Trach care/Suctioning

Normal tracheostomy cuff pressure

Maintain at 18-25mmHg

First 24 hours after insertion

Do not suction, refer to ENT
Bleeding risk too great

Tracheostomy complications

Infection
Pneumonia
Hemorrhage
Tracheal injury
Obstruction
Subcutaneous emphysema
Pneumothorax

Risk factors for displacement

Excessive coughing
Obesity or thick neck
Trach ties not secured properly
Agitation
Turning
Transferring

Emergency equipment in room @ all times

Replacement trach
Obturator
Sterile hemostat
Ambu bag
Suction equipment

Trach suctioning pressures by age

Infants: 80-100 mmHg
Children: 100-120 mmHg
Adults: 100-150mmHg

Complication with suctioning

hypoxemia, cardiac dysrythmias, laryngeal spasm/couch, bradycardia, nasal trauma & bleeding.

Max diameter of suction catheter

No larger than 1/2 diameter of artificial airway

Nursing interventions for client with trach

Trach care
Prevent tissue damage
Air warming and humidification
Communication
Nutrition

Trach care: dressing change procedure

Remove old dressing
Clean skin around the stoma with 1/2 H2O2
Rinse with NS
Change ties
Apply trach dressing

Assess for following every shift

Tracheal deviation
Patency of trach
Integrity of skin

Frequency of trach ties change

every 48hrs or prn

Endotracheal tube

a catheter that is inserted by a MD or specially trained personel into the trachea through the mouth or nose in order to maintain an open air passage or to deliver oxygen or to permit the suctioning of mucus or to prevent aspiration of the stomach content

Tracheostomy Tube

a small incision is made by a surgeon in the patient's neck & tube is inserted directly in to the trachea, temporary or permanent air way.

Cuff for Peds

15-20 mmHg

Obturator

guide used to insert trach tube

Hypoxia

lack of oxygen

Upper airway obstruction signs and symptoms

gurgling, restlessness, excessive oral secretions, drooling, gastric secretions, inability to clear secretions from upper airway w/ coughing

Lower airway obstructions signs and symptoms

wheezes, crackling, absent or diminished breath sounds

Yankauer

rigid suction catheter used to remove secretions and foreign material from the oral cavity

Suctioning Documentation

Respiratory assessments before and after
Type and size of trach tube
Frequency and extent of care
Care completed
Client tolerance
Any complications
amount, consistency, color, odor of secretions
Route of suctioning, patient's response to suctioning
condit

Pediatric considerations

catheters should be 1/2 diameter of trach tube, thick secretions are harder to suction b/c smaller catheters need to be used, do not push catheter more than 0.5 cm past the tip of the artificial airway, do not suction longer than 5 seconds.

Gerontologic considerations

elastic recoil & gas exchange may not be as good, capillaries may be fragile--higher risk for bleeding or damage, higher risk for bleeding if on aitiplatlet or anticoagulant.

Ambu bag

Bag used to pre-oxegenate a client (especially before suctioning and trach care)

Inner cannula

Removable inner tube within an outer tracheostomy tube that can be removed for cleaning

hyperinflation

giving the client breaths that are 1 to 1.5 times the tidal volume through the ventilator circuit or via a manual resuscitation bag