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Tracheostomy Care
and Suctioning Safety

Master airway protection, sterile technique, and the safety priorities that prevent hypoxia and infection during tracheostomy care.

NCLEX-RN

What Is a Tracheostomy?

A tracheostomy is a surgical opening (stoma) created in the anterior neck into the trachea. A curved tube is inserted to maintain a patent airway, bypassing the upper airway entirely.

Trach tube Stoma Trachea

Key Terms

Stoma
The surgical opening in the neck through which the tube passes.
Inner Cannula
Removable inner tube cleaned to prevent mucus obstruction.
Obturator
Guide used during insertion; kept at bedside for emergencies.

Why Suctioning Matters

Because the cough reflex and natural clearance are impaired, secretions accumulate. Suctioning removes mucus to maintain a patent airway, but it also removes oxygen, so timing and technique are critical.

Core Rule: Suction Limits

Pressure
Adult wall suction: \( 100\text{–}120 \) mmHg. Higher pressure damages mucosa.
Duration
Each pass \( \leq 10 \) seconds to limit hypoxia.
Attempts
Limit to \( \leq 3 \) passes; allow rest and re-oxygenation between.

Core Rule: Hyperoxygenate First

Before and between every suction pass, hyperoxygenate the client with \( 100\% \) oxygen for \( 30\text{–}60 \) seconds. This builds an oxygen reserve to offset the loss during suctioning.

Hyper- oxygenate Suction Re- oxygenate Repeat cycle ≤ 3 passes

Insertion vs. Withdrawal

Inserting Catheter Withdrawing Catheter
Suction on?No suctionApply suction
MotionAdvance gentlyRotate while pulling out
DepthUntil resistance, then pull back \( 1 \) cmContinuous withdrawal
Time limit—\( \leq 10 \) seconds

Suctioning Step by Step

1
Assess & explain. Verify indication, perform hand hygiene, don sterile gloves.
2
Hyperoxygenate with \( 100\% \) O₂ for \( 30\text{–}60 \) seconds.
3
Insert without suction until resistance, then withdraw \( 1 \) cm.
4
Apply suction while withdrawing, rotating, for \( \leq 10 \) seconds.
5
Re-oxygenate and reassess. Wait, then repeat only if needed (\( \leq 3 \) passes).

Example 1: Reading Cues

A client with a new trach has coarse audible secretions, RR \( 28 \), and SpO₂ falling to \( 90\% \). What is the priority action?

Example 2: Pressure Setting

An adult client needs suctioning. The wall regulator currently reads \( 160 \) mmHg. What should the nurse do?

Example 3: Emergency

During care, the trach tube is accidentally dislodged within the first \( 72 \) hours after surgery. What is the nurse's priority?

Common Mistakes

✕ Suctioning on insertion
Applying suction going in strips oxygen and traumatizes the mucosa.
✕ Passes too long
Suctioning longer than \( 10 \) seconds causes hypoxia and arrhythmias.
✕ Scheduled suctioning
Suction by assessment, not routine; needless passes harm tissue.
✕ Skipping oxygenation
Failing to hyperoxygenate before/after causes desaturation.

Safety Summary

Parameter Adult Standard
Suction pressure\( 100\text{–}120 \) mmHg
Time per pass\( \leq 10 \) seconds
Passes per session\( \leq 3 \)
Hyperoxygenation\( 100\% \) O₂, \( 30\text{–}60 \) s
When to suctionBy assessment, not schedule
Suction appliedOn withdrawal only

Question 1 of 5

When suctioning an adult tracheostomy, what is the maximum recommended duration for each suction pass?

Question 2 of 5

At what point during the procedure should the nurse apply suction?

Question 3 of 5

Which intervention should the nurse perform immediately before each suction pass?

Question 4 of 5

Which items are essential to keep at the bedside for a client with a tracheostomy?

Question 5 of 5

What is the recommended suction pressure range for an adult tracheostomy?

Key Takeaways

1
Suction by assessment, never on a fixed schedule.
2
Hyperoxygenate before and between every pass.
3
Suction only on withdrawal, \( \leq 10 \) seconds, \( \leq 3 \) passes.
4
Keep emergency equipment at the bedside at all times.

You're Ready for Safe Trach Care

Remember: protect the airway, oxygenate generously, suction precisely, and keep emergency supplies close. Patient safety comes first.