Question

Identify the steps needed to perform suctioning on a patient with a tracheostomy tube..

Discuss risk factors associated with infection related to a tracheostomy tube and hospitalization.

What are the guidelines for implementing airborne, droplet, and contact precautions?

Answer 1

Tracheostomy is a small surgical opening made on the anterior trachea for the open airway.

1. Indications that the patient may require suctioning include:

• Noisy and or moist respirations

• Increased respiratory effort

• Prolonged expiratory breath sounds

• Restlessness

• Reduced oxygen saturation levels

EQUIPMENT REQUIRED FOR SUCTIONING.

• Shoulder roll—diapers or small rolled towel

• Suction machine

• Suction catheter

• Collection container for secretions

• Sterile normal saline

• Sterile or nonsterile gloves

• Appropriate protective equipment

• Water

• Manual ventilation bag

PROCEDURE PERFORMING SUCTIONING

Action	Rationale
Explain the procedure to the patient	Relieve patient anxieties
Switch on the suction unit and check for the suction machine and pressure	To ensure the machine is working correctly.
Wash hands	Reduce the risk of cross-infection
Check pre-oxygenation if receiving oxygen or ventilated	To prevent hypoxia
Remove tracheostomy devices before open suctioning	To allow access for sterile suction catheter tip
Connect suction catheter keeping catheter tip covered	To reduce the risk of transferring the infection
Do not apply suction whilst introducing the catheter	To avoid mucosal irritation, damage & hypoxia.
suction should not exceed 10 seconds	To avoid mucosal irritation, damage & hypoxia.
Observe the patient throughout the procedure to ensure their general condition is not affected	Tracheal suction may cause vagal stimulation leading to bradycardia
Remove the glove from the dominant hand by inverting it over the used catheter & dispose of the clinical waste bag	To minimize the risk of infection
If O2 delivery was increased, review for return to the previous level.	To prevent unnecessary oxygen delivery

AFTERCARE:

• Flush the connection tubing with clean water
• If the patient needs further suction, repeat the above actions using a new glove & a new catheter
• Record the procedure with Date & Time.

2. With every Surgical Procedure there is some risk factor associated.

1. Early Complications

• Bleeding
• pneumothorax
• Damage to esophagus
• Tracheostomy tube can be blocked by blood clots

2.Delayed Complications

• tracheomalacia
• tracheoesophageal fistula

Patient with prolonged Hospitalization is Prone to Pneumonia

3.The most important step in preventing infection is hand hygiene and the use of Universal Precaution Methods.

• use standard precautions when caring for all patients
• use contact precautions when providing care to patients who are known or suspected to be infected or colonized with pathogens that are transmitted by direct or indirect contact.
• perform hand hygiene
• don a gown and gloves

Hand Hygiene Must be Practised

• after touching blood, fluids, secretions, and excretions;
• after touching contaminated items;
• immediately after removing gloves; and
• between patient contacts