oximeter and probe
non-fenestrated inner cannula
specimen collection container
label
laboratory transport bag
laboratory request form
cardiac monitor
PROCEDURE
Watery/White/Translucent Normal

Yellow/Tan/Green Infection

Brown Prior bleeding

Red Active bleeding

ORAL SUCTIONING

Use of a rigid plastic suction

catheter, known as a yankauer to
remove pharyngeal secretions
through the mouth
Oral suctioning catheter is not used
for tracheotomies
Patients with CVAs, drooling,
impaired cough reflex related to
age or condition, or impaired
swallowing
 Purpose

Maintain a patent airway

Improve oxygenation
Removing mucous secretions and foreign
material (vomit or gastric secretions) from
the mouth and throat (oropharynx)
 Complications

Hypoxemia
Trauma to the airway
Nosocomial infection
Cardiac dysrhythmia (related to
the hypoxemia)
PROCEDURE
Nebulization
 Nebulizer

A nebulizer is a piece of medical

equipment that a person with asthma or
another respiratory condition can use to
administer medication directly and
quickly to the lungs.

liquid medicine very fine mist

Purpose
INDICATIONS
CONTRAINDICATIONS
 SYRINGE 3CC
SALINE SOLUTION (NSS)

MEDICATION ADMINISTRATION
MANIFOLD RECORD (MAR)
 SIDE
EFFECTS

TACHYCARDIA
PALPITATIONS
DIZZINESS
NAUSEA
NERVOUSNESS
PROCEDURE
SUCTIONING
Question Drill
 QUESTION #1
A patient with a tracheostomy needs to be suctioned.
What would you do first before suctioning the patient?

A. Hyperoxygenate the patient before suctioning

B. Assist the patient into Sim's position
C. Disconnect pulse oximetry
D. Have the patient bear down
 QUESTION #1
A patient with a tracheostomy needs to be suctioned.
What would you do first before suctioning the patient?

A. Hyperoxygenate the patient before suctioning

Before suctioning a patient with a tracheostomy you would need to

hyperoxygenate the patient because during suctioning you will be
decreasing the patient's oxygen supply.
 QUESTION #2
The nurse caring for a client with a pneumothorax and who has had a
chest tube inserted notes continuous gentle bubbling in the suction
control chamber. What action is most appropriate of the nurse?

A. Increase the suction pressure so that the bubbling becomes vigorous.

B. Do nothing since this is an expected finding.
C. Immediately clamp the chest tube and notify the physician.
D. Check for an air leak because the bubbling should be intermittent.
 QUESTION #2
The nurse caring for a client with a pneumothorax and who has had a
chest tube inserted notes continuous gentle bubbling in the suction
control chamber. What action is most appropriate of the nurse?

B. Do nothing since this is an expected finding.

Continuous gentle bubbling should be noted in the suction control

chamber. Bubbling should be continuous in the suction control
chamber and not intermittent.
 QUESTION #3
When suctioning a client with a tracheostomy, when is the best time
to occlude the vent on the suction catheter?

A. Before inserting the catheter

B. When inside the inner cannula
C. While withdrawing the catheter
D. When the client begins coughing
 QUESTION #3
When suctioning a client with a tracheostomy, when is the best time
to occlude the vent on the suction catheter?

C. While withdrawing the catheter

The vent on a suction catheter is occluded after the catheter is fully inserted and is being
withdrawn. This reduces the potential for hypoxemia. Closing the vent before insertion or when
the catheter is just inside the inner cannula prolongs the time that oxygen is removed from the
airway. Coughing may or may not coincide with the proper time to occlude the vent; therefore,
it is not used as a criterion for this action.
 QUESTION #4
As a student nurse, you know that the suction procedure should
only last for how long?

A. Approximately 40 seconds
B. Approximately 30 seconds
C. Approximately 15 seconds
D. Approximately 5 seconds
 QUESTION #4
As a student nurse, you know that the suction procedure should
only last for how long?

C. Approximately 15 seconds

Suction should last for a maximum of 15 seconds to minimize risk of

complications such as hypoxaemia or a vasovagal response.
 QUESTION #5
What is the recommended pressure setting for the suction unit?

