For knowledge:
catheter.
 Explain the procedure to the
patient
 Prepare necessary equipment’s
such as:
 Sterile towel, kidney basin,
mask and gloves
 Gauze/Sponges cotton
swabs
 Hydrogen peroxide, Sterile
water and antiseptic
solution
 Tracheostomy tie, sterile
basin & brush/Pipe cleaner
 Sterile tracheostomy
dressing set/kit and
suction machine
 Assess the condition of stoma
such as redness, swelling,
bleeding secretions and
subcutaneous emphysema at the
neck
For Skills:
 Place the patient in comfort
position in a semi-fowler – to help
patient to cough and breathe
more easily.
 Wear mask, wash hands and don
on sterile gloves – To deter the
spread of microorganisms
 Open sterile package and basin
needs for suctioning and care in
an appropriate place in the
bedside table or overhead
without contaminating the inner
surface – To maintain sterility of
the items.
 Pours sterile saline and hydrogen
peroxide or sterile water into
sterile basin – To lubricate
catheter and to decrease friction
also to smoothen passage of the
 Hydrogenates the patient for 1-2
minutes – Providing increase
percentage of oxygen to prevent
hypoxia deprivation during
suctioning.
 Turns the suction machine on to
the appropriate pressure – To
provide safe and negative
pressure that according to the
patient’s age because excessive
negative pressure can precipitate
pneumothorax.
 Don gloves – to deter spread of
microorganisms
 Holding the sterile suction
catheter with dominant hand,
connect it to the suction tubing
that is held with the non-dominant
hand. – This prevents
microorganisms into respiratory
tract.
 Moisten the catheter by dipping it
into the basin of sterile saline,
Occlude the suction control port
to check suction. – It helps to
move secretions through catheter
and ensures the suction
equipment is functioning well
before insertion.
 Remove the oxygen
administration equipment with the
non-dominant hand – It allows
access to the tracheostomy tube.
 Using the dominant hand, gently
insert the catheter into the
trachea. Advance the catheter to
4-5 inches until the patient’s
cough. Take note that do not
occlude the suction port when
inserting the catheter. – By
inserting catheter can cause
 trauma to the mucosa and
remove oxygen from the
respiratory tract.
 Apply suction by occluding the
suction control port with the
thumb of non-dominant hand.
Gently rotate the catheter with
the thumb and index finger of the
dominant hand as you withdraw
the catheter. Limit suctioning to
10-15 seconds duration only at 3-
5 minutes interval. Instill NSS into
tracheostomy tube with the use of
syringe to loosen secretions. – It
removes secretions from all
surfaces of the airway and
prevent trauma from suction
pressure on one area of the
airway.
 Encourage catheter with saline
and assess the need for repeat
suctioning. Allow the patient to
rest at least 3-5 minutes between
suctioning. Re-administer oxygen
between suctioning efforts and
when suctioning is completed. –
It allows time interval and
replacing the oxygen helps to
compensate for hypoxia induced
by previous suctioning,
 When procedure is completed,
turn off the suction and
disconnect the catheter from the
suction tubing. Remove gloves
inside out and dispose it, the
catheter in a waster receptacle
an wash hands. – It limits the
transmission of microorganism
and deter the spread of it by
direct contact.
 Adjust the patient’s position.
Auscultate the chest to evaluate
breath sounds the don clean
gloves. – reassessment helps
evaluate the effect of suctioning.
 With your non-dominant hand,
unlock the inner canula by turning
the lock about 90-degree counter
clock wise.
 With non-dominant hand, remove
the inner cannula by gently
pulling it out toward you using an
outward and downward half are
movement of the wrist.
 Soak the inner cannula in the
hydrogen peroxide solution for
several minutes.
 Change gloves and remove the
cannula from soaking solution.
Clean the lumen and entire inner
cannula thoroughly using the pipe
cleaner or brush moistens with
sterile saline solution.
 Agitate and inspect the cannula
for cleanliness by holding it at
eye level and looking this into the
light.
 After rinsing the cannula, gently
tap it against the inside edge of
the sterile solution bowl.
 Dry the inside of the cannula by
using two or three pipe cleaners
twisted together. (Do not dry the
outer surface)
 Suction the outer cannula
 Clean the flange of the outer
cannula if necessary, using
cotton-tipped application or
gauze square moistened with
sterile saline solution.
 Grasp the outer flange of the
inner cannula and insert the
cannula in the direction of its
curvature.
 Lock the inner cannula in place
by turning the lock clock wise
 about 90 degrees to as upright
position
 Gently pull on the inner cannula
to ensure that the position is
secured.
 Change a tie
 Place gauze between stoma site
and the tracheostomy tube or
absorb solutions and prevent
irritation of stoma.
 Document the procedure,
observation of stoma, Cleaning of
the stoma should be performed
every 8 hours & tie be changed
every 24 hours or as frequently
as needed.