HHC Health & Home Care Clinical Policy And

HHC HEALTH & HOME CARE Section: 11-7
Pediatrics: Tracheostomy Suctioning __RN
PURPOSE:
To clear the airway and remove secretions which cannot
effectively be coughed up.
CONSIDERATIONS:
1. The cardinal indication for suctioning is the
presence of coarse breath sounds or rhonchi that
persist in spite of the patient's effort to cough. Other
indications include constant cough, retractions and
inability to clear secretions.
2. Suctioning should only be done as needed to keep
the tracheostomy tube patent. Need can be
determined by chest auscultation and signs of
increased respiratory effort.
3. Cardiac arrhythmia, vagal stimulation, and
laryngospasm may occur during suctioning. In the
event of heart irregularity or color changes,
suctioning should be discontinued.
4. Oxygen depletion may occur. Therefore, preoxygenate
before and after the procedure, unless
directed otherwise by the physician.
5. Suction apparatus should be cleaned or tubing
changed according to durable medical equipment
(DME) vendor's protocol.
6. Suction apparatus should be set at 40-60mm Hg -
neonate to six months, 60-100mm Hg - six months
to 10 years, 80-120mm Hg - 10 years to adolescent.
7. Occlusion of the tracheostomy tube is life threatening.
Infants and children are at greater risk than adults
because of the smaller diameter of the tube.
8. To avoid trauma to the tracheobronchial wall, the
suction catheter should be marked prior to
suctioning. Calibrated catheters may be utilized or
measurement may be performed by placing suction
catheter through sample tracheostomy tube (same
size as child's). Mark a line on the catheter, which
will provide a guide to inserting catheter. Suction
catheter should be inserted to a point just shortly
beyond the end of tracheostomy tube.
9. In children who require long-term cannulation with a
tracheostomy tube and who are not
immunosuppressed, using a sterile suction catheter for
each suction pass may not be optimal. Replacing the
suction catheter at least every 24 hours and using a
clean, no-touch technique may be used.
10. If the clean, no-touch is an option, the
recommendation of the equipment company
supplying the tracheostomy supplies should be
followed to clean and store the suction catheter
between suctioning.
11. Avoid suctioning after meals.
EQUIPMENT:
Suction apparatus capable of producing negative
pressure (standard is 80mm of pressure, range is
from 40-100)
Container for secretions
Suction catheter (the diameter should be approximately
half the diameter of the tracheostomy tube) No. 8-10
Two cups
Sterile saline
Sterile water
Impervious trash bag
Gloves
Supplemental oxygen
PROCEDURE:
1. Adhere to Universal Precautions.
2. Explain procedure to caregiver and patient, in age
appropriate manner.
3. Test suction apparatus.
4. Check tracheostomy tube to be sure it is tied
securely.
5. Remove sterile catheter from wrapping and attach
to plastic suction tubing.
6. Aspirate secretions.
a. Leaving thumb off air vent, gently insert
catheter into tracheostomy to premeasured line.
b. Gently aspirate secretions by covering the air
vent and rotating catheter. Never exceed 3 to 4
seconds with each suctioning.
c. In presence of tenacious secretions, 0.5cc to
2cc of sterile saline may be instilled into
tracheostomy tube prior to suctioning.
d. Each time you remove the catheter, allow the
patient three to five breaths before repeating
procedure or re-oxygenate with supplemental
oxygen.
e. The oral cavity can be suctioned after the
tracheostomy tube is cleared. Never suction
oral cavity first unless catheter is changed
before inserting into tracheostomy tube.
f. Rinse catheter tubing with sterile water to
prevent clogging.
g. Auscultate lungs to ascertain results.
7. Discard soiled supplies and solutions in appropriate
containers.
AFTER CARE:
1. Reassure patient and caregiver.
2. Document in patient's record:
a. Color of patient.
b. Consistency, color and amount of secretions.
c. Patient's tolerance of procedure.
d. Changes in vital signs or complications that
may have occurred.
e. Instructions given to caregiver.
3. Clean and change tubing according to DME
supplier's guidelines.
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