Nursing Demos: Tracheostomy Care and Suctioning

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Chime music today. Were gonna be performing trach care on a patient. So i i have my patient chart here jaime jones.
Mr. Number 5891351329 date of birth one62. We also want to verify that the patient has no allergies and then we want to check the order.
The physician order for the skill. Were about to perform states here trach care suctioning every 12 hours as needed now were going to go gather our supplies. Well need a drape suction catheter.
Extra pair of sterile gloves. Hemostat. Bandage scissors.
Pulse. Oximeter and our trach care kit. Which will have our cleaning solution trach ties and gauze now im gonna go enter the patients room knock knock knock hi mr.
Jones its sarah your nurse. Im here to perform trach care and suctioning how are you today okay im gonna wash my hands gonna get some gloves on here i hear some rattling in your chest. There i think.
Thats important that we get that gunk out of you just gonna bring the bed. Up. Here are you having any pain or anything okay good can you tell me your name and date of birthkay.
We have jaime jones. Mr. 5891351329 date of birth.
One 1662 okay good now. Imma just take a quick listen to you here take some deep breaths okay and again again and again all right sounds like we want to get some stuff cleared out of your chest. There im also gonna put this thing on your finger.
Here. The pulse ox. Lets see how your oxygen level is doing right now okay.

a nurse is performing suctioning for a client who has a tracheostomy-0
a nurse is performing suctioning for a client who has a tracheostomy-0

It looks like we could use a little bit of suctioning all right. Im just gonna get my stuff all set up okay so im gonna grab my suction catheter here from the wall for adults. We want 100 to 120 on the suction level for pediatrics.
Its 80 to 100. And you want to make sure that the suctions actually set to continuous okay so its always applying pressure for us okay now im gonna set up my field. Im gonna take the drape place it over mr.
Jones chest put this across you mr. Jones so we dont make a mess okay and now im gonna prepare my field we want to open up the suction catheter and now were gonna open up our trach care kit now remember everything inside the trach care kit is sterile apply my sterile gloveskay now im gonna set up my field so id get this drape out remember shiny side down okay grab my suction catheter. Im gonna separate my gauze theres two different types of gauze in here ive got regular four by fours and the drain sponges with the slit in it thats gonna go around the trach.
When im finished got the trach ties got our normal saline solution packages of hydrogen peroxide pipe cleaner and cotton tip applicators okay. Im gonna open up the saline now doing okay there mr. Jones okay good im looking at my pulse ox all right im gonna open this up.
Im gonna pour 50 of the saline into the large compartment and then the other 50 between the other two compartments so 25 and 25 here okay. Then ive got my hydrogen peroxide. Open that were gonna put that in with the 50 saline.
So youre gonna have a solution of 50 hydrogen peroxide 50. Saline. Okay now im going to remove the inner cannula from the patient.
Im gonna keep one hand sterile and ive got one hand clean. Always want your sterile hand to be your dominant hand. Im gonna unlock the trach cannula okay mr.
Jones take some deep breaths here im just removing your inner cannula im gonna clean it so put that in the 50 50 solution okay now were gonna let that marinate for a little bit. And im going to grab my suction catheter and imma prepare to suction the patient now. Its important that once i start suctioning that im always keeping my left hand.
Which is my dominant hand sterile and my right hand clean okay im gonna attach the two together okay. I want to prime my suction catheter with the normal saline choo choo choo choo choo choo choo choo choo okay all right mr. Jones.
Im gonna go ahead and suction you go ahead take some nice deep breaths okay good gonna remove the trach collar. And now im going to go ahead and apply suction now remember were not applying suction as we go down. But on the way back up so im going to insert the catheter.
I feel a little bit of resistance going to choo choo choo choo suction as im coming up with some circles.

a nurse is performing suctioning for a client who has a tracheostomy-1
a nurse is performing suctioning for a client who has a tracheostomy-1

Okay. I want to apply the oxygen again going to clear my catheter choo choo choo choo choo choo choo. Okay.
Mr. Jones it sounds like weve got a little bit of secretion still in there so were gonna suction again take some deep breaths for me okay good all right here we go feel a little bit of resistance. Then suction choo choo choo choo.
Choo choo choo choo choo choo choo choo. Okay reapply the oxygen clear our catheter okay and we always want to be assessing what our secretions look like the thickness and the color. Now i can go ahead and re separate my two suction devices get rid of this now im going to clean the inner cannula so remember its sitting here in the 50 50 solution.
Were gonna take the pipe. Cleaner and were gonna get all this gunk out of the inner cannula here so make sure your clean hand is only holding onto this top part of the inner cannula okay good now were going to rinse. It in the other saline solution.
Okay good and then we want to make sure to dry because remember this is going back into the patients airway okay dry it off okay good now with my clean hand. Im going to reinsert. Okay.
And you want to make sure it locks into place. There okay good all right now im no longer sterile. All right mr.
Jones now im gonna continue with my trach care. Were just gonna clean up around the side a little bit and change your gauze okay take the cotton tip applicator put it in the saline solution gonna remove this gauze here from around his neck. Were gonna replace that eventually clean around the trach site okay youre looking for any irritated skin.
Anything that might be stuck to the patients neck clean that you can take a gauze and dry it make sure everythings still clean okay. Good now were going to change. The trach ties.
Now. This is when its nice to have a partner. But if not it can be done individually.
Im gonna take the tie now put my rail down here get a little more comfortablekay. Were gonna start it on this side. You want to start it on the side where the tie was where the knot is originally and were gonna tie it on the opposite side as the last person okay match up make sure.
Its equal in length okay.

a nurse is performing suctioning for a client who has a tracheostomy-2
a nurse is performing suctioning for a client who has a tracheostomy-2

Mr. Jones. Lets lift up your head.
Here get this around your neck. Okay thread. It through okay you never want to loosen.
The trach ties. Before you have new ties intact. Unless you have another person here to hold it for you you dont want this trach to become dislodged okay now im gonna untie this side and remove the old ties okay good lift up your head.
There a little bit for me okay good now ill apply the clean gauze. This is to catch any secretions if the patient happens to cough up on their own. There you go all right.
And then you also want to make sure that the trach ties are about one fingers width. So that theyre not too tight. But tight enough to keep the trach in place.
Okay lets remove the drape. Ill reapply the oxygen doing okay there mr. Jones okay good im gonna reassess now listen to my lung sounds again take some deep breaths for me okay again again again okay sounds much better.
And then lets look at. What your pulse. Ox.
Is. Reading your pulse ox. Is much better it.
s up to 97 . Thats good okay. Mr.
Jones. Im finished with what i needed to do is there anything else i can get for you right now im just gonna clean up my area here put this back turn this off im gonna lower the bed. You have your call light right by you okay ill be back in about a half hour to an hour to check on you mr.
Jones push your call light. If you need anything ambient chime music. .

a nurse is performing suctioning for a client who has a tracheostomy-3
a nurse is performing suctioning for a client who has a tracheostomy-3

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