The procedure
Universal precautions must be used when
conducting tracheostomy suction, i.e. wearing gloves
and a plastic apron, washing hands after removing
gloves to avoid recontamination and disposing of
waste appropriately (Wood 1998a). Hands must also
be washed before and after the procedure to prevent
nosocomial infection, as gloves do not replace the
need for hand washing. Use of universal precautions
and a non-touch technique will help minimise the
transfer of bacteria to the patient.
The suction catheter should be entered to a predetermined
length, measured using a tracheostomy
tube the same size as the patient's. This should be
recorded in the child's notes as a point of reference.
Much of the nursing literature supports the use of
shallow suction technique, where the catheter can
be advanced up to 0.5cm past the end of the tube
(Hodge 1991, Runton 1992, Spence et al 2003).
Deep suctioning causes oedema and inflammation
of the trachea (Bailey et al 1988, cited in McGormack
2003), and can cause necrotising tracheobronchitis
and pneumothoraces (Young 1995). Therefore, this
protocol recommends that the suction
catheter must not be inserted
further than the end of the
tracheostomy tube.
Once the catheter is
inserted to the correct
length, negative pressure
can be applied. Adult
nursing literature
suggests that suction
pressure should not
be applied for more
than 10-15 seconds and
should be shorter for
those with impaired
respiratory or
cardiac function
(Gasey 1989).
There is no
researdi
To ensure safety
and reduce distress
the child needs
to be positioned
appropriately