tracheotomy open system

1.	Goal: The patient will exhibit improved breath sounds and a clear, patent airway. Identify the patient.
2.	Determine the need for suctioning. Verify the suction order in the patient’s chart. For postoperative patient, administer pain medication as prescribed before suctioning.
3.	Explain what you are going to do and the reason to the patient, even if the patient does not appear to be alert. Reassure patient you will interrupt procedure if he or she indicates respiratory difficulty.
4.	Perform hand hygiene.
5.	Adjust bed to comfortable working position. Lower side rail closer to you. If patient is conscious, place him or her in a semi-Fowler’s position. If patient is unconscious, place him or her in the lateral position, facing you. Move the over-the-bed table close to your work area and raise to waist height.
6.	Place towel or waterproof pad across patient’s chest.
7.	Turn suction to appropriate pressure:
8.	For a wall unit for an adult: 100 to 150 mm Hg; neonates: 60 to 80 mm Hg; infants: 80 to 100 mm Hg; children: 100 to 120 mm Hg
9.	For a portable unit for an adult: 10 to 15 cm Hg; neonates: 6 to 8 cm Hg; infants 8 to 10 cm Hg; children 10 to 12 cm Hg
10.	Put on a disposable, nonsterile glove and occlude the end of the connecting tubing to check suction pressure. Place the connecting tubing in a convenient location. If using it, place resuscitation bag connected to oxygen within convenient reach.
11.	Open sterile suction package using aseptic technique. The open wrapper or container becomes a sterile field to hold other supplies. Carefully remove the sterile container, touching only the outside surface. Set it up on the work surface and pour sterile saline into it.
12.	Put on face shield or goggles and mask. Put on sterile gloves. The dominant hand will manipulate the catheter and must remain sterile. The nondominant hand is considered clean rather than sterile and will control the suction valve (Y port) on the catheter.
13.	With dominant gloved hand, pick up sterile catheter. Pick up the connecting tubing with the nondominant hand and connect the tubing and suction catheter.
14.	Moisten the catheter by dipping it into the container of sterile saline, unless it is a silicone catheter. Occlude Y-tube to check suction.
15.	Using your nondominant hand and a manual resuscitation bag, hyperventilate the patient delivering three to six breaths or use the sigh mechanism on a mechanical ventilator.
16.	Open the adapter on the mechanical ventilator tubing or remove oxygen delivery setup with your nondominant hand.
17.	Using your dominant hand, gently and quickly insert catheter into trachea.
18.	Advance the catheter to the predetermined length. Do not occlude Y-port when inserting catheter.
19.	Apply suction by intermittently occluding the Y port on the catheter with the thumb of your nondominant hand, and gently rotate the catheter as it is being withdrawn. Do not suction for more than 10 to 15 seconds at a time.
20.	Hyperventilate the patient using your nondominant hand and a manual resuscitation bag, delivering 3 to 6 breaths. Replace the oxygen delivery device, if applicable, using your nondominant hand and have the patient take several deep breaths. If the patient is mechanically ventilated, close the adapter on the mechanical ventilator tubing and use the sigh mechanism on a mechanical ventilator.
21.	Flush catheter with saline. Assess effectiveness of suctioning and repeat as needed and according to patient’s tolerance. Wrap the suction catheter around your dominant hand between attempts.
22.	Allow at least a 30-second to one-minute interval if additional suctioning is needed. No more than three suction passes should be made per suctioning episode. Encourage patient to cough and deep breathe between suctionings. Suction the oropharynx after suctioning the trachea. Do not reinsert in the tracheostomy after suctioning the mouth.
23.	When suctioning is completed, remove gloves from dominant hand over the coiled catheter, pulling it off inside out. Remove glove from nondominant hand and dispose of gloves, catheter, and container with solution in the appropriate receptacle. Remove face shield or goggles and mask. Perform hand hygiene.
24.	Turn off suction. Assist patient to a comfortable position. Raise bed rail. Offer oral hygiene after suctioning.
25.	Reassess patient’s respiratory status, including respiratory rate, effort, oxygen saturation, and lung sounds.