A. 130 mmHg
B. 140 mmHg
C. 120 mmHg
D. 150 mmHg

 QUESTION #5
What is the recommended pressure setting for the suction unit?

C. 120 mmHg

The recommended pressure setting is 120 mmHg. This should be

sufficiently high to clear secretions while avoiding damage to the
bronchial mucosa.
NEBULIZATION
NCLEX Drill
 QUESTION #1
All of these orders are received for a patient having an acute asthma
attack. Which one will the nurse administer first?

A. IV Methylprednisolone (Solu-medrol) 60mg

B. Triamcinolone (Azmacort) 2 puffs per MDI
C. Albuterol (Ventolin) 2.5 mg per nebulizer
D. Salmeterol (serevent) 50 mcg per DPI
 QUESTION #1
All of these orders are received for a patient having an acute asthma
attack. Which one will the nurse administer first?

C. Albuterol (Ventolin) 2.5 mg per nebulizer

Albuterol is a rapidly acting bronchodilator and is the first-line

medication to reverse airway narrowing in acute asthma attacks. The
other medications work more slowly.
 QUESTION #2
A client is receiving Isoetharine Hydrochloride (Bronkosol) via a
nebulizer. The nurse monitors the client for which side effect of this
medication?

A. Constipation
B. Diarrhea
C. Bradycardia
D. Tachycardia
 QUESTION #2
A client is receiving Isoetharine Hydrochloride (Bronkosol) via a
nebulizer. The nurse monitors the client for which side effect of this
medication?

D. Tachycardia

Side effects that can occur from a beta 2 agonist include tremors,
nausea, nervousness, palpitation, tachycardia, peripheral
vasodilation, and dryness of the mouth or throat.
 QUESTION #3
A patient with asthma is receiving a nebulizer of Cromolyn. The
patient reports a burning sensation in the nose along with a horrible
taste in their mouth. As the nurse you will?

A. Immediately stop the nebulizer

B. Re-adjust the nebulizer
C. Call a rapid response because the patient is having a potential
anaphylactic reaction to the medication.
D. Reassure the patient this is a temporary side effect of this
medication
 QUESTION #3
A patient with asthma is receiving a nebulizer of Cromolyn. The
patient reports a burning sensation in the nose along with a horrible
taste in their mouth. As the nurse you will?

D. Reassure the patient this is a temporary side effect of this

medication.
Cromolyn can temporarily cause the following side effects during
administration: sneezing, burning in nose, itchy/watery eyes, bad
taste in mouth. Reassure the patient that these are temporary side
effects of this medication.
 QUESTION #4
A pt presents to the ER with difficulty breathing, SOB, chest pain,
fatigue and dizziness. Upon checking the vital signs the nursing
student notices that the patient's SPO2 level is 96%, yet the patient
complains of difficulty with breathing. What is the next thing the
student will do?

A. Do nothing because the patient's SpO2 is within normal range

B. Apply oxygen via nasal cannula @ 2l/min
C. Give the patient a bronchodilator via nebulizer
D. Apply the simple face mask
 QUESTION #4
1. A pt presents to the ER with difficulty breathing, SOB, chest pain,
fatigue and dizziness. Upon checking the vital signs the nursing
student notices that the patient's SPO2 level is 96%, yet the
patient complains of difficulty with breathing. What is the next
thing the student will do?
C. Give the patient a bronchodilator via nebulizer
Give the patient a nebulizer because the signs they present with are
characteristic of asthma so giving them a bronchodilator will help
open the airway
 QUESTION #5
What would the nurse monitor for before applying oxygen to a
COPD patient?

A. Breath sounds
B. Heart rate
C. Blood Pressure
D. Respirations
 QUESTION #5
What would the nurse monitor for before applying oxygen to a
COPD patient?

D. Respirations

The nurse will need to monitor a patient's respirations before and

(even during ) therapy to ensure that the patient does not stop
breathing, because they might be a CO2 retainer (err on the side of
caution)