Care essential 3: Suction appropriately

Patients receiving positive-pressure mechanical ventilation have a trach­e­­ostomy, endotracheal, or nasotracheal tube. Most initially have an
endotracheal tube; if they stay on the ventilator for many days or weeks, a tracheotomy may be done. Tracheotomy decisions depend on patient specifics. Controversy exists as to when a tracheotomy should be considered; generally, patients have tracheotomies before being managed on a med-surg unit.

Although specific airway management guidelines exist, always check your facility’s policy and procedure manual. General suctioning recommendations include the following:

  • Suction only as needed—not according to a schedule.
  • Hyperoxygenate the patient before and after suctioning to help prevent oxygen desaturation.
  • Don’t instill normal saline solution into the endotracheal tube in an attempt to promote secretion removal.
  • Limit suctioning pressure to the lowest level needed to remove secretions.
  • Suction for the shortest duration possible.

If your patient has an endotracheal tube, check for tube slippage into the right mainstem bronchus, as well as inadvertent extubation. Other complications of tracheostomy tubes include tube dislodgment, bleeding, and infection. To identify these complications, assess the tube insertion site, breath sounds, vital signs, and PIP trends. For help in assessing and managing tube complications, consult the respiratory therapist.

If your patient has a tracheostomy, perform routine cleaning and care according to facility policies and procedures.