Tracheostomy Care Nurses

Tracheostomy care and tracheal suctioning are high-risk procedures. To avoid poor outcomes, our nurses—whether seasoned veterans or novices—adhere to evidence-based guidelines. Experienced nurses may overestimate their trach care competence, so we ensure continuous training. Tracheostomy patients, often housed on general nursing units as well as ICUs, are at high risk for airway obstruction, impaired ventilation, infection, and other lethal complications. Our skilled bedside nursing care prevents these complications, focusing on open and closed suctioning and site care.

Suctioning a Trach Tube

A tracheostomy tube may have a single or double lumen and can be cuffed or uncuffed, fenestrated (allowing speech) or unfenestrated. Each type requires specific management. For instance, before suctioning a fenestrated tube, our nurses insert a plain inner tube to prevent catheter puncture through the fenestrated opening. Suctioning always involves:

Assessment
Oxygenation management
Use of correct suction pressure
Liquefying secretions
Using the proper-size suction catheter and insertion distance
Appropriate patient positioning
Evaluation

Our nurses keep emergency equipment nearby to handle any complications.

When to Suction

Suctioning is performed only when patients can’t clear their own airways, tailored to individual needs rather than a set schedule. Our nurses assess for increased work of breathing, changes in respiratory rate, decreased oxygen saturation, copious secretions, wheezing, or unsuccessful attempts to clear secretions. Fine crackles in the lung bases may indicate excessive fluid, and wheezing patients are evaluated for asthma or allergy history.

Suctioning Technique

Before suctioning, our nurses hyperoxygenate the patient, using two to three deep breaths for spontaneously breathing patients or four to six compressions with a manual ventilator bag for ventilator patients. We use suction pressure of up to 120 mm Hg for open-system suctioning and 160 mm Hg for closed-system suctioning, limiting each session to three catheter passes. Suctioning during catheter extraction lasts up to 10 seconds, with 20 to 30 seconds between passes. Catheter size is calculated to not exceed half the inner diameter of the trach tube, typically using a #12 French catheter for closed suctioning. Insertion distance is premeasured: 0.5 to 1 cm past the distal end for open systems and 1 to 2 cm for closed systems.

Liquefying Secretions

We liquefy secretions by humidifying secretions and hydrating the patient, avoiding normal saline solution (NSS) or saline bullets due to risks like bacterial colonization, reduced oxygen saturation, and damage to bronchial surfactant. Despite some outdated practices, our nurses follow evidence-based methods, avoiding NSS and ineffective nebulized fluids.

Evaluation

After suctioning, our nurses assess and document the patient’s physiologic and psychological responses, sharing findings during nurse-to-nurse shift reports and interdisciplinary rounds.

Trach Site Care and Dressing Changes

Our tracheostomy dressing changes promote skin integrity and prevent infection at the stoma site and respiratory system. We follow evidence-based protocols for site care, ensuring thorough cleaning and appropriate dressing materials, tailored to each patient’s needs.

Tracheostomy Care Nurses