Tracheostomy Care and Suctioning Return Demonstration

Aki Notes BSN 2-YB-9

Oxygen Therapy in the hospital so u have to check it first in the nursing

– Indicated for clients who have hypoxemia due to the
reduced ability for diffusion of oxygen through the
respiratory membrane, hyperventilation, or substantial
loss of lung tissue due to tumors or surgery.
– Also indicated for clients with severe anemia or blood
loss, or similar conditions in which there are
inadequate numbers of RBCs or hemoglobin to carry
the oxygen.
– Prescribed by physician
• O2 concentration – they will tell you how much u
will give to the patients whether 20%, 40%, 60%
up to 100%
• Method of delivery – these are types of devices
that will be used when giving O2 therapy. We have
low flow type delivery (mababang O2 lang ang i-
poprovide ng specific device hidni sya pwedeng
pang mataas) and high flow type delivery (specific
amount of O2 is prescribed to the patient hindi siya
bumababa).
• Liter flow per minute – pt. should be given only for
like around 5L per unit.
– Monitored by nurse
• O2 saturation – oxygen are given to the patients
that have O2 desaturation in their body, we’re
going to use pulse oxymeter to detect any
desaturation on the O2 levels of the client. Normal
in pulse oxymeter is 95%-100%.
– Emergency measure
• Nurse initiate the therapy – Nurse can provide O2
therapy only as an emergency measure when
there is no doctor yet. Nurse may initiate but on
limited amount only. For emergencies they can
only give 2-3L per minute of O2 through nasal
cannula on the patient.
• Contact physician for order after giving O2
station dapat hindi siya nag spark kase pwede itong
mag cause ng sunog sa patient.
• Avoid materials that generate static electricity such as
woolen blanket and synthetic fabrics. Cotton fabrics can
be used to prevent the cause of fire. This is also the
reason kung bakit we don’t allow patients to use their
own blankets.
• Avoid use of volatile, flammable materials like oils,
greases, alcohol, ether and acetone. This will only
contribute to the cause of fire.
• Humidify oxygen. Always refill the humidity tank of the
O2 kase kapag nag dried out ito it will only cause
infection to the patient.
Oxygen Delivery System
• Low-flow System – example of devices used in here
are:
o Nasal cannulas
o Face mask
o Oxygen tents
o Transtracheal catheters
• High-flow System – example of devices used in here
are:
o Venturi mask – for patients with COPD
Artificial airway (Tracheostomy)
- An opening into the trachea through the neck
- A tube is inserted through this opening and an artificial
airway is created
- Performed using two techniques:
• Open surgical method – tracheotube is used
• Percutaneous insertion – transtracheal is used

Oxygen Source
• Portable system (Cylinders or tanks) – can be
travelled or transported.
• Wall mounted outlets – these are seen on the
patients room.
Tracheostomy tube
– Oxygen is also considered as humidifying device
because O2 is a dried gas so you need to place a – This type of tracheostomy tube is dual lumen meaning
humidifying tank to moisten the air that the 2 tubes are inserted inside
patients receive para hindi ma dried out ang
mucus membrane ng patients.

Safety precautions
• Place cautionary signs reading “No Smoking: Oxygen in
Use” at the door, foot board or in the O2 tank.
• Make sure that electric devices are in good working
condition to prevent the occurrence of short-circuit
sparks. There are old equipment’s that are being used

