Berman 8e Skill 26-02 Tracheostomy

Skill 26-2 Suctioning a Tracheostomy or Endotracheal Tube Student _______________________________________ Date _______________ Essential/ critical elementElementCompetency Demonstrated Yes No1. Introduced self and verified clients identity.2. Explained procedure to client and discussed how results will be used.3. Gathered appropriate equipment.4. Performed hand hygiene and observed other appropriate infection control procedures. 5. Provided for client privacy.6. Prepared client. a. Placed client in semi-Fowlers position, if not contradicted.7. Prepared equipment (open suction system). a. Attached resuscitation apparatus to oxygen source. Adjusted oxygen flow to 100. b. Opened sterile supplies. c. Poured sterile normal saline or water in sterile basin. d. Placed sterile towel, if used, across clients chest below tracheostomy. e. Turned on suction and set pressure in accordance with agency policy. f. Applied goggles, mask, and gown if necessary. g. Applied sterile gloves. h. Attached the suction catheter to the suction tubing.8. Flushed and lubricated the catheter. a. Placed catheter tip in sterile saline solution. b. Occluded thumb control and suctioned a small amount of sterile solution through catheter. 9. Hyperventilated lungs with a resuscitation bag before suctioning (if no copious secretions). a. Summoned an assistant if one was available for this step. b. Using nondominant hand, turned on oxygen to 12 to 15 L/min. c. If client was receiving oxygen, disconnected oxygen source from tracheostomy tube using nondominant hand. d. Attached resuscitator to tracheostomy or endotracheal tube. e. Compressed Ambu bag three to five times as client inhaled. f. Observed rise and fall of clients chest to assess adequacy of each ventilation. g. Removed resuscitation device and placed it on bed or clients chest with connector facing up. Variation Using a Ventilator to Provide Hyperventilation a. If client was on a ventilator, used ventilator for hyperventilation and hyperoxygenation.10. If client had copious secretions, did not hyperventilate with resuscitator. Instead, kept regular oxygen delivery device on and increased liter flow or adjusted FiO2 to 100 for several breaths before suctioning. 11. Quickly but gently inserted catheter without applying suction. a. With nondominant thumb off suction port, quickly but gently inserted catheter into trachea through tracheostomy tube. b. Inserted catheter about 5 in., or until client coughed, before applying suction. 12. Performed suctioning. a. Applied suction for 5 to 10 seconds by placing nondominant thumb over thumb port. b. Rotated catheter by rolling it between dominant thumb and forefinger while slowly withdrawing it. c. Withdrew catheter completely and released suction. d. Hyperventilated client. e. Suctioned again, if needed. 13. Reassessed clients oxygenation status and repeated suctioning. a. Observed clients respirations and skin color. Checked clients pulse if necessary, using nondominant hand. b. Encouraged client to breathe deeply and cough between suctions. c. Allowed 2 to 3 minutes with oxygen. d. Flushed catheter and repeated suctioning until air passage was clear and breathing was relatively effortless and quiet. e. After each suction, picked up resuscitation bag with nondominant hand and ventilated client with no more than three breaths. 14. Disposed of equipment and ensured availability for next suction. a. Flushed catheter and suction tubing. b. Turned off suction and disconnected catheter from suction tubing. c. Wrapped catheter around sterile and peeled glove off so that it turned inside out over catheter. Removed other glove. d. Discarded gloves and catheter in moisture-resistant bag. Performed hand hygiene. e. Replenished sterile fluid and supplies so that suction was ready for use again. f. Ensured that ventilator and oxygen settings were returned to presuctioning setting. 15. Provided for client comfort and safety. a. Assisted client to a comfortable, safe position that aided breathing. Variation Closed Suction System (In-Line Catheter) a. If catheter was not attached, applied clean gloves, aseptically opened a new closed catheter set, and attached ventilator connection on T piece to ventilator tubing. Attached client connection to endotracheal tube or tracheostomy. b. Attached one end of suction connecting tubing to suction connection port of closed system and other end of connection tubing to suction device. c. Turned suction on, occluded or kinked tubing, and depressed suction control valve to set suction to appropriate level. d. Used ventilator to hyperoxigenate and hyperinflate clients lungs. e. Unlocked suction control mechanism if required by manufacturer. f. Advanced suction catheter enclosed in its plastic sheath with dominant hand. Steadied T piece with nondominant hand. g. Depressed suction control valve and applied intermittent suction for no more than 10 seconds and gently withdrew catheter. h. Repeated as necessary. i. When suctioning was completed, withdrew catheter into its sleeve and closed access valve, if appropriate. j. Flushed catheter by instilling normal saline into irrigation port and applied suction. Repeated until catheter was clear. k. Closed irrigation port and closed suction valve. l. Removed and discarded gloves. Performed hand hygiene. ___ Used effective body mechanics throughout procedure. ___ Communicated appropriately with the client. ___ Documented all relevant information. Comments _______________________________________________________________________ __________________________________________________________________________________ Overall Performance Satisfactory Unsatisfactory Evaluator _______________________________ Berman Snyders Skills in Clinical Nursing, 8e Copyright 2016 by Education, Inc. All rights reserved. Y, dXiJ(x(I_TS1EZBmU/xYy5g/GMGeD3Vqq8K)fw9 xrxwrTZaGy8IjbRcXI u3KGnD1NIBs RuKV.ELM2fiVvlu8zH (W uV4(Tn 7_m-UBww_8(/0hFL)7iAs),Qg20ppf DU4p MDBJlC5 2FhsFYn3E6945Z5k8Fmw-dznZxJZp/P,)KQk5qpN8KGbe Sd17 paSR 6Q