Endotracheal and Tracheostomy

video 1: endotracheal suctioning

• when a patient is on endotracheal tube, there is chance of lossof peep and oxygen desaturation.
• micoorganisms enter into the respiratory system when suctioingthrough an open catheter
• there is chance of cross infection when the patient cough backwhile suctioning
• closed suction system helps to maintain peep and breathingsystem stable, reduce the chance of use of ventilators and therebyhelps in faster recovery
• in order to use a trachseal, check the internal diameter ofendotracheal tube
• carefully review the instructions before opening the trachsealpack
• take out the clip and attach to the patient’s bedding
• connectvtrachseal with the endotracheal tube with a push twistmanner and without giving pressure to the cuff
• catheter mount may be used to connect the trach seal andbreathing system
• attach the day sticker to the tube to check the day of changingthe trach seal
• saw tooth pattern of flow over the screen and crackles in thetrachea shows retained pulmonary secretions, increased peakinspiratory pressure in volume controlled ventilation and decreasedtidal volume in pressure controlled ventilation, deterioration ofoxygen saturation and arterial blood gas, visible secretions in theairway, patient’s inability to make an effective cough, suspectedaspiration of upper airway secretions are indications ofsuctioning
• in order to start suctioning, regulate the vaccum, initiate thesucton unit
• a vaccum pressure of 80-100 mmhg in neonates and less than150mm of hg in adults is recommended
• attach the suction tubing with the vaccum source
• negative pressure must be checked by occluding the suction tubebefore attching
• ensure that suction valve lock is functioing
• administration of 100% oxygen is mandatory before suctioningevent in both pediatrics and adults for 30-60 seconds
• when the numbers of the et tube and suction catheter allign, itmeans that catheter is located at the distal end of theendotracheal tube
• extend two centimeters more to clear the murphy’s eyes to startsuctioing
• press down the suction valve and withdraw the suctioncatheter
• suctioing must not exceed 15 seconds each time
• when the suction cather fully withdrawn, a black mark appearsas indicator
• close the isolation valve, if using a 72 hours version
• by using a syringe or ampule of saline, irrigate the closedsuction catheter
• close the irrigation port and lock the suction valve
• in order to remive the trach seal, slide the disconnectionwedge between trach seal and et tube and then remove the trachseal
• reconnect the breathing system with the endotracheal tube

2. video 2: tracheal suctioning

• traheal suctioing must be perfomed every 12 hours as perinstructions
• artcles inclde, a drape, suction catheter, hemostat, bandagescissiors, extra pair of sterile gloves, trach care kit(cleaningsolution, trach tie, gauze), pulse oximeter
• address the patient by name and explain the procedure to thepatient
• wash hands and put on the gloves
• perform auscultation to check for any crackles
• raise the bed level to easy work
• ask for any discomfort to the patient
• confirm patient identity with name and date of birth
• check the oxygen levels using the pulse oximeter
• start suctioing, grab the suction catheter and maintain theenough suction pressure
• check for negative pressure
• drape the patient
• prepare the sterile field with the tracheal kit and wear thesterile gloves
• 50 percent of the saline and 50 percent hydrogen peroxide mustbe mixed in the large bowl
• another 50 percent of the saline solution must be divided andpoured into two different bowls
• remove the inner cannula and connect the oxygen into the outercannula
• keep the inner cannula in the 50-50 solution
• make sure to keep dominant hand sterile and must hold thesuction catheter
• non dominant hand must be clean and must hold the suctiontube
• prime the suction catheter with the normal saline
• insert he cather straight and do not apply any suctioing whileinserting
• while feeling resistance, withdraw back in a rotatory mannerwhile suctioing at the same time
• clear the catheter
• clean and dry the inner cannula and reinsert it
• remove the gloves
• clean the area around the tracheal tube using the normalsaline
• apply new tracheal tie and then remove the old trachealties.
• perform reassessment with ausculation and pulse oxymetery
• reposition the bed
• clean the area and wash hands and record procedure