Tracheostomy Suctioning (also refer to Tracheostomy Care)

Tracheostomy Suctioning Policy 

(Refer also to Tracheostomy Care) 

Purpose 

Tracheal suctioning involves the removal of secretions from the trachea or bronchi while stimulating the cough reflex. Tracheal suctioning helps to maintain a patent airway and provide optimal exchange of oxygen and carbon dioxide. Tracheal suctioning is to be performed as frequently as the resident’s condition warrants or as ordered by the physician. 

Policy 

• Tracheostomy suctioning is performed by a licensed nurse or respiratory therapist, per a physician's order, utilizing sterile/aseptic technique. 

• Prior to initiating tracheostomy suctioning, if oropharyngeal suctioning is needed, a Yankauer suction may be used. Sterile suction kits are used for the tracheostomy suctioning. 

• If ordered by the physician, hyperoxygenate prior to suctioning by means of an ambu bag attached to the oxygen flow meter set at 100% oxygen (liquid oxygen tank required). The order must include the number of breaths used to hyperoxygenate the resident. 

• The suction procedure should last no longer than 10 seconds to prevent hypoxia. Allow adequate time between each catheter insertion for normal breathing to aid in re-oxygenation. 

• The suction catheter is introduced gently into the tracheostomy tube. Suction should not be applied during catheter insertion to prevent injury to the mucous membranes. 

• The suction catheter is to be inserted until resistance is felt or the resident starts to cough, then withdraw slightly before suction is applied. 

• Disposable suction collection bottle and tubing will be changed as needed every 24 hours. 

Complications 

The actual suctioning procedure may cause some complications for the resident, including hypoxia, tissue trauma, infection, vagal stimulation, or bronchospasm. 

Equipment 

• Suction Machine 

• Sterile Suction Kit Containing or equivalent: 

• Sterile Suction Catheter (14 to 18 F) 

• Sterile Solution Container 

• Sterile Gloves 

• Sterile Saline – Pour Bottle 

• 2x2 Gauze Sponges – 2 

• Oxygen Set-Up 

• Ambu Bag 

Procedure 

I. Assess breath sounds and respirations. 

II. Position the resident in semi-Fowler’s position if possible. 

III. Open the suction kit and sterile 2x2 sponges, using the wrapper to create a sterile field. 

IV. Pour 30 to 50 cc of sterile normal saline into the sterile solution container, using aseptic technique. 

V. Turn on the suction unit. 

VI. Attach the sterile suction catheter to the connecting tubing by holding the catheter in your dominant hand (sterile hand) and the connecting tube in your non-dominant hand. 

VII. Hyperoxygenate the resident using the ambu bag for the prescribed number of breaths. (Requires MD Order) 

VIII. Insert the sterile suction catheter gently into the tracheostomy tube until resistance is felt or the resident coughs. Pull back slightly. 

IX. Place the thumb of your non-dominant (non-sterile) hand over the suction control. 

X. Rotate the catheter between the thumb and index finger of your sterile hand while applying intermittent suction and withdrawing the catheter. Do not suction for longer than 10 seconds. 

XI. The procedure may be repeated as indicated until the airway is clear, allowing adequate time between each catheter insertion for normal breathing. Flush the catheter with sterile normal saline between each insertion. 

XII. Rinse the connecting tubing, shut off the suction machine, and dispose of equipment. 

XIII. Assess the resident’s breath sounds and respirations. 

Documentation in the TAR &/or Nurses’ Notes 

• Date, time & frequency of procedure 

• Color, consistency, amount, odor of secretions 

• Respirations - Rate, depth, and regularity 

• Breath sounds 

• Resident cooperation and response to the procedure 

References 

• Centers for Medicare & Medicaid Services (CMS), Requirements of Participation for Long-Term Care Facilities. 

• State Operations Manual (SOM), CMS.