TRACHEOSTOMY TUBE

SUCTIONING
 TRACHEOSTOMY
• is a surgical procedure which consists
of making an incision on the anterior
aspect of the neck and opening a direct
airway through an incision in the
trachea.
TRACHEOSTOMY TUBE

 A SURGICAL
INCISION IN THE
TRACHEA
WHERE THE
PATIENT CAN
BREATH
PARTS OF TRACHEOSTOMY TUBE
DIFFERENT TYPES OF TRACHEOSTOMY TUBES

Cuffed Tracheostomy Tube

Consists of three parts:
•Outer cannula with an
inflatable cuff and pilot tube
• An inner cannula
• An obturator
 Cuffless tubes
• More suitable for long term ventilation
• patient must have effective cough and
gag reflex to prevent aspiration risk
 Fenestrated Tube

• Have an opening on the

posterior wall of outer cannula
allowing air to flow through
the upper airway and hence
allows patient to speak
• Often used during weaning
process
 DIFFERENT TYPES OF
TRACHEOSTOMY TUBES
 PURPOSE OF
TRACHEOSTOMY TUBES:
• PROVIDE AND MAINTAIN PATENT
AIRWAY
• REMOVE TRACHEOBRONCHIAL
SECRETIONS WHO ARE UNABLE TO
COUGH
• PERMIT THE USE OF POSITIVE
PRESSURE VENTILATION
• PREVENT UNCONSCIOUS CLIENTS FROM
ASPIRATING SECRETIONS
 PURPOSE OF
TRACHEOSTOMY TUBES:

• KEEPS THE TRACHEOSTOMY AREA

CLEAN AND FREE FROM
IRRITATION AND INFECTION
• KEEPS THE TUBES FREE FROM
MUCUS
• PROVIDE MOIST AIR FOR THE
PATIENT TO BREATH
 CONSIDERATIONS:

 NEVER REMOVE
OUTER CANNULA, IF
ACCIDENTALLY
EXPELLED KEEP
AIRWAY OPEN WITH
A HEMOSTAT
 CONSIDERATIONS:

 ALWAYS KEEP AN
EXTRA, COMPLETE
TRACHEOSTOMY
TUBE AT THE BED
SIDE AND A OBTURATOR

FORCEP OR
TRACHEAL
DILATOR OR
OBTURATOR
KELLY FORCEP
 CONSIDERATIONS:

 WITH SIGNS
OF CYANOSIS,
DOB, TUBE
DISLOCATION
CALL DOCTOR
AS ONCE
 CONSIDERATIONS:

 DO NOT USE
COTTON OR
COTTON
APPLICATOR
AROUND THE
TRACHEOSTOMY
AREA
CONSIDERATIONS:

 ALWAYS
HAVE
SIGNAL
RIGHT
WITHIN
REACH
 PREPARATION
AND PROCEDURE

1. Provide and label

small containers for
holding the catheters
Label for nasal
catheter
Label the other with
tracheal catheter

2. Check materials and

apparatus
 PREPARATION AND
PROCEDURE

3. Explain procedure

4. Catheter should be
about half the diameter of
the tracheostomy tube. If
too small suctioning will
be ineffective. Too large
a catheter may injure
tissue and or totally
obstruct the airway
 PREPARATION AND
PROCEDURE

5. Put on sterile gloves

6. Hold catheter in
dominant hand and the
connector in the non-
dominant hand
 PREPARATION AND
PROCEDURE

7. Using the sterile gloved

hand, place the catheter tip
in the NSS; using the
thumb on the other hand,
occlude the thumb control,
and suction a small
amount of sterile solution
through the catheter.
Determines if suction is working
properly
 PREPARATION AND
PROCEDURE

8. If patient does not

have copious
secretions,
hyperventilate the
lungs with a
resuscitation bag
before suctioning.
Hyperventilating the client
who doesn’t have copious
secretions can force the
secretions up the
respiratory tract
 PREPARATION AND
PROCEDURE

9.Remove the oxygen

device

10. With non-dominant

hand off the suction
port, quickly but
gently insert the
catheter into the
trachea thru the
tracheostomy tube.
 PREPARATION AND
PROCEDURE

11. Insert the catheter about 10 to 12.5 cm (4

to 5 inches ) or until the client coughs
To prevent tissue trauma and oxygen loss,
suction is not applied during insertion of the
catheter
 PREPARATION AND
PROCEDURE

12. Apply suction for 5 to 10

secs. By occluding the thumb.
Rotate the catheter by rolling
it between your thumb and
forefinger while slowly
withdrawing it.
Suction time is restricted to
10 secs or less to minimize
oxygen loss. Rotating the
catheter as it is withdrawn
prevents tissue trauma by
minimizing suction time in a
specific area
 PREPARATION AND
PROCEDURE

13. Withdraw the catheter completely and

release the suction

14. If secretions are thick, flush the catheter in

the sterile solutions, and insert 3 to 5 ml of
sterile NSS through the tracheostomy tube into
the trachea. Then suction
To liquefy the secretions for easy suction
 PREPARATION AND
PROCEDURE

15. Encourage client to breath deeply

and cough. Repeat the suction until the
air passage is clear and the breathing is
relatively effortless and quiet. Do not
suction for more than 3 to 5 mins in total
Suctioning too long can deplete
client’s oxygen supply
 SUCTIONING

