Tracheostomy Care and Suctioning Manual - Breath of Life
Tracheostomy Care and Suctioning Manual - Breath of Life
Tracheostomy Care and Suctioning Manual - Breath of Life
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<strong>Tracheostomy</strong> <strong>Care</strong> <strong>and</strong> <strong>Suctioning</strong> <strong>Manual</strong><br />
© 2009 <strong>Breath</strong> <strong>of</strong> <strong>Life</strong> Home Medical Equipment <strong>and</strong> Respiratory Services
Parts <strong>of</strong> a <strong>Tracheostomy</strong> Tube:<br />
• Outer Cannula - The outer cannula is<br />
the main body <strong>of</strong> the tracheostomy<br />
tube. It is held in place with a<br />
trach tube holder that fits around the<br />
patients neck.<br />
Some trach tubes have a cuff on the<br />
end <strong>of</strong> them. This cuff is an inflatable<br />
balloon that seals against<br />
the tracheal wall when inflated. It<br />
helps to protect the airway from<br />
aspiration <strong>of</strong> oral secretions <strong>and</strong><br />
prevents air from escaping through the mouth.<br />
Some patients do not require a cuff such as a patient<br />
who is not on a ventilator, patients who do not have<br />
swallowing issues <strong>and</strong> pediatric patients.<br />
Some outer cannulas have holes called fenestrations<br />
that allow airflow to escape <strong>and</strong> allow the patient to<br />
speak.<br />
• Inner Cannula – Some trach tubes have<br />
inner cannulas. The inner cannula fits<br />
inside the outer cannula. It is important<br />
to remove the inner canula <strong>and</strong> clean it<br />
to prevent mucus plugging <strong>and</strong> build up.<br />
The inner cannula locks into place to<br />
avoid removal.
• Obturator - The obturator is used to help<br />
make insertion <strong>of</strong> the trach tube easier. The<br />
obturator has a round tip that sticks out <strong>of</strong> the<br />
end <strong>of</strong> the outer<br />
cannula. This<br />
protects the<br />
trachea from any<br />
damage as the<br />
trach tube is inserted into the airway. This<br />
must be removed as soon as the trach tube<br />
is inserted as it occludes the airway while in<br />
place.<br />
NOTE: Patients can NOT breathe while this is in place<br />
How to Deflate <strong>and</strong> Inflate the Cuff<br />
Minimal leak technique is used to limit the amount<br />
<strong>of</strong> air that is put in the cuff that sits against the<br />
tracheal wall. Once the cuff is inflated, withdraw<br />
a small amount <strong>of</strong> air until you hear a slight leak at<br />
the end <strong>of</strong> inspiration.<br />
The inflated cuff seals the airway so that the patient<br />
can get the prescribed tidal volume that the<br />
physician has ordered. It is important to monitor<br />
this pressure so that damage to the tracheal wall<br />
does not occur.<br />
Another technique used to check cuff pressure is to use<br />
the minimal occluding volume. To do this procedure you<br />
put enough air in the cuff so that no leak is heard during<br />
inspiration. If you are using a pressure manometer it is preferred<br />
to have a cuff pressure reading <strong>of</strong> 25 cm H2O.
Tracheosotmy <strong>Care</strong><br />
It is important to keep the stoma <strong>and</strong> the trach<br />
tube clean. To do this trach care should be done<br />
at least twice a day <strong>and</strong> as needed. This includes<br />
cleaning the inner cannula, around the trach<br />
tube <strong>and</strong> the stoma. Cleaning the trach tube is<br />
done by using clean technique. The trach tube<br />
should be changed once a month. This is always<br />
done using a sterile technique.<br />
Good h<strong>and</strong> washing technique is vital to prevent<br />
infections. You must always use gloves when<br />
dealing with trach tubes.<br />
<strong>Tracheostomy</strong> Dressings:<br />
Trach tubes have a dressing around them that is<br />
used to protect the skin.<br />
The dressing should be changed when doing trach<br />
care or as needed.<br />
Trach dressings should not be moist or soiled.<br />
<strong>Tracheostomy</strong> Tube Ties:<br />
<strong>Tracheostomy</strong> tube ties are used to keep<br />
the trach tube in place to prevent accidental<br />
removal <strong>and</strong> to minimize movement <strong>of</strong> the trach<br />
tube. The ties should be changed daily with trach<br />
care or as needed. They should not be moist or soiled.<br />
Equipment Needed:<br />
Suction equipment<br />
Dale trach holder
Procedure:<br />
Wash your h<strong>and</strong>s<br />
Take the old holder <strong>of</strong>f while holding the tube<br />
in place .<br />
Insert the end <strong>of</strong> the new holder into the slit on<br />
the side <strong>of</strong> the outer flange <strong>of</strong> the trach tube.<br />
Place the other end in the other side.<br />
Pull the sides so that they are tightly secure<br />
making sure to get two fingers under the holder.<br />
Wash your h<strong>and</strong>s<br />
Cleaning the Inner Cannula:<br />
It is very important to keep the inner<br />
cannula <strong>of</strong> the trach tube clean <strong>and</strong> free<br />
from dried secretions. Dried secretions can<br />
occlude the trach tube <strong>and</strong> make it difficult<br />
for the patient to breathe.<br />
To remove the inner cannula, turn the inner<br />
cannula counter clockwise, then remove it.<br />
If the inner cannula has flange clips, pinch<br />
them <strong>and</strong> then remove the inner cannula.<br />
The inner cannula should be changed at<br />
least daily or as needed. It should be replaced with a clean new inner cannula or<br />
should be washed using sterile technique if using a non-disposable inner cannula.
