OXYGEN THERAPY

AND
TRACHEOSTOMY
SUCTIONING
By:
Carmencita R. Pacis PhD MAN RN
LEARNING OBJECTIVES
◦ Review knowledge and understanding of oxygen therapy and
suctioning
◦ Implement safe and quality nursing care during tracheal suctioning.
◦ Practice skills in promoting physiologic responses in the performance
of oxygen therapy and suctioning a tracheostomy tube.
OXYGEN
THERAPY
◦ 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.
OXYGEN THERAPY
◦ Prescribed by physician
◦ O2 concentration
◦ Method of delivery
◦ Liter flow per minute
◦ Monitored by nurse
◦ O2 saturation
◦ Emergency measure
◦ Nurse initiate the therapy
◦ Contact physician for order after
Oxygen source:

◦ Portable system (Cylinders or

tanks)
◦ Wall outlets

_________________

Humidifying device
NOTES
Portable oxygen delivery systems are available to increase the client’s independence. Oxygen cylinders need to
be handled and stored with caution and strapped securely in wheeled transport devices or stands to prevent
possible falls and outlet breakages. They should be placed away from traffic areas and heaters

Oxygen administered from a cylinder or wall-outlet system is dry. Dry gases dehydrate the respiratory mucous
membranes.

Humidifying devices that add water vapor to inspired air are thus an essential adjunct of oxygen therapy,
particularly for liter flows over 4 L/min

These devices provide 20% to 40% humidity. A humidifier bottle is attached below the flow meter gauge so that
the oxygen passes through water and then through the specific oxygen tubing and equipment prescribed for the
client.

Humidifiers prevent mucous membranes from drying and becoming irritated and loosen secretions for easier
expectoration. Oxygen passing through water picks up water vapor before it reaches the client. The more
bubbles created during this process, the more water vapor is produced. Very low liter flows (e.g., 1 to 2 L/min by
nasal cannula) do not require humidification. When a client is breathing very low flow oxygen, enough
atmospheric air is inhaled (which naturally has water vapor in it) to prevent mucosal drying
Safety precautions
◦ Place cautionary signs reading “No Smoking: Oxygen in Use”

◦ Make sure that electric devices are in good working condition to prevent
the occurrence of short-circuit sparks

◦ Avoid materials that generate static electricity such as woolen blanket

and synthetic fabrics. Cotton fabrics can be used.

◦ Avoid use of volatile, flammable materials like oils, greases, alcohol, ether
and acetone.

◦ Humidify oxygen.
NOTES
Place cautionary signs reading “No Smoking: Oxygen in Use”

Make sure that electric devices are in good working condition to prevent the
occurrence of short-circuit sparks

Avoid materials that generate static electricity such as woolen blanket and
synthetic fabrics. Cotton fabrics can be used.

Avoid use of volatile, flammable materials like oils, greases, alcohol, ether and
acetone.

Humidify oxygen. Place sterile water into the oxygen humidifier to prevent
dryness and irritation of mucous membrane in the airway
Oxygen Delivery System
◦Low-flow System
◦ Nasal cannulas
◦ Face mask
◦ Oxygen tents
◦ Transtracheal catheters
◦High-flow System
◦ Venturi mask
NOTES
Low-flow and high-flow systems are available to deliver oxygen to the
client. The choice of system depends on the client’s oxygen needs,
comfort, and developmental considerations. Low-flow systems deliver
oxygen via small-bore tubing. Low-flow administration devices include
nasal cannulas, face masks, oxygen tents, and transtracheal catheters.
Because with these types of devices room air is also inhaled along with
the supplemental oxygen, the fraction of inspired oxygen (FiO2) will vary
depending on the respiratory rate, tidal volume, and liter flow. High-flow
systems supply all the oxygen required during ventilation in precise
amounts, regardless of the client’s respirations. The high-flow system
used to deliver a precise and consistent FiO2 is the Venturi mask with
large-bore tubing
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
◦ Percutaneous insertion
NOTES
Artificial airways are inserted to maintain a patent air passage for clients whose airways have
become or may become obstructed. A patent airway is necessary so that air can flow to and from
the lungs. Clients who need airway support due to a temporary or permanent condition may
have a tracheostomy.