• is aspirating
secretions through a
catheter connected
to a suction machine
or wall suction outlet.
PURPOSES OF SUCTIONING

1. To remove secretions that obstructs the

airway.
2. To facilitate ventilations.
3. To prevent infection that may result from
accumulated secretions
4. To obtain secretions for diagnostic
purposes
Equipment Use for Suctioning

1. Suction
catheter - are long
flexible tubes that
are used to
remove fluids from
the mouth and
airways.
 Suction Machine

WALL SUCTION
UNIT

PORTABLE SUCTION
 Types of Suction Catheter:
1. Open-tipped
- has a large opening
at the end of the catheter
and two opposite eyes.
This type is more
effective when the
mucus is very thick and
tenacious.
 Types of Suction Catheter:

2. Whistle-tipped
it has rounded tip
with a hole in the
center of the tip. It is
less irritating to
respiratory tissues
 Types of Suction Catheter

3. Yankauer – is
effective for
the removal of oral
and oropharyngeal
secretions
 French (Fr) Scale –
gauge used to measure the size
of the suction catheter.
Adult
Fr 12 – 18

Children
Fr 8 – 10

Infants
Fr 5 - 8
 SUCTIONING A
TRACHEOSTOMY
PARTS OF ENDOTRACHEAL
TUBE
Endotracheal Intubation
ENDOTRACHEAL SUCTIONING
TRACHEAL SUCTIONING
 ENDOTRACHEAL /
TRACHEAL SUCTIONING
Step 1: Gather the following equipment and supplies
 ENDOTRACHEAL /
TRACHEAL SUCTIONING
Step 2: Prepare the equipment
 ENDOTRACHEAL /
TRACHEAL SUCTIONING
POSITION YOUR PATIENTS IN A
COMFORTABLE POSITION(SEMI-FOWLERS)
 ENDOTRACHEAL /
TRACHEAL SUCTIONING
Step 3: Perform hand hygiene
 ENDOTRACHEAL /
TRACHEAL SUCTIONING
Step 4: Put on sterile gloves
 ENDOTRACHEAL /
TRACHEAL SUCTIONING
Step 5: Open the suction catheter
package.
 ENDOTRACHEAL /
TRACHEAL SUCTIONING
 ENDOTRACHEAL /
TRACHEAL SUCTIONING
Step 7: Holding the catheter with
dominant hand and the connector in non-
dominant hand attach the suction
 ENDOTRACHEAL /
TRACHEAL SUCTIONING
Step 8:
•Using sterile gloved hand
gently and quickly insert
the catheter without
applying any suction

•Slowly insert the catheter a

maximum of 6 inches or
until the client coughs or
feel resistance
 ENDOTRACHEAL /
TRACHEAL SUCTIONING
Step 9:
• Apply suction as you withdraw the
catheter. Do not apply suction for longer
than 10 seconds. (5-10 secs.)
• Rotate, the catheter by rolling the
catheter between the thumb and
forefinger while slowly withdrawing it.
 ENDOTRACHEAL /
TRACHEAL SUCTIONING

Step 10:
• Allow the patient 20 to 30
seconds to rest between
suction passes. When the
patient's airway is clear
and you are finished
suctioning, fill a clean
basin with Normal Saline
 ENDOTRACHEAL /
TRACHEAL SUCTIONING
Step 11: Clean the catheter and
connecting tubing between each suction
pass
 ENDOTRACHEAL /
TRACHEAL SUCTIONING
Step 12:
•Turn off the suction machine. Slide the
catheter back into the package and
disconnect it from the connecting tubing.
•Hang the connecting tubing on the
suction machine with the tip pointing up.
 ENDOTRACHEAL /
TRACHEAL SUCTIONING
Step 13:
•Discard gloved properly. Wash your hands
with soap and dry with a clean towel.
 ENDOTRACHEAL /
TRACHEAL SUCTIONING

Step 14.
•Document relevant data
a. Date and time of suctioning
b. Nature and amount of secretions
c. Note the patient’s respiration before
and after suctioning.
 Indication of Endotracheal
intubation
• Upper airway obstruction (e.g. secondary
to burn, tumor, bleeding)
• Apnea
• High risk of aspiration
• Ineffective clearance of secretions
• Respiratory distress
• Respiratory arrest
• Cardiac arrest
 CONTRAINDICATION

The following are only relative

contraindications to tracheal intubation:
1.Severe airway trauma or obstruction that
does not permit safe passage of an
endotracheal tube.
2.Cervical spine injury, in which the need for
complete immobilization of the cervical spine
makes endotracheal intubation difficult.
 ADVANTAGES
• easily and quickly performed
• larger tube facilitates suction and
procedures such as
bronchoscopy
• less kinking of tube
 DISADVANTAGES
• not recommended in patients with
suspended cervical injury
• uncomfortable
• mouth care more difficult to perform
• impairs ability to gag and swallow
• may increase salivation
• may cause irritation and ulceration of the
mouth
 Endotracheal Tubes
Nursing Management
1.The patient requires continuous monitoring
and assessment.
2. If tracheal and endotracheal tube is in
place. It is necessary to suction the patient’s
secretions.
3. Tracheal suctioning is performed when
adventitious breath sounds are detected.