- Hello, welcome to Santa Fe College nursing labs.
Today I'm gonna be demonstrating tracheostomy care.
There are gonna be two parts to this video.
Part one is gonna include the suctioning of the trach
and part two will include the changing
of the inner cannula or washing
of the inner cannula including changing
the dressing below the tracheostomy.
We need to make sure that we have
the correct equipment in the room
in order to do tracheostomy care and suctioning.
We have out a workstation on wheels,
which we use to check the order.
We have the suction canister and suction machine.
We also have out ambu bag,
which is attached to an oxygen source.
Any patient with a tracheostomy needs
to have a new tracheostomy at bedside.
It needs to have the new trach including
the obturator in place, so that in an event
of an emergency where the current trach is dislodged,
there is a new one that is the correct size
right at bedside.
I have gathered my supplies, checked my doctor's order
and now it's time to enter the room.
Sanitize, wash my hands.
Hello Mrs. Jones, how are you doing today?
I'm gonna introduce myself to the patient.
I am gonna ask her to state her first and last name
as well as her date of birth.
I am gonna double check her arm band
that she is the correct patient.
I am gonna explain to the patient
what we are gonna do and then I am gonna double check
the room for all the necessary equipment.
So, Mrs. Johnson, I am gonna go ahead
and suction your trach and I'm just gonna make sure
I have all of the necessary equipment.
I'm checking I have my ambu bag,
which is attached to oxygen.
I can go ahead and turn my oxygen on as well now.
I'm gonna remove the one tie on
the trach tent in order to make it easier
for myself to move later on with one hand.
I can see that she has a new tracheostomy
including obturator at bedside.
I'm gonna go ahead and check
my suction machine and canister.
For suctioning a tracheostomy
it is recommended that you
are between 80 and 100 millimeters of mercury,
which I am.
Next I need to raise the patient up
to a height that is comfortable for me.
When I do tracheostomy suctioning
I also need to raise the head of the bed
and make sure that the patient
is at a 45 degree angle.
Before I suction the patient I need
to listen to the breath sounds.
If you need a review listening to breath sounds,
please watch the physical assessment video.
Usually breath sounds are listened
to under the gown.
You do not want to listen over the gown.
But for the purpose of the video
I'm gonna be listening over the gown.
Next I'm gonna move my supplies closer
to the patient in order to start suctioning.
I'm gonna lower this rail so I do not hurt my back.
The supplies that you need to do trach suctioning include
sterile normal saline or sterile water,
a sterile container in order to check your suction,
sterile suction catheter, and then I have two pairs
of sterile gloves.
You always bring extra gloves
in case you contaminate by accident.
The first thing I'm gonna do to get my supplies ready
is fill up my sterile container.
I'm gonna open the cap.
Put the cap upside down.
When you're opening a new bottle
of normal saline or sterile water
you want to make sure that the bottle is within date,
that it has not expired.
If you are the first person opening this bottle
you also want to label it with
the date and time and your initials when you open it.
Most hospital policies are after 24 hours
this bottle is considered non-sterile
and has to be thrown out.
I'm gonna loosen my cap.
The cap goes face up.
When I hold my bottle, I want my palm on the label
so that you avoid dripping any liquid
onto the label.
I'm just gonna pour a little bit
of normal saline or sterile water into my cup.
Again then replace the cap.
I am then gonna want to open up my suction catheter,
maintaining sterility.
I then need to put my sterile gloves on.
I am right handed, so my right glove goes on first.
Pick up, step back.
I'm then gonna put on my left glove.
Step back from the table.
My hands are, at the moment, still sterile.
I'm gonna go ahead and pick up my sterile suction catheter
and I want to wrap this around my dominant hand,
which for me is my right hand.
I want to hold it in this position.
I am now purposely gonna contaminate my left hand.
I have to reach for my suction tubing
without touching my left and my right hand
I need to attach the suction catheter
to the tubing.
This hand and the end part of the suction catheter
is now contaminated and not considered sterile.
I'm gonna go ahead and check to make sure
my catheter and suction is working,
without touching the edges.
I'm gonna go ahead now and wrap
the catheter back around my hand
in order to remain sterility.
I have wrapped the catheter around my hand,
I am then gonna go ahead and remove the mist collar.
Before we suction we need to hyperoxygenate the patient.
You can do this a couple of different ways.
If the patient is able to, you can ask them
to take two to three deep breaths in.
If the patient is ventilated you can use
the sign mechanism.
If the patient is not ventilated
you can also attach an ambu bag to oxygen
and when they breath in you can deflate the bag
to help increase their inspiratory volume.
I'm gonna go ahead and hyperoxygenate my patient.
So take a deep breath in.
Good and another deep breath.
And one more.
Excellent.
Now I'm gonna go ahead and suction the patient.
We are only suctioning as long as the trach.
We do not put the suction catheter
all the way down until it meets resistance.
We do not want to damage the airway.
When inserting the catheter,
you do not have the suction on.
Only when withdrawing the catheter.
The patient may cough as I'm withdrawing
the catheter and suctioning.
When you are withdrawing the suction catheter,
you want to twist in order to get
all the surfaces of the tracheostomy tube.
Your patient may cough when you're suctioning.
I'm gonna go ahead and just clear my suction tubing.
Depending on your patient, you may need
to suction again or you may not suction.
You can at this point double check breath sounds
before you suction again.
Or if when you first listened to them
and they sounded really junky
and you know you need to suction again
or you got a copious amount of fluid out,
you would want to suction a second or third time.
Since we are not gonna suction again
for this patient, I'm gonna go ahead
and replace my mist collar.
I'm gonna disconnect my suction catheter
from my suction tubing.
I can then turn off my suction machine.
My gloves can now come off
and I can throw my catheter away.
I want to make sure that I replace my trach tent
appropriately, that it is nicely secured
over the patient's trach.
That is the end of part one.
Next up will be part two where
we will be cleaning the inner cannula
and cleaning around the dressing site.