There are a few options for assisting a patient in clearing their airway.
It is preferred for a patient cough and clear the tracheostomy tube on their own. A patient may cough into a tissue or cloth by holding the cloth in front of their tracheostomy tube. Secretions are easier to expel from the tracheostomy tube when they are thinned by the use of humidification therapy.
If a patient cannot clear the secretions due to thick secretions or if the patient has a weak cough, deep suctioning with a suction catheter may be used.
Deep suctioning is the procedure where a suction catheter is inserted into the tracheostomy tube and suction is applied to remove accumulated secretions.
The use of deep suctioning should not be scheduled or over used. It is only upon assessment of the patient that deep suctioning should be performed. This procedure should remain flexible and based on the care givers’ assessment and patient need. It is uncomfortable for a patient to undergo deep suctioning. The cough reflex is stimulated and the procedure can cause bronchospasm and decreased oxygen saturation.
The trouble most people have with suctioning is knowing for how deep, for how long, with how much pressure.
The table below will highlight these three details:
|Pressure||120 – 150 cmH20|
|Depth||Insert catheter into airway. When resistance is met withdraw catheter 2 cm. Mark this point by holding your finger on the cather as the end point of insertion.|
HINT! Take a breath as the catheter enters the trach tube. When you feel you need a breath it will be about the same time that your patient needs a breath. (Make this a standout box)
Suctioning also stimulates the coughing reflex in the trachea and at the carina. Be gentle and allow plenty of time between suctioning attempts for pre-oxygenation and for the patient to catch their breath.
Clean vs. Sterile Technique
For home care, it is acceptable to use a clean suction catheter and a pair of non-sterile gloves or freshly washed hands. The area should be kept clean.
In any other professional healthcare setting suctioning should be performed under sterile technique. It is important to maintain a sterile procedure.
Normal Saline Lavage
The routine use of normal saline lavage prior to suctioning is not advised. Although saline may stimulate a cough, the actual instillation of saline does not thin the secretions. The direct instillation of saline may move microorganisms further down the airway and could cause a decrease in oxygen saturation and dyspnea. The selective use of normal saline lavage is advised only for very high or tenacious secretions that cannot be removed by routine suctioning.
Watch the “Airway Suctioning Tips” video.