<strong>Tracheostomy</strong> <strong>Care</strong>:<br />
It is important to use sterile technique to minimize infection.<br />
Equipment Needed:<br />
• Sterile tracheostomy cleaning kit which includes<br />
� Sterile tray<br />
� Sterile field<br />
� Sterile brush<br />
� Sterile 4x4 gauze pads<br />
� Sterile pipe cleaners<br />
� Sterile gloves<br />
� Sterile dressing pads<br />
� Sterile trach ties<br />
• Clean inner cannula<br />
• 3% Hydrogen peroxide<br />
• Sterile water<br />
• Sterile suction catheter<br />
• Suction machine<br />
• Ambu bag<br />
Procedure:<br />
1. Wash your h<strong>and</strong>s<br />
2. Open the cleaning kit <strong>and</strong> spread the sterile field out<br />
on to the work area.<br />
3. Pour the hydrogen peroxide in one tray <strong>and</strong> the sterile<br />
water in the other side<br />
4. Place the sterile glove on your dominant h<strong>and</strong><br />
5. Remove the items from the kit with the sterile gloved<br />
h<strong>and</strong> <strong>and</strong> put them on the sterile field<br />
6. Suction the patient<br />
7. Disconnect the patient from the vent with your non-sterile<br />
h<strong>and</strong>.
8. Unlock <strong>and</strong> remove the inner cannula with your non-sterile<br />
h<strong>and</strong> <strong>and</strong> place it in the tray with the hydrogen peroxide to<br />
soak. If using a non-disposable inner cannula.<br />
9. Insert a clean inner cannula into the trach tube <strong>and</strong><br />
reconnect the patient to the vent.<br />
10. Use the sterile brush to clean the inner<br />
cannula with<br />
11. Rinse the inner cannula with the sterile water<br />
12. Use the sterile 4x4 to dry the inner cannula.<br />
13. Store the clean inner cannula in a covered<br />
container<br />
14. Suction the patient as needed<br />
15. Remove the soiled trach dressing using the<br />
non-sterile h<strong>and</strong><br />
16. Clean the skin with a gauze pad moistened in the<br />
sterile water. Dry the skin with a sterile 4x4.<br />
17. Apply a clean trach dressing <strong>and</strong> change the tube<br />
holder if needed.<br />
18. Throw away all <strong>of</strong> the disposable supplies<br />
19. Wash your h<strong>and</strong>s
<strong>Tracheostomy</strong> Tube Change:<br />
<strong>Tracheostomy</strong> tubes need to be changed monthly to decrease the chance <strong>of</strong><br />
infection. You should always have a back up trach tube. One <strong>of</strong> the same size <strong>and</strong><br />
one a size smaller.<br />
Do Not change the trach tube unless you<br />
have gone through proper training.<br />
It is very important to use sterile technique during the trach change procedure.<br />
Equipment Needed:<br />
• Sterile tracheostomy tube<br />
• Sterile gloves<br />
• Sterile water soluble lubricant<br />
• Sterile towel<br />
• Suction equipment<br />
• 10 cc syringe<br />
• Ambu bag<br />
• Sterile 4x4 gauze<br />
• Trach tube holder<br />
• Trach dressing<br />
• Hydrogen Peroxide<br />
Procedure:<br />
1. Wash your h<strong>and</strong>s<br />
2. Open the sterile towel for the sterile field<br />
3. Open the sterile supplies <strong>and</strong> place them on the<br />
sterile field<br />
4. Put the sterile glove on your dominant h<strong>and</strong><br />
5. Make sure the new trach tubes cuff is fully deflated.<br />
Be sure to not contaminate the tube by touching anything<br />
with it.<br />
6. Remove the inner cannula <strong>and</strong> replace it with the obturator
7. Check the cuff by inserting 10 cc <strong>of</strong> air in the cuff <strong>and</strong> check<br />
holes.<br />
8. Lubricate the tip <strong>of</strong> the tube with a water soluble lubricant.<br />
Do not use a petroleum based product.<br />
9. Suction the patient if needed<br />
10. If the patient has a cuff, deflate the cuff by<br />
pulling out all <strong>of</strong> the air out <strong>of</strong> the cuff.<br />
11. Remove the trach dressing <strong>and</strong> the trach tube<br />
holder<br />
12. Clean the skin as needed with a sterile 4x4 <strong>and</strong><br />
sterile water<br />
13. Disconnect the patient from the ventilator. You<br />
may need for someone to ventilate the patient<br />
