This is the process of extracting excessive secretions and mucus plug through a surgical opening in the trachea using the appropriate suction catheter and required vacuum pressure. This activity is performed usually early in the morning after the child wakes up from bed and before going to bed in the evening. It is also done when the child shows signs of respiratory distress, desaturation on pulse oximetry, audible/visual signs of secretions in the tube, vomiting and after any respiratory treatment.
Aims
· Keep airway patent
· Prevent chest infections
· Ensure comfort
Requirements
· Sterile gloves
· Sterile gauze
· Examination gloves
· Pulse oximeter
· Receiver for saline
· Irrigation solution (normal saline)
· Self inflating bag/mask
· Mackintosh cape and towel
· Suction apparatus
· Suction catheters (half the diameter of the tracheostomy tube)
Steps
1. Establish rapport (Refer to steps)
2. Explain procedure (Refer to steps)
3. Provide privacy
4. Perform five moments of hand hygiene
5. Arrange needed items and send to bedside
6. Call for assistance
7. Place infant on the back with rolled blanket/towel and a semi-Fowler’s position in older children for better access to the neck
8. Put unconscious child in a lateral position
9. Set vacuum pressure at 80-100mm/hg for infants and 100-120mm/hg for older children
10. Wear examination gloves
11. Connect suction catheter to machine tubing
12. Turn on the suction machine
13. Place tube of catheter into saline to moisten it and test its efficiency
14. Put 2-5ml of normal saline into tracheostomy tube
15. Allow child to cough out secretions into a gauze when the secretions are thick
16. Ask the child to take 3 deep breaths or use self inflating bag to give 3-5 deep breaths
17. Gently insert a suction catheter into the tracheostomy tube at 0.5cm beyond or just to the end of the tracheostomy tube
18. Put thumb over the opening of the catheter to create a vacuum
19. Use a gentle circular motion while withdrawing the catheter
20. Perform this step in about 5 seconds
21. Draw saline from the receiver through the suction catheter to clean out the mucus
22. Allow child to catch his/her breath or repeat self inflating bag breathing
23. Allow child to rest 20-60 seconds in between suctioning
24. Repeat suction until child’s respiratory sound is clear and catheter returns with little or no mucus
25. Rinse the suction catheter, slip it back into the package and disconnect it from the connecting tubing
26. Turn off suction machine
27. Suspend the connecting tubing of the suction machine with the tip pointing up
28. Put child in a desirable position in bed
29. Express appreciation to child/caregiver
30. Dispose off, decontaminate and clean other items
31. Document findings manually/electronically
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