Performing Tracheostomy or Endotracheal Suctioning (Inline System)

Performing Tracheostomy or Endotracheal Suctioning (Inline System)

Equipment
■ For the once-a-day steps: procedure gloves; inline suction catheter.
■ When suctioning: sterile normal saline.
■ Be Smart! Inline suction is used only with a mechanical ventilator.
■ Linen-saver pad.

Assessment
■ Assess respiratory status (i.e., respiratory rate, depth, and rhythm; breath sounds; color; and pulse oximetry results).
■ Assess for signs that indicate the need for suctioning:
■ Restlessness.
■ Cyanosis.
■ Labored respirations.
■ Decreased oxygen saturation.
■ Increased heart and respiratory rates.
■ Visible secretions in the airway.
■ Presence of adventitious breath sounds during auscultation.

Post-Procedure Reassessment
■ Assess color, amount, and consistency of secretions.
■ Evaluate the patient’s tolerance of the procedure; note signs of
respiratory distress during and after the procedure.
■ Compare breath sounds, VS, and pulse oximetry before and after suctioning.

Key Points
Daily Procedure Steps
■ Prepare the equipment.
■ Open the inline suction catheter package, maintaining sterility.
■ Remove the adapter on the ventilator tubing and attach the suction catheter equipment to the ventilator tubing.
■ Reconnect the adapter on the ventilator tubing.
■ Attach the other end of the inline catheter to the connection tubing going to suction. Suction Procedure Steps
■ Assist the patient to semi-Fowler’s position unless contraindicated.
■ Don clean gloves and place a linen-saver pad on the patient’s chest.
■ Unlock the suction control port.
■ Adjust suction regulator according to guidelines or agency policy.
■ Hyperoxygenate the patient according to agency policy.
■ Unlock the inline catheter; with your dominant hand, insert the suction catheter gently, with suction off. Ask the patient to take slow, deep breaths if she can cooperate.
■ Be Safe! Do not apply suction as you enter or advance into the airway.
■ Be Safe! Advance the suction catheter gently, aiming downward, no further than the carina tracheae (premeasure). Do not force the catheter.
■ Apply continuous suction as you withdraw the catheter, but for no longer than 15 seconds.
■ Avoid saline lavage during suctioning.
■ Be Safe! Repeat suctioning as needed, allowing intervals of at least 30 seconds between suctioning. Make sure to hyperoxygenate the patient between each pass.
■ Withdraw the suction catheter completely into the sleeve, until you see the indicator line.
■ Use normal saline to clear secretions from the catheter. Attach the prefilled, 10-mL container of saline to the saline port on the inline equipment; squeeze the container while applying suction.
■ Lock the suction regulator port.
■ Provide mouth care and reposition the patient.

Documentation
■ Record:
■ Date, time, and reason for suctioning.
■ Size of suction catheter.
■ Amount, color, consistency, and odor of secretions.
■ Respiratory status before and after suctioning.
■ Patient’s tolerance of the procedure.
■ Any complications as a result of the procedure, and interventions performed in response.

Insert into the airway by maneuvering the catheter within the sterile

sleeve