with the ambu bag while you change out the<br />
trach<br />
14. Remove the trach tube using a forward,<br />
downward motion.<br />
15. With your sterile h<strong>and</strong>, gently insert the new trach tube within<br />
30 minutes with the obturator in place.<br />
16. Immediately remove the obturator<br />
17. Insert the inner cannula into the trach tube<br />
18. Inflate the cuff using minimal leak technique or<br />
using a Cuff manometer.<br />
19. Check to see if adequate air exchange is taking<br />
place by placing your h<strong>and</strong> over the opening <strong>of</strong><br />
the cannula. If no air exchange, the tube is not<br />
in the trachea <strong>and</strong> should be removed<br />
immediately <strong>and</strong> the patient manually<br />
ventilated with a mask<br />
20. Once the tube is in place, stabilize the tube<br />
with one h<strong>and</strong> until secured in place with a<br />
tube holder.
21. After the tube is secure, reconnect the patient to the ventilator<br />
22. Apply trach dressing<br />
23. Dispose <strong>of</strong> all supplies<br />
24. Wash your h<strong>and</strong>s<br />
Early Warning Signs<br />
It is very important for you to know the signs<br />
<strong>and</strong> symptoms <strong>of</strong> infection or other problems.<br />
Signs <strong>of</strong> Infection:<br />
• Changes in sputum color, volume, odor <strong>and</strong><br />
consistency<br />
Causes <strong>of</strong> infection include not washing h<strong>and</strong>s properly,<br />
using<br />
• Dirty equipment<br />
• Improper suctioning<br />
• Improper trach changes<br />
• Improper stoma care<br />
<strong>Breath</strong>ing Symptoms:<br />
• Increased shortness <strong>of</strong> breath<br />
• Wheezing<br />
• Increased coughing<br />
• Increased respiratory rate<br />
• Increased accessory muscle use<br />
Sputum Changes:<br />
• Color change (yellow, green, tan or<br />
brown)<br />
• Increase in quantity<br />
• Change in consistency<br />
• Bloody
Stoma Symptoms:<br />
• Pulsating tracheostomy tube<br />
• Bleeding from the stoma<br />
• Discharge or odor from the stoma<br />
• Swelling or redness<br />
Other Symptoms:<br />
• Fever<br />
• Loss <strong>of</strong> appetite<br />
• Rapid weight gain<br />
• Swelling <strong>of</strong> h<strong>and</strong>s <strong>and</strong> feet<br />
• Headaches<br />
• Sleepiness<br />
• Visual disturbances<br />
• Dizziness<br />
• Cyanosis<br />
• Confusion or anxiety<br />
Call <strong>Breath</strong> <strong>of</strong> <strong>Life</strong> with any equipment problems.<br />
If you are having any physical problems contact your physician<br />
If you are having severe physical problems call 911
Emergency Procedures<br />
Emergency Reinsertion <strong>of</strong> the <strong>Tracheostomy</strong> Tube<br />
Sometimes as a patient is being suctioned<br />
or as trach care is being performed the trach<br />
tube could accidentally become displaced.<br />
If this happens, try to replace the trach<br />
immediately. To keep the patients airway<br />
open the following actions should be taken:<br />
1. Replace the trach tube, using a new sterile trach tube<br />
OR<br />
2. Reinsert the original trach tube<br />
OR<br />
3. Occlude the stoma <strong>and</strong> use an ambu bag <strong>and</strong> mask to<br />
ventilate the patient at a rate <strong>of</strong> 8-16 breaths per minute<br />
until EMS arrives.<br />
Reinsertion Procedure:<br />
1. If at all possible, insert the obturator <strong>and</strong> put the<br />
water soluable lubricant on the outer cannula.<br />
2. Insert the trach tube, using an upward curved motion.<br />
The tube will slide into place as you apply gentle pressure.<br />
3. When the tube is in place, immediately pull the obturator out.<br />
4. Apply the trach tube holder to stabilize the trach tube.<br />
5. Insert the inner cannula .<br />
6. Inflate the tracheostomy cuff.<br />
7. Make sure you can feel air coming from the opening <strong>of</strong> the<br />
cannula by placing your h<strong>and</strong> over the opening. If the<br />
patient is on a ventilator, connect him/her to the ambu<br />
bag <strong>and</strong> watch for the chest to rise <strong>and</strong> fall as you squeeze<br />
the bag.