A tracheostomy is an opening into the trachea through the neck. A tube is usually inserted
through this opening and an artificial airway is created.

A tracheostomy is performed using one of two techniques: the traditional open surgical method
or via a percutaneous insertion.

The percutaneous method can be done at the bedside in a critical care unit.

The open technique is done in an operating room where a surgical incision is made in the trachea
just below the larynx. A curved tracheostomy tube is inserted to extend through the stoma into
the trachea.
Tracheostomy tube
NOTES

When the client breathes through a tracheostomy, air is no

longer heated, humidified, and filtered as it is when passing
through the upper airways; therefore, special precautions are
necessary. Humidity may be provided with a mist collar. Clients
with long-term tracheostomies may use a heat moisture
exchange device known as a “Swedish nose” that fits onto the
connector of the inner cannula. They may also wear a stoma
protector such as a 4×4 gauze held in place with a cotton tie
over the stoma or a light scarf to filter air as it enters the
tracheostomy.
Suctioning
◦ Aspiration of secretions
through a catheter
connected to a suction
machine or wall suction
outlet.
◦ To clear air passages
◦ Sterile technique
NOTES

When clients have difficulty handling their secretions or an

artificial airway is in place, suctioning may be necessary to
clear air passages. Suctioning is the aspiration of secretions
through a catheter connected to a suction machine or wall
suction outlet. Sterile technique is recommended for all
suctioning to avoid introducing pathogens into the airways.
 ◦ To maintain a patent airway and prevent
airway obstructions
◦ To promote respiratory function (optimal
Purposes of exchange of oxygen and carbon dioxide
Suctioning a into and out of the lungs)
tracheostomy ◦ To prevent pneumonia that may result
from accumulated secretions
◦ To obtain secretions for diagnostic
purposes
Methods of
Suctioning:
◦Open method

◦Closed airway/ tracheal

suction system (In-line
suctioning)
NOTES
The traditional method of suctioning a tracheostomy is sometimes referred to as the
open method. If a client is connected to a ventilator, the nurse disconnects the client
from the ventilator, suctions the airway, reconnects the client to the ventilator, and
discards the suction catheter. Drawbacks to the open airway suction system include
the nurse needing to wear personal protective equipment (e.g., goggles or face
shield, gown) to avoid exposure to the client’s sputum and the potential cost of
onetime catheter use, especially if the client requires frequent suctioning.

With the closed airway/tracheal suction system (in-line suctioning), the suction
catheter attaches to the ventilator tubing and the client does not need to be
disconnected from the ventilator. The nurse is not exposed to any secretions because
the suction catheter is enclosed in a plastic sheath. The catheter can be reused as
many times as necessary until the system is changed. The nurse needs to inquire
about the agency’s policy for changing the closed suction system.
 ◦ Hypoxemia
◦ Trauma to the airway
Complications: ◦ Nosocomial or health care-associated
infection
◦ Cardiac dysrhythmia
NOTES
Suctioning is associated with several complications: hypoxemia, trauma
to the airway, nosocomial or health care–associated infection, and
cardiac dysrhythmia, which is related to the hypoxemia
Important things to
remember:
◦ Assessment:
◦ Dyspnea
◦ Bubbling or rattling breath sounds
(adventitious sounds)
◦ Poor skin color (pallor, duskiness, or
cyanosis)
◦ Restlessness
◦ Tachycardia
◦ Decreased oxygen saturation level
◦ Frequency: PRN
◦ Sterile procedure
NOTES
The nurse decides when suctioning is needed by assessing the client for signs of respiratory
distress or evidence that the client is unable to cough up and expectorate secretions. Dyspnea,
bubbling or rattling (adventitious) breath sounds, poor skin color (pallor, duskiness, or cyanosis),
restlessness, tachycardia, or decreased oxygen saturation (SpO2) levels (also called O2 sat) may
indicate the need for suctioning.

Suctioning irritates the mucous membranes which may increase secretions if performed too
frequently and can cause the client’s O2 saturation to drop further, put the client in
bronchospasm, and if the client has a head injury, cause the intracranial pressure to increase. In
other words, suctioning is based on clinical need versus a fixed schedule. The frequency of
suctioning depends on the client’s health and how recently the intubation was done.

