307 Skill Checklists for Taylor's Clinical Nursing Skills: A Nursing Process Approach, 3rd edition Nome, Date, Unit Position. InsituctorfEveluator: Position SKILL 14-11 Suctioning the Tracheostomy: Open System : i Goal: the patient exhibitsimprovedoreath sounds onda clea patent ciwey. Comments Needs Practice cellent —— —_] i Bring necessary equipment tothe bedside stand or overbed table. —— | 2-Perform nand hygiene and put on PPE, ifindicated. — —— | 3.tdentty the patient. — | + Glose curtains around bed and close the door tothe room, ifpossible —— —— —_| 5 determine the need for suctioning. Verify the suction order inthe patient's chart, Assess for pain or the potential to cause pain, Administer paln medication, as prescribed, before suctioning. —— —— —| 6 kxptain to the patient whatyou are going to do and the reason or doing it, even ifthe patient does not appear to be alert. Reassure the patient you wil interrupt the proce- dure ifhe or she indicates respiratory dificulty. — — | 7-Aujust bed to comfortable working position, usually elbow height ofthe caregiver (VISN 8 Patient Safety Center, 2009). Lower side rai closest to you. if patient is conscious, place ‘him or her in a semi-Fowler's position. f patient is uncon- scious, place him or her in the lateral position, facing you. Move the overbed table close to your work area and raise to ‘waist height —— —— —_| 8 Place towel or waterproof pad across patient's chest. —— — —_| 9.1wn suction co appropriate pressure. — — =| Forawail uniefor an adult: 100-120 mm Hg (Roman, 2005); neonates: 60-80 mm Hg: Infants: 80-100 mm Hg: children: 80-100 mm Hg; adolescents: 80-120 mm Hg (reton, 2007) —— —| Fora portable unitfor an adult: 10-15 em Hg; neonates: 6-8 em Ng: nfants 8-10 cm Hg; children 8-10 cm Hg; adolescents: 8-10 om Hg. — — | Puronadisposable, clean glove and occlude the end of the connecting tubing to check suction pressure. Place the connecting tubing in a convenient location. if using, place resuscitation bag connected to oxygen within convenient reach, (coy 20:1 Wouter Lge liek Wain Sicherheit “nung Pcs pon ean ned een.Excellent Satisfactory Needs Practice SKILL 14-11 Suct ning the Tracheostomy: Open System (Continued) Comments 10, Open sterile suction package using aseptic technique, The ‘open wrapper or container becomes a sterile field to hold ‘other supplies. Carefully remove the sterile container, ‘touching only the outside surface. Set it up on the work surface and pour sterile saline nto I. 11. Put on face shield or goggles and mask, Puton sterile gloves. The dominant hand will manipulate the catheter ‘and must remain sterile. The nondominant hand is consid ‘ered clean rather than sterile and will control the suction valve (Y-port) on the catheter. 12, With dominant gloved hand, pick up sterile eatheter, Pick ‘up the connecting tubing with the nondominant hand and connectthe tubing and suction catheter, 13, Moisten the catheter by dipping it into the container of sterile saline, unless itis silicone catheter. Occlude ¥-tube tocheck suction. 14, Using your nondominant hand and a manval resuscitation bag, lyperventilate the patient, delivering three to six breaths or use the sigh mechanism on a mechanical ventilator. 15, Open the adapter on the mechanical ventilator tubing oF remove oxygen delivery setup with your nondominant hand, 16. Using your dominant hand, gently and quickly insert catheter into trachea. Advance the catheter to the predeter- ‘mined length. Do not occlude Y-port when inserting ‘catheter. 117. Apply suction by intermittent occluding the Y-port on ‘the catheter withthe thumb of your nondominant hand, and gently rotate the catheter as ti being withdrawn. Do not suction for more than 10 to 15 seconds ata time. 16. Hlyperventilate the patient using your nondominant hand ‘and a manual resuscitation bag, delivering three to six breaths. Replace the oxygen delivery device, I applicable, using your nondominant hand and have the patient take sev: eral deep breaths. IFthe patient is mechanically ventiated, lose the adapter on the mechanical ventilator tubing and, use the sigh mechanism on a mechanical ventilator. 19, Flush catheter with saline. Assess the effectiveness of, suctioning and repeat, as needed, and according to patient’ tolerance. Wrap the suction catheter around your ‘dominant hand between attempts. ‘og 2011by ewes Upp Win in Ces Cine se ‘Attra ats precede ams yn an lec,309 Excellent Satisfactory Needs Practice SKILL 14-11 Suctioning the Tracheostomy: Open System (Continued) Comments 20. Allow at least a 30-second to 4-minute interval if additional ‘suctioning is needed. No more than three suction passes Should be made per suctioning episode. Encourage the patient to cough and deep breathe between suctionings. Suc- tion the oropharynx after suetioning the trachea. Do not reinsert inthe tracheostomy after suctioning the mouth. 21, When suctioning is completed, remove gloves from domi- nant hand over the oiled catheter, pulling t off inside out. Remove glove from nondominant hand and dispose of loves, catheter, and container with solution in the appro- Driate receptacle. Assist patient toa comfortable position. Raise bed rail and place bed inthe lowest position, 22. Turn off suction. Remove supplemental oxygen placed for suctioning, if appropriate. Remove face shield or goggles and maste Perform hand hygiene. 23. Offer oral hygiene ater suctioning, 24, Reassess patient's respleatory status including respiratory rate, effort, oxygen saturation, and lung sounds, 25. Remove additional PPE, fused. Perform hand hygiene. coy 20:1 Wohestweteth Lg. lie kn Si Chess TavSChataag si ‘ving es ochre Pc yma eon