Purpose

To ensure the patency of an altered airway and to minimize pulmonary complications.

Equipment

1. Sterile tracheostomy suction kit
2. Suction source with connecting tubing
3. Sterile saline solution
4. Gauze sponges (noncotton lined)
5. Five cc sterile syringe/saline solution droperette
6. Personal protection equipment (goggles, glasses, gloves, and mask)
7. Ventilating bag
8. Oxygen

Procedure

1. Saline solution (2 to 3 cc) may be instilled with a sterile syringe or saline solution droperette to stimulate a cough and loosen tracheal secretions prior to suctioning.
2. Two-glove rather than one-glove suctioning technique is recommended to prevent exposure to infectious tracheal secretions.
3. Suctioning is indicated when the patient has a productive cough, adventitious breath sounds (rhonchi) over the upper airways, secretions that are audible or visible, or increase in ventilator pressure.
4. Gently advance the suction catheter until resistance is met and then withdraw the catheter slightly before applying suction.
5. Interventions to thin pulmonary secretions include increased humidification and examination of the patient's general hydration status.
6. When suctioning through a tracheostomy tube with an inner cannula, do not remove the cannula. The inner cannula remains in place during suctioning so that the outer cannula does not collect secretions.
7. If oropharyngeal or nasal suctioning is required, complete after tracheal suctioning. Discard suction catheter. Do not reinsert catheter into trachea.
8. Effective use of the ventilating bag requires a cuffed tracheostomy tube. Without the cuff inflated, the forced oxygen from the ventilating bag will escape around the tube with little or no effect on lung expansion.
9. Bronchodilator treatments and chest physical therapy, if ordered, should be done prior to the suctioning procedure.