(ambient chime music)
Today we're gonna be performing trach care on a patient.
So I have my patient chart here.
Jaime Jones, MR number 5891351329.
Date of birth one, 16, '62.
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 we're about to perform.
States here, "Trach care suctioning
"every 12 hours as needed."
Now we're going to go gather our supplies.
We'll 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 I'm gonna go enter the patient's room.
Knock, knock, knock.
Hi, Mr. Jones.
It's Sarah, your nurse.
I'm here to perform trach care and suctioning.
How are you today?
Okay, I'm gonna wash my hands.
Gonna get some gloves on here.
I hear some rattling in your chest there.
I think that's 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 birth?
'Kay, we have Jaime Jones, MR 5891351329.
Date of birth one, 16, '62.
Okay, good.
Now I'mma 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.
I'm also gonna put this thing on your finger here,
the pulse ox.
Let's see how your oxygen level is doing right now.
Okay, yeah.
It looks like we could use a little bit of suctioning.
All right, I'm just gonna get my stuff all set up.
Okay.
So I'm gonna grab my suction catheter here
from the wall.
For adults, we want 100 to 120 on the suction level.
For pediatrics, it's 80 to 100,
and you want to make sure that the suction's
actually set to continuous, okay?
So it's always applying pressure for us.
Okay, now I'm gonna set up my field.
I'm gonna take the drape,
place it over Mr. Jones' chest,
put this across you, Mr. Jones,
so we don't make a mess.
Okay, and now I'm gonna prepare my field.
We want to open up the suction catheter.
And now we're gonna open up our trach care kit.
Now remember, everything inside
the trach care kit is sterile.
Apply my sterile gloves.
'Kay, now I'm gonna set up my field.
So I'd get this drape out.
Remember, shiny side down.
Okay.
Grab my suction catheter.
I'm gonna separate my gauze.
There's two different types of gauze in here.
I've got regular four by fours
and the drain sponges with the slit in it.
That's gonna go around the trach when I'm finished.
Got the trach ties.
Got our normal saline solution.
Packages of hydrogen peroxide.
Pipe cleaner.
And cotton tip applicators.
Okay, I'm gonna open up the saline now.
Doing okay there, Mr. Jones?
Okay, good.
I'm looking at my pulse ox.
All right, I'm gonna open this up.
I'm 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 I've got my hydrogen peroxide.
Open that.
We're gonna put that in with the 50% saline.
So you're gonna have a solution
of 50 hydrogen peroxide, 50 saline.
Okay.
Now I'm going to remove the inner cannula from the patient.
I'm gonna keep one hand sterile and I've got one hand clean.
Always want your sterile hand to be your dominant hand.
I'm gonna unlock the trach cannula.
Okay, Mr. Jones.
Take some deep breaths here.
I'm just removing your inner cannula.
I'm gonna clean it.
So put that in the 50-50 solution.
Okay, now we're gonna let that marinate for a little bit,
and I'm going to grab my suction catheter
and I'mma prepare to suction the patient.
Now it's important that once I start suctioning
that I'm always keeping my left hand,
which is my dominant hand, sterile
and my right hand clean.
Okay, I'm 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.
I'm gonna go ahead and suction you.
Go ahead, take some nice, deep breaths.
Okay, good.
Gonna remove the trach collar.
And now I'm going to go ahead and apply suction.
Now remember, we're not applying suction as we go down,
but on the way back up.
So I'm going to insert the catheter.
I feel a little bit of resistance.
Going to choo, choo, choo, choo,
suction as I'm coming up with some circles.
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 we've got a little bit
of secretion still in there,
so we're 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 I'm going to clean the inner cannula.
So remember, it's sitting here in the 50-50 solution.
We're gonna take the pipe cleaner
and we're 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 we're 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 patient's airway.
Okay, dry it off.
Okay, good.
Now with my clean hand,
I'm going to reinsert.
Okay, and you want to make sure it locks into place there.
Okay, good.
All right, now I'm no longer sterile.
All right, Mr. Jones.
Now I'm gonna continue with my trach care.
We're 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.
We're gonna replace that eventually.
Clean around the trach site.
Okay, you're looking for any irritated skin,
anything that might be stuck to the patient's neck.
Clean that.
You can take a gauze and dry it.
Make sure everything's still clean.
Okay, good.
Now we're going to change the trach ties.
Now this is when it's nice to have a partner,
but if not, it can be done individually.
I'm gonna take the tie now.
Put my rail down here,
get a little more comfortable.
'Kay, we're gonna start it on this side.
You want to start it on the side where the tie was,
where the knot is originally,
and we're gonna tie it on the opposite side
as the last person, okay?
Match up.
Make sure it's equal in length.
Okay, Mr. Jones.
Let's 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 don't want this trach to become dislodged.
Okay, now I'm gonna untie this side
and remove the old ties.
Okay, good.
Lift up your head there a little bit for me.
Okay, good.
Now I'll 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 finger's width
so that they're not too tight,
but tight enough to keep the trach in place.
Okay, let's remove the drape.
I'll reapply the oxygen.
Doing okay there, Mr. Jones?
Okay, good.
I'm gonna reassess now.
Listen to my lung sounds again.
Take some deep breaths for me.
Okay, again.
Again.
Okay, sounds much better.
And then let's look at what your pulse ox is reading.
Your pulse ox is much better.
It's up to 97%.
That's good.
Okay, Mr. Jones.
I'm finished with what I needed to do.
Is there anything else I can get for you right now?
I'm just gonna clean up my area here.
Put this back.
Turn this off.
I'm gonna lower the bed.
You have your call light right by you.
Okay.
I'll 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)