TRACHEOSTOMY CARE AND SUCTIONING RETDEM 1

Aki Notes Tracheostomy Care and Suctioning Return Demonstration
• Inner cannula – is inserted to the outer cannula, it is
also not bendable
• Shaft – at the end of this there is a cuff that balloons
when we put air, it blocks the whole airway of the
patient so that the air can only enter and exit through
the tube and not outside the tube anymore.
• Fenestrated tracheostomy tube – means have
additional hole on top before the cuff so that air can
get out there. We are able to talk to our patients
because of this.
• Faceplate – also called tube flange
• Pilot balloon – this is where we are going to insert
the syringe and this is where we inject air ranges from
5-10cc, water is not allowed to be injected here. If the
cuff is already inflated with air the pilot balloon also
have air up to the inside at matigas siya. If manipis or
pipi ung pilot balloon probably nag leak na ung air
inside and can be accidentally misplaced inside.
• Tracheostomy mask – used to deliver oxygen to the
patients. Placed on top of the tracheostomy on the
neck and connected to the O2.
• Tracheostomy tube – have filter to filter the air in
and out.
Suctioning
– When clients have difficulty handling their secretions
or an artificial airway is in place, suctioning may be
necessary to clear air passages.
– Aspiration of secretions through a catheter connected
to a suction machine or wall suction outlet.
– To clear air passages and remove all the secretions
that may block the airway of the client.
– Tracheosuctioning is an invasive procedure wherein
we need to perform the procedure using sterile
technique to prevent the introduction of
microorganism inside and to prevent infection.
Purpose of Suctioning a Tracheostomy
• To maintain a patent airway and prevent airway
obstructions
• To promote respiratory function (optimal exchange of
oxygen and carbon dioxide into and out of the lungs)
TRACHEOSTOMY CARE AND SUCTIONING RETDEM 2
BSN 2-YB-9
means to have balance exachnage of O2 in and out the
lungs of the pt.
• To prevent pneumonia that may result from
accumulated secretions. Lalo na kung long term ang pt.
at bed ridden dahil sila ang mas nangangailangan ng
suction to prevent hospital acquired pneumonia
• To obtain secretions for diagnostic purposes. To test
the secretions if they wanted to know what type of
infection or m.o is there
Methods of Suctioning
• Open method – manually suction the tracheostomy of
the patient
• Closed airway/ tracheal suction system (In-line
suctioning) – used together with the mechanical
ventilator. We don’t pull tracheostomy of the patient in
mechanical ventilator instead we can connect the inline
suction catheters.
Complications
• Hypoxemia – Remember when suctioning we are not
just vacuuming the secretions but also we are taking
out some of the O2 in the lungs of the client that’s why
he/she can have hypoxemia. So doing suctioning
always hyperventilate or hyperoxygenate the client.
• Trauma to the airway of the mucus membrane. Only 1
cm lang dpt ung lalagapas sa tracheostomy tube kapag
pinasok. When u hit the bifertition of the trachea of the
client pwede mo matamaan mucus membrane and
hahatakin nya yan that causes wounds or trauma to the
airway of the client.
• Nosocomial or health care associated infection – if we
are not going to utilize strict aseptic technique we might
spread infection.
• Cardiac dysrhythmia – too much suctioning cause heart
to pump more faster to the point na nahihirapana na
siya that results to dysrhythmia.
Important things to remember
• Assessment:
o Dyspnea – nahihirapan ba siyang huminga?
o Bubbling or rattling breath sounds (adventitious
sounds like crackles, rhonchi, rales) – naririnig mo
ba ito? Parang nag snork
o Poor skin color (pallor, duskiness, or cyanosis)
o Restlessness
o Tachycardia
Aki Notes Tracheostomy Care and Suctioning Return Demonstration BSN 2-YB-9

o Decreased oxygen saturation level – always check Parts of Tracheostomy Tube

pulse oxymeter of the patient
• Frequency: PRN
• Sterile procedure

Suction machine
• Portable suction unit
o Adult: 10-15mmHg
o Children: 5-10mmHg
o Infants: 2-5mmHg
• Wall suction unit
o Adult: 100-120mmHg
o Children: 95-110mmHg
o Infants: 50-95mmHg

