# Presentation: 107139

## The Suctioning & Tracheostomy Task Force Approach to Ensure Competency

**Kelly D. Skinner, MSN, CRRN, ANP, GNP, Maureen Levesque, BSN, RN, **
**& James T. Daniel, BSN, RN**
**VA Boston Healthcare System NOVA Chapter 226**

**Those with inner cannulae that are disposable**
**Those with inner cannulae that are non-disposable**
**Those that do not have inner cannulae**
**Cuffed**
**Uncuffed**
**Fenestrated**
**Talking tracheostomy tubes**

_**Members**_
**Maureen Levesque, BSN, RN**
**Kelly D. Skinner, MSN, CRRN, ANP, GNP**
**Patricia Pollick, RPT**
**Michael Meegan, ADN, RN**
**Michelle Bissonnette, BSN©, RN**
**Arthur Briggs, MS, RN**
**James T. Daniel, BSN, RN**
**The Suctioning & Tracheostomy Task Force at the **
**VA Boston Healthcare System utilizes a creative approach **
**to educate and ensure the competencies of the nursing staff **
**related to tracheostomy tube suctioning, nasotracheal **
**suctioning, and tracheostomy care.**** **

**The Suctioning & Tracheostomy Task Force**

**Suction Catheter Supplies**

**Suctioning Demonstration by Shahira Vargas, LPN**

**Tracheostomy Tubes**

**l**

**Types of Tracheostomy Tubes**

**Tracheostomy Care Supplies**

**Competencies**

**Shiley**

**Portex**

**)**

-                       **DEPARTMENT OF VETERANS AFFAIRS**
**                        ****VA BOSTON HEALTHCARE SYSTEM**
**                                                                                                                 **
**                             ****Tracheostomy Care Competencies **
**METHOD OF VALIDATION:**
**(O)  OBSERVATION                               (V) VERBAL                             **
**(D)   DEMONSTRATION                        (PR)  PEER REVIEW**
**(W)  WRITTEN ASSESSMENT**
**1.   Obtain a tracheostomy care kit.**
**2.   Assess condition of stoma- redness, swelling, secretions, presence**
**       ****of purulence or bleeding, etc.     **
**3.    Explain procedure to patient.**
**4.    Suction trachea before tracheostomy care.**
**5.    Wash hands thoroughly.**
**6.    Assemble equipment from tracheostomy kit.**
**7.     Don goggles and sterile gloves.**
**8.    Clean the external end of the tracheostomy tube with 1⁄2 strength**
**        ****hydrogen peroxide.**
**9.     Clean the stoma area with 1⁄2 strength peroxide-soaked sponges, **
**         ****using a single sweep with each sponge.**
**10.   Loosen and remove crust with sterile cotton swabs.**
**11.   Repeat step 9 using normal saline-soaked sponges.**
**12.   Use sterile dry sponge to dry area.**
**13.   If there is a disposable inner cannula, change it.**
**14.   If it is a reusable inner cannula, remove it and clean it in**
**        ****hydrogen peroxide solution. Use a brush or pipe cleaners to **
**        ****clean inside it.  Then, rinse it in sterile saline solution, dry it, **
**        ****and reinsert the inner cannula into the tracheostomy tube.**
**15.   Change tracheostomy ties.**
**16.   Dispose of disposable supplies.**
**17.   Wash hands**
**18.   Document procedure and outcome in patient’s record.**
**19.   Ensure sterile suction catheter kit is available at patient’s bedside.  **
**20.   Ensure suctioning equipment is changed every twenty-four hours.**
**____________________________________  Date: ______________**
**Employee Signature**
** ****___________________________________   Date: ______________**
**Evaluator Signature**

