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This one is about: (Trach) Suctioning Precautions
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(This document was excerpted from a post received on Cleft-talk)
I have read some very disturbing posts on various lists regarding the dangers of over suctioning or reckless suctioning lately. I wonder does this list have any auto responders on this topic? I think this would be helpful to the new folks that sign on.
When Matthew had his trach we picked up pretty fast that not all the ICN nurses were as careful or as well trained as they needed to be. Some suction too deep or w/too large of a catheter. The first time we saw Matthew get suctioned he cried and his whole body would recoil in discomfort. Out of shear concern for just gentleness we quickly wanted to learn how to do it ourselves and I moved into the hospital (stayed in the Mommy's room for three weeks) so that my husband and I were the only ones that suctioned him.
This is what I think parents should know:
1.) When you hear that the baby needs to be suctioned WAIT a minute or two and give them an opportunity to cough. Praise them when they cough. This cough reflex is a great sort of self survival tool. You don't want them to get too dependent on being suctioned so that they stop trying to cough the secretions out.
2.) Do not suction any deeper that the length of the trach (ask the ENT what the length is or check yourself on your extra trach). The reason you do not want the baby suctioned too deep is that deep suctioning will cause scar tissue and before that it will cause soreness to the point that you may see blood in the secretions. If this means you have to get tough w/ the nurses DO IT. I calculate that in a month's stay Matthew had about 22 different nurses, some were students. (Yes there are student nurses in ICN). They had 3 babies to watch and sometimes they rush or they have limited experience. We didn't see any other babies w/trachs in the ICN when we were there. We would ask them "How far down are you supposed to go?" and SEVERAL told us "Oh just go until you get resistance." The resistance is the baby's trachea, the tissue area beyond the trach. Our ENT told us to go down no deeper than 6. The catheters have numbers on them 4,5...6 etc. We decided just to be safe not to go down any further than 5.
3.) We were told by some nurses not to suction while he was eating. Well since he eats so often and for so long than proved to be a problem because eating would sometimes make him make secretions so we learned we could safely suction him "on the top" meaning only put the catheter in approx. 1/2" just barely to where the numbers start. This gave him much more comfort while eating. The reason you DO NOT want to suction more deeply than "on top" while eating is it will cause the baby to throw up.
4.) Watch the catheter size. We used 6 and sometimes 8. Watch the amount of suction pressure that it is not turned up too high or it will really be uncomfortable for the baby.
We found that when we did all of the above Matthew did not recoil in discomfort while being suctioned. He actually smiled at times and was content as though relieved to have a little help getting those secretions out.
In addition to suctioning they should also be clear on:
1.) How often to change or clean the catheters. We changed to a new one every 12 hours. Thankfully we never had any infections.
2.) How often and how to change the ties. May I suggest the velcro ties as they are easier than the shoestring type. Faster to change on a wiggly baby.
3.) How often the trach should be changed and how it should be maintained.
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