Sterile suctioning is necessary to remove these secretions from the trachea and bronchi to
maintain a patent airway.
 Suction machine
◦Portable suction unit
◦Adult: 10-15mmHg
◦Children: 5-10mmHg
◦Infants: 2-5mmHg
◦Wall suction unit
◦Adult: 100-120mmHg
◦Children: 95-110mmHg
◦Infants: 50-95mmHg
NOTES

Suction apparatus used may be portable or a wall unit type. For

portable units: set to 10-15 mmHg for adult patients, 5-10
mmHg for children and 2-5 mmHg for infants. If wall unit is used:
set it to 100-120 mmHg for adults, 95-110 mmHg for children
and 50-95 mmHg for infants.
Suction catheter
◦Tip:
◦Open-tipped
◦Whistle tipped
◦Sizes:
◦Adult: Fr 12 to Fr 18
◦Children: Fr 8 to Fr 10
◦Infants: Fr 5 to Fr 8
NOTES
Suction catheters may be either open tipped or whistle tipped. The whistle-tipped
catheter is less irritating to respiratory tissues, although the open-tipped catheter may
be more effective for removing thick mucous plugs. Most suction catheters have a thumb
port on the side to control the suction. The catheter is connected to suction tubing,
which in turn is connected to a collection chamber and suction control gauge. The
catheter size varies for each client, use Fr 12 to Fr 18 for adults, Fr 8 to Fr 10 for children
and Fr 5 to Fr 8 for infants

To prevent hypoxia when tracheostomy suctioning is administered, the outer diameter of

the suction catheter should not exceed one half the internal diameter of the
tracheostomy. A rule of thumb to determine suction catheter size is to double the
millimeter size of the artificial airway. For example, an artificial airway (e.g.,
tracheostomy) diameter of 8 mm × 2 = 16. A size 16 French suction catheter would be
the largest size catheter that would be safe to use.
Oxygen therapy with
Suctioning a Tracheostomy
tube procedure:
◦ Determine the need for suctioning and
the time last suctioning was done
◦ Introduce self and verify clients identity
◦ Explain the procedure
◦ Perform hand hygiene and observe
other appropriate infection prevention
procedures
◦ Provide privacy and place client in
semi-fowlers position
Oxygen therapy with
Suctioning a Tracheostomy
tube procedure:

◦ Prepare the equipment

◦ Attach resuscitation bag (Ambu
Bag) to oxygen source
◦ Open sterile supplies
◦ Pour sterile saline solution or sterile
water into sterile container
◦ Place sterile towel across client’s
chest
◦ Turn on suction apparatus
◦ Apply PPE if necessary
◦ Wear sterile gloves
Oxygen therapy with Suctioning a
Tracheostomy tube procedure:
◦ Hold catheter using dominant
hand and suction connector by
non-dominant hand, and
attach them
◦ Flush and lubricate the
catheter
◦ Hyperventilate the lungs using the Ambu
Bag before suctioning (3-5x as client
inhales); WARNING: Do not hyperventilate
if with copious secretions.
Oxygen therapy with Suctioning
a Tracheostomy tube
procedure:
◦ Quickly but gently insert the suction catheter
without applying suction (0.5 to 1cm past the
distal end of tube)
◦ Apply suction 5 to 10 seconds in a rotating
motion while slowly withdrawing the catheter
◦ Hyperventilate the client
◦ Reassess client
◦ Repeat suctioning if needed
 Encourage client to do deep
Encourage breathing and cough in between
suctions

Oxygen Allow
Allow 2-3 minutes rest with oxygen
(if between suctions
therapy with
Suctioning a Flush Flush the catheter after each suction
Tracheostomy
tube Dispose
If done with procedure, dispose
equipment and ensure availability for
procedure: the next suction.

Dispose catheter and gloves

Dispose properly
 Be sure that
ventilator and
Perform hand oxygen settings are
Oxygen hygiene returned to
pre-suctioning
therapy with settings

Suctioning a
Tracheostomy Document procedure and

tube relevant data:

• Date and time
suctioning was done,
procedure: Assist client to a
comfortable and amount and description
of secretions,
safe position assessment before and
after procedure
Watch the link for the procedure
Open suctioning: https://www.youtube.com/watch?v=yeuj0_-DFgQ
Inline Catheter Suction technique: https://www.youtube.com/watch?v=85eraWgiraw