-                        **DEPARTMENT OF VETERANS AFFAIRS**
**                           ****VA BOSTON HEALTHCARE SYSTEM**
**                                                                                                                 **
**                             ****Nasotracheal Suctioning Competencies **
**METHOD OF VALIDATION:**
**(O)  OBSERVATION                               (V) VERBAL                             **
**(D)   DEMONSTRATION                        (PR)  PEER REVIEW**
**(W)  WRITTEN ASSESSMENT**
**1.    Explain procedure to patient.**
**2.    Assess vital signs and breath sounds.**
**3.    Wash hands, don goggles or glasses, and mask.**
**4.    Position patient in a sitting position with head back.**
**5.    Turn on suction and set regulator at 100-120 mmHg.  Secure **
**        ****connecting tube to suctioning source.**
**6.    Ensure that equipment is functioning properly.**
**7.    Open suction catheter kit and lubricant (if indicated).**
**8.    Preoxygenate patient with 100% O2:**
**       ****a) Conscious patient may take deep breaths.**
**       ****b) Ambu unconscious patient.**
**9.    Put on sterile gloves.**
**10.   Secure suction catheter to connecting tubes.**
**11.   Lubricate catheter.**
**12.   Gently pass catheter through the patient’s nostril to the pharynx.**
**13.   Do not suction on insertion.**
**14.   Apply intermittent suction while withdrawing catheter for 5-10**
**         ****seconds.**
**15.   Allow patient to rest.**
**16.   Repeat steps 8-15 until airway is clear.**
**17.   Monitor vital signs and breath sounds.**
**18.   Dispose of disposable supplies.**
**19.   Wash hands.**
**20.  Document procedure and outcome in patient’s record.**
**21.  Ensure sterile suction catheter kit is available at patient’s bedside.**
**22.  Ensure suctioning equipment is changed every twenty-four hours.**
**___________________________________  Date: ______________**
**Employee Signature**
** ****___________________________________   Date: _____________**
**Evaluator**** ****Signature**

**                          ****DEPARTMENT OF VETERANS AFFAIRS**
**                             ****VA BOSTON HEALTHCARE SYSTEM**
**                                                                                                                 **
**                       ****Tracheostomy Tube Suctioning Competencies **
**METHOD OF VALIDATION:**
**(O)  OBSERVATION                               (V) VERBAL                             **
**(D)   DEMONSTRATION                        (PR)  PEER REVIEW **
**(W)  WRITTEN ASSESSMENT**
**1.    Assess vital signs and breath sounds.**
**2.     Wash hands, don goggles or glasses, mask, and gloves.**
**3.     Explain procedure to patient to reduce anxiety and encourage**
**         ****cooperation.**
**4a.  Position the conscious patient with an intact gag reflex in Semi-Fowler’s to **
**        ****prevent aspiration of secretions.**
**4b.   Position the unconscious patient side-lying to facilitate drainage of **
**       ****secretions by gravity and prevent aspiration.**
**5.   Turn on suction regulator at 100-120 mmHg.**
**6.    Ensure equipment is functioning properly.**
**7.    Open suction catheter kit.    **
**8.    Preoxygenate patient with 100% O2:**
**       ****a) Conscious patient may take deep breaths.**
**       ****b) Ambu unconscious patient.**
**9.     Don sterile gloves.**
**10.   Secure suction catheter to connecting tubes.**
**11.    Insert catheter into tracheostomy without suction, using sterile**
**          ****technique.**
**12.   Apply intermittent suction while withdrawing and rotating catheter for**
**        ****5-10 seconds.**
**13.  Oxygenate patient.**
**14.  Rinse catheter with saline to clear secretions.**
**15.  Repeat steps 9-16 until airway is clear.**
**16.  Perform nasal and oral pharyngeal suctioning after lower airway**
**        ****suctioning, if  indicated.**
**17.  Assist patient to a comfortable position.**
**18.   Dispose of disposable supplies.**
**19.   Wash hands.**
**20.   Ensure sterile suction catheter kit is available at patient’s bedside.**
**21.   Ensure suctioning equipment is changed every twenty-four hours.**
**22.   Document procedure and outcome in patient’s record.**
**___________________________________                 Date: ______________**
**Employee Signature**
** ****___________________________________                 Date: ______________**
**Evaluator**** ****Signature**

**Suctioning & Tracheostomy CD now available. **
**This mandatory program is offered regularly.**
**This educational workshop is included in SCI  orientation.**
**VA Web-Based Tutorials will be available soon.**

**VA Web-Based Tutorials & Educational CD **