RT Clinic: Sterile Suctioning a Tracheostomy Patient

RT Clinic Description
Sterile suctioning a tracheostomy patient can be intimidating for the beginner, but the process is very simple. The patient wants the mucous out, you have to get it with a sterile catheter :) Usually, cough, hacking, and a bright, red face are involved. Be prepared for it.
My sterile technique wasn't perfect in the clip, but you can get the point.
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[@staceyarey7904]

You have been an enormous help!!!! With the schools being 100% online while the coronavirus runs rampant in our country, we nursing students have been left to learn everything from horrible videos and reading textbooks. I am a tactile learner, so it has been a nightmare. Then comes along someone like you!!! I have already said many times that "if you truly know your material, you can teach it to a 10 year old." In other words, you are comfortable with yourself, clearly have mastered your craft, and you are able and willing to share your knowledge with others. Thank you for not posting pretentious crap - hate when people use a teaching platform to show off their vocabulary!! It is like, okay! You possess an extensive vocabulary!! Now can you actually attempt to explain this material in a manner that is easy to digest?!! You have accomplished this feat - thank you for that!

[@rtclinic]

Wow! Thank you Stacey for the kind words. 😊

[@barbbosworth520]

I am an RN with a trach. Instead of inserting the suction catheter until you meet resistance (the Carina, which is VERY UNCOMFORTABLE!!!). You know the length of the trach tube because it is marked on the faceplate. Note the markings on the suction catheter For the length, and ONLY go in until you reach the marking corresponding to the trach tube length, plus a little more to clear the distal part of the tube. Many facilities have a NOTE on the wall, listing this information, so that everyone knows how far to insert the suction catheter and cause less distress for the patient.

[@sheiladaly1507]

EXACTLY - you do not need to go the length of the tube.

[@paulahand-cortes3218]

I am a nursing student and this was a great video. To answer your question, I believe it is intermittent suctioning instead of bam bam bam. LOL. Thank you for taking time to do these videos. They really have helped me out.

[@Humbletrader08]

Im a nurse and this is very helpful,, specially your other video, the different type of tracheostomy tube tutorial, please continue making this kind of video, its very informative and can help many nursing students and Rt students, thank you sir God bless you,,

[@sinclair657]

Thank you for the demo. Pam,pam,pam (intermittent suctioning)

[@mitchkrdr]

bop bop bop aka Intermittent suctioning :) .. Thank you for this wonderful video! Very helpful!

[@mrCHIPPDOGG]

We're going to stick with bop bop bop, thank you very much lol

[@ginagrucelski7874]

Is it really a sterile procedure though?

[@cherishasanders6503]

Hi, thank you for these videos. I'm a new nurse and trach's scare the heck outta me! (Airway stuff in general so thanks to all the RT people!). Anyway... what should your wall suction unit be set to?

[@rtclinic]

For adults wall suction should be set between 80 mmHg and 120 mmHg. I would go on the higher side. Caring for trach patients definitely gets easier with time. Thanks for your comment!

[@smoothmove9258]

I saw one RT inserted 5cc of NS solution into inner cannula prior to suctioning. Is it right or wrong?

[@rtclinic]

Doing it routinely is not best practice because it has been shown to increase the incidence of VAP. With that said, sometimes RTs need to use small amounts of NS to loosen thick, tenacious secretions, but this should only be done as needed.

[@rtclinic]

The NS may have been used to clean the catheter before or after suctioning...in that case it is good. Instilling into an inserted catheter is not good.

[@nozyspy4967]

At what point was the patients head amputated?

[@rtclinic]

🤣😂

[@rn9167]

so the dominant hand is the non-sterile hand? the good thing is that I am left-handed too :)

[@bassamalmulhim67]

very informative , and fun , Thank You !!

[@brandytomlinson7925]

What about the saline ? Like how do you do that part

[@rtclinic]

Technically saline is only supposed to be used to clean the suction catheter. Most hospital policies warn against instilling saline directly into the tracheostomy.

[@tinkshu4002]

Man you great keep it up

[@maryganus2191]

How long should you suction down the trach? In secs?

[@latoyah6634]

15

[@rtclinic]

It will vary by the patient's tolerance. Sometimes it is good to get it all at once, so 15 seconds would be the max. Usually, once your are proficient you can do everything in about 8 to 10 secs.

[@ligisoby5822]

Do you put saline first?

[@rtclinic]

Per hospital standards you should not instill saline first, but to increase effectiveness of the suctioning at home..yes

[@eugeneabreut5208]

Jimmy i am a new paramedic and I’m doing inter facility transports. Occasionally i get trach pateints. If i have a trach patient that there sats are going down and i am trying to suction with no success what can that mean. If it is a bad mucus plug, what would You suggeste?. Also if they do go into respiratory distress with there o2 dropping below 90, should i bag them throught the trach or is it ever suggested to take out trach and ventilate through there mouth with bvm.

[@rtclinic]

The first thing to note on a trach patient is... cuffed or uncuffed. Cuffed would inflate and ventilate through the trach. Uncuffed you would likely use the patients oropharynx. Taking out the trach is very touchy...when you remove it, you take a big chance that you may not get them tubed. I would leave it in and then tube them orally. Pull the trach when the ET passes the cords. I hope this helps!

[@eugeneabreut5208]

Jimmy McKanna - RT Clinic thanks!

[@thomasstokes9584]

@@eugeneabreut5208 let me clarify. Most trachs have an "Inner Cannula", take out the inner cannula immediately as often the plug may just be in the catheter, once removed you have re-established a PATENT airway! If is indeed in the inner cannula, just clean it and remove the plug and then reinsert. If the occlusion seems to be deeper, then you can instill a VERY SMALL amount (1-2cc of normal saline) and then use your BVM to "positive" pressure ventilate the patient, this will often dislodge the plug and then you can immediately suction and remove it. The key to what I'm talking about is the absolute need to immediately re-establish a patent airway, then you can ventilate, oxygenate and your patients sats will improve. Also NEVER suction with the purpose of intentionally "Banging" on the Carina as this video suggests. I often teach to only advance the catheter to about 14 (the number 14 marking on the catheter), this is usually adequate to "stimulate" a cough without hitting the carina (can be very painful to do so).

[@mbm7443]

Great video, very informative. But honestly suctioning is not really a sterile procedure in the real world.. only in school. Most people don’t even wear the sterile gloves when doing open suctioning.

[@rtclinic]

That's too bad because we really should to provide the best care to our patients

[@ItzDanDan]

What could happen to the pt if they use just clean? Do u mean it could make his secretion worse?

[@rtclinic]

Without sterile technique we could introduce bacteria into their lower airway. It would easily grow down there.

[@omosefeosagie2233]

Can an LVN do this?

[@rtclinic]

I know that an LVN could do it, especially if they regularly work with trach patients. I don't know if there is something as a part of their licensure that would not allow it.

[@lyfevibes]

Yes, I’ve been doing this for almost 2 years.

[@dawnysmitty]

Yes I’m a Pediatric Trach Vent nurse and I’ve been doing this for 8 years

[@MzVan21]

@@dawnysmitty any more tips??.. I'm currently working with a pediatric pt...

[@dtorres42]

Great thank you

[@koryaiine7393]

Michael!

[@bettyjaxon]

Good morning!

[@rtclinic]

Thanks Betty! I hope you have a good one too.

[@HoneyShug]

Thank you

[@515coldfire]

Wear a mask?

[@rtclinic]

Definitely