Procedure for tracheal bronchial suctioning in adults.pdf

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Volume 8 Patient Care ASHFORD AND ST PETER’S HOSPITALS NHS TRUST PROCEDURE FOR TRACHEAL BRONCHIAL SUCTIONING See also: Tracheostomy care pictorial guide Tracheostomy care observation chart Tracheostomy care competency Tracheostomy Care Plan Procedure for removal of inner cannula of a tracheostomy tube 1.0 DEFINITION Tracheal bronchial suctioning is the removal of sputum via placement of a sterile suction catheter into a tracheostomy tube using a sterile non-touch technique. 2.0 AIMS Tracheal bronchial suctioning aims to effectively remove the maximum amount of secretions with minimal risk of complications to the patient. 3.0 INDICATIONS FOR PROCEDURE 3.1 A tracheostomy provides a patient with a patent airway. If the patient is unable to clear secretions from the airway independently, suctioning is indicated 3.2 Frequency for tracheal suction is determined by individual clinical assessment of patient need and should not be considered as a routine procedure. The following are recognised indications for tracheal suction and include:- • Patient request of inability to cough up secretion • Increased coughing of patient • Audible secretions in chest by listening or chest auscultation • Secretions felt on chest by resonance on chest wall • Increased work of breathing and/ or use of accessory muscles • Tachypnoea / increase in respiratory rate • Change in skin colour or peripheral desaturation indicated by a significant reduction in SpO2 from baseline • Reduction in anticipated ventilatory parameter (if patient receiving non-invasive positive pressure ventilation) 4.0 EQUIPMENT/ PREPARATION REQUIRED • Emergency equipment, ambu bag -valve mask, Tracheostomy Emergency Box • A functional suction unit 13.5 – 20 Kpa (Glass & Graz, 1995 Regan, 1998) • Correct size sterile catheters (Formula Tracheostomy tube size –2 x2 i.e. size 8 tube : 8 – 2 = 6 x2 = 12) • Yankeur suction catheter • Disposable sterile gloves • Latex universal gloves • Protective eye wear • Apron Ratified May 2006 Reviewed Issue 1 Page 2 of 8
• 1 bottle of Sterile Water (To be used for 24 hours, label with change date and ‘For Suction’) • Connected oxygen delivery supply (tracheostomy mask and tube if patient on air) 5.0 COMPONENTS OF PROCEDURE • Preparation of patient and equipment • Suctioning technique • Evaluation of procedure 6.0 GUIDELINE FOR PROCEDURE Volume 8 Patient Care ACTION Preparation of equipment and patient Ratified May 2006 RATIONALE 1. Wash hands with liquid soap or alcohol hand gel To reduce the risk of cross-infection and put on apron. (Rossoff et al, 1993). 2. Explain procedure to patient. To gain consent, allay any fears and enable the patient to co-operate. 3. Apply protective eye goggles (to be worn throughout the suction procedure). 4. Remove inner cannula and replace with clean inner cannula. 5. Consider pre-oxygenation of patient prior to procedure. Indicated if previous evidence of increased work of breathing, indicators of respiratory distress, tachypnoea and deoxygenation during or after previous suctioning procedures. Pre-oxygenation procedure: Increase the inspired oxygen concentration by 50% to the patient three minutes prior to procedure. NB: For Chronic Obstructive Pulmonary Disease (COPD) patients; increase the inspired oxygen with 20% only (Rogge, 1989) 6. Select the appropriate size suction catheter for patient need. To calculate correct catheter size • Subtract 2 from the size of the tracheostomy tube • Multiply by 2 (Caroll, 1994). To reduce the risk of cross infection from the patient’s secretions. To avoid passage of potential sputum plug into patient on suctioning. To reduce the risk of arrhythmia and hypoxia (Odell et al, 1993). COPD patients have an altered serum carbon dioxide response mechanism and have a dependent on carbon dioxide levels to maintain their respiratory drive. Catheter size should be less than half the tracheal diameter (Young, 1984). The lowest possible pressure should be used to reduce complications (Regan, 1998). Reviewed Issue 1 Page 3 of 8
Page 1: PROCEDURE FOR TRACHEAL BRONCHIAL SU
Page 5 and 6: Suctioning technique Volume 8 Patie
Page 7: Czarnik RE, Stone KS, Everhart CC,

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