• Obturator – during start of insertion it is inserted to

the nasal cannula of pt. serve as guide and lock from
Suction catheter the end of the outer cannula. Also protect lumen.
• Tip
o Open-tipped – nag suction din sa tip of catheter. Retdem – Tracheostomy Care and Suctioning
o Whistle tipped – top is not open, nasa gilid lang 1) Assess rate, rhythm and depth of respiration.
 Assess rate, rhythm and depth of respiration. To look
ung mga butas sa suctioning.
for signs & symptom of hypoxemia & hypercapnia
• Sizes infection or pain
o Adult: Fr 12 to Fr 18  Assess passage of air through tracheostomy tube.
o Children: Fr 8 to Fr 10  Assess pt. Ability to cough (amount & character sputum)
o Infants: Fr 5 to Fr 8 should clear/white
 Be aware of when and why the trach was inserted, how
Tracheostomy it was performed, the type and size of tube inserted
– A surgical opening in the trachea through the neck just 2) Explaining the procedure
below the larynx 3) Handwashing
4) Providing Privacy
– A tube is placed in the opening, thus air goes in and
5) Preparing the client and the equipment.
out of the tube, rather than the nose, mouth, and  Position the client to a semi-fowler’s to promote lung
throat expansion
– Because the nose and throat are bypassed, the air  Open the tracheostomy kit or sterile basins. Pour
does not get filtered and humidified. hydrogen peroxide and sterile normal saline into
separate container.
– This leads to MUCOUS!
 Establish sterile field.
– Performed Using Two Techniques:  Open other sterile supplies as needed.
• Open surgical method  Don gloving
• Percutaneous Insertion  Remove oxygen sources
– Indications 6) Removing the inner cannula
• To relieve upper airway obstruction.  Remove the inner cannula tube gently by pulling it out
• To improve respiratory function toward you in line with its curvature and place the
obturator.
• Respiratory paralysis
 Place the inner cannula in the solution. to moisten dried
secretions
Tracheostomy Tube 7) Removing the dressing
– A curved tube that is inserted into a tracheostomy 8) Cleansing the neck plate
stoma (the hole made in the neck and windpipe).  Cleanse neck plate with cotton applicators and hydrogen
– Types: peroxide aseptically.
• Single-lumen cuffed 9) Rinsing the neck plate
• Dual-lumen cuffed – pt. is able to speak here  Rinse neck plate using cotton applicators with sterile
water or saline solution aseptically.
• Dual-lumen cuffed Fenestrated
TRACHEOSTOMY CARE AND SUCTIONING RETDEM 3
Aki Notes Tracheostomy Care and Suctioning Return Demonstration BSN 2-YB-9

10) Cleansing the skin under the neck plate

 With hydrogen peroxide and cotton applicator, cleanse
thoroughly the skin under the neck plate aseptically.
11) Rinsing the skin
 Rinse skin under the neck plate using cotton applicator
with sterile water or saline.
12) Drying the skin under the neck plate
 Using a dry cotton applicator pat dry the skin under the
neck plate.
13) Removing / changing tie
 With the old tie in place, insert one 3 end of the new tie
through the neck plate from back to front.
 Pull the tie ends until it is even then bring both ends
around the back of the neck to the other side.
14) Inserting the tape
 Insert the end of the tape through the second opening
of the neck plate from back to front observing proper
position.
15) Tying and securing the tape / tie
 Tie securely the two ends of the new tape at the side of
the neck.
 Place one finger under tracheostomy ties to test security.
 Place a folded 4 in x 4 in gauze square under the tie
knot and apply tape over the knot.
16) Cutting and removing old tapes
 Cut or remove old tracheostomy tapes and discard
properly.
17) Taping and padding the tie. Placing the inner cannula
 Placed a folded 4 in x 4 in gauze square under the tie
knot and apply tape over the knot.
18) Discard all soiled dressing and according to
institutional policy.
19) Position the client to comfortable position.
20) Document change and cleaning done to tracheostomy
tube.
 Record suctioning, tracheostomy care, and the dressing
change
 Note the assessments before and after the procedure

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TRACHEOSTOMY CARE AND SUCTIONING RETDEM 4