Assessment After Reinsertion:<br />
After you have reinserted the tracheost tracheostomy tube<br />
observe the patient skin color <strong>and</strong> heart rate. If at<br />
anytime during reinsertion you notice the patient<br />
becoming blue or the heart rate changes significantly,<br />
stop trying to reinsert the tube <strong>and</strong> occlude the stoma<br />
<strong>and</strong> ventilate the patient with an ambu bag <strong>and</strong> mask.<br />
Call 911 immediately <strong>and</strong> ventilate the patient.<br />
Continue to ventilate the patient with the bag <strong>and</strong><br />
mask until EMS arrives.<br />
Reinsertion <strong>of</strong> the trach tube should take no longer<br />
than 30 seconds. You should have at least one trach<br />
tube that is 1 size smaller than the tube that the<br />
patient has. This will make insertion easier if you are<br />
having difficulty due to a swollen airway.<br />
NOTE: Reinsertion <strong>of</strong> trach tubes can be difficult.<br />
It is important to make sure you perform this<br />
procedure re in front <strong>of</strong> the respiratory therapist<br />
at the hospital before the patient is discharged<br />
to home.
Infection Control:<br />
It is important to keep infections from spreading<br />
to or from patients <strong>and</strong> caregivers. To prevent<br />
this from occurring it is important to use good<br />
h<strong>and</strong>washing techniques before <strong>and</strong> after having<br />
contact with blood, body fluids <strong>and</strong> after removing<br />
your gloves.<br />
It is equally important to wear gloves when doing<br />
any procedure where the h<strong>and</strong>s may come into<br />
contact with blood or body fluids.<br />
A mask should be worn if the patient has any<br />
communicable respiratory diseases.<br />
H<strong>and</strong>washing:<br />
Good h<strong>and</strong>washing must be done with all<br />
procedures to prevent infections. Not<br />
doing proper h<strong>and</strong>washing technique is one<br />
<strong>of</strong> the most common sources <strong>of</strong> infections.<br />
The following is proper procedure for washing h<strong>and</strong>s:<br />
1. Wet your h<strong>and</strong>s with warm water<br />
2. Use antibacterial soap<br />
3. Wash your h<strong>and</strong>s for 1-2 minutes making sure<br />
to wash with friction the back <strong>and</strong> palm <strong>of</strong> each<br />
h<strong>and</strong> <strong>and</strong> between all fingers.<br />
4. Rinse your h<strong>and</strong>s thoroughly under the running<br />
water<br />
5. Dry h<strong>and</strong>s well with a paper towel
<strong>Suctioning</strong>:<br />
Coughing is important to clear out secretions<br />
from the airway. Some patients with<br />
respiratory illness have weak coughs <strong>and</strong> have<br />
difficulty getting the secretions out <strong>of</strong> the<br />
airway. Secretions can obstruct the airway<br />
making it difficult for the lungs<br />
to get the oxygen they need. <strong>Suctioning</strong><br />
removes the secretions from the airways which<br />
will allow the patient to breathe better.<br />
<strong>Suctioning</strong> can be done either by performing a<br />
sterile procedure or a clean procedure.<br />
When a patient needs suctioned they will begin to<br />
breathe noisy, cough or if on a ventilator the high<br />
pressure alarm may be alarming. More experienced<br />
patients will request to be suctioned. Notify the<br />
physician if you notice an increase in sputum<br />
production or blood in the sputum.<br />
Points to remember:<br />
• Always wash your h<strong>and</strong>s before <strong>and</strong> after<br />
suctioning the patient.<br />
• Always wear gloves when suctioning<br />
• Make sure to follow either the sterile or<br />
clean technique<br />
• Discard used suction catheters<br />
• <strong>Suctioning</strong> should only be done when necessary
The Suction Machine:<br />
Suction machines have a negative<br />
pressure when applied to the<br />
airway, the secretions<br />
can be removed. Each machine<br />
comes with a vacuum gauge. The<br />
recommended ranges are:<br />
• Adults: -80 to -120mmHg<br />
• Children: -80 to -100 mmHg<br />
• Infants: -60 to -80 mmHg<br />
There will also be a container for<br />
the secretions to accumulate in; a<br />
connection tube that attaches<br />
to the suction catheter; a short<br />
tube that connects<br />
to the machine pump, <strong>and</strong> a bacterial filter.<br />
How to Use the Suction Machine:<br />
1. Connect the short, clear plastic tubing between<br />
the canister <strong>and</strong> the suction machine.<br />
2. Connect the long, clear plastic connecting tube<br />
to the connector that goes to the canister.<br />
3. Plug the machine into a st<strong>and</strong>ard wall outlet.<br />
4. Turn the machine on <strong>and</strong> occlude the end <strong>of</strong> the<br />
long connecting tube. Adjust the regulator setting<br />
according to the recommended values.<br />
• Clockwise – increases the suction<br />
• Counterclockwise – decreases the suction<br />
5. Empty <strong>and</strong> clean the canister at least once<br />
a day, or whenever the fluid level reaches<br />
the full line. Flush the fluid down the toilet.<br />
6. Before the canister is replaced, it should be<br />
washed with a mild, non-detergent soap such<br />
as Palmolive <strong>and</strong> water. Rinse well with hot<br />
water.
NOTE: It is important to always clean the<br />
suction canister after emptying the contents.<br />
This helps to prevent bacteria from contaminating<br />
the suction machine.<br />
7. Clear the suction tubing by suctioning water up<br />
through the tubing.<br />
8. The longer suction tubing should be thrown away<br />
monthly or whenever it can no longer be cleared<br />
adequately.<br />
Portable Suction Units<br />
Portable suction units are used for those patients<br />
who travel. It can also be used as a back-up<br />
system in case <strong>of</strong> power failure.<br />
Instructions:<br />
1. Turn the unit on by turning the switch to<br />
the ON position. The unit will be running<br />
on power from one <strong>of</strong> three sources:<br />
• Home electricity<br />
• Vehicle, cigarette lighter adapter<br />
• Units internal battery<br />
2. The charging light will come on if the unit is<br />
plugged into a wall outlet.<br />
3. The suction pressure can be adjusted by<br />
Turning the knob on the top <strong>of</strong> the side<br />
unit clockwise.<br />
4. Empty <strong>and</strong> clean the canister at least once<br />
per day. The fluids should be flushed down<br />
the toilet.<br />
5. The canister should be washed with a mild<br />
non-detergent soap <strong>and</strong> water <strong>and</strong> rinsed with<br />
warm water.
Sterile Suction Procedure:<br />
When sterile technique is used, a sterile suction<br />
catheter kit is used each time.<br />
Equipment:<br />
Instructions:<br />
• Suction machine <strong>and</strong> tubing<br />
• Sterile suction catheter kit<br />
• Sterile distilled water<br />
• Sterile normal saline, for thick secretions<br />
• Ambu bag<br />
• Oxygen if ordered<br />
1. Wash your h<strong>and</strong>s<br />
2. Plug in the suction machine, connect<br />
the<br />
tubing to the jar <strong>and</strong> turn on the<br />
machine<br />
3. Set the vacuum gauge to the proper<br />
suction<br />
pressure.<br />
4. Open the sterile catheter kit being<br />
careful not<br />
to touch the glove or the catheter.<br />
5. Fill the suction kit water cup with<br />
sterile water.<br />
6. Ambu the patient for 4-6 breaths. If<br />
oxygen is<br />
ordered, make sure the ambu bag is<br />
attached<br />
to the oxygen source.<br />
7. Put the sterile glove on your dominant h<strong>and</strong>.<br />
8. With the non-sterile h<strong>and</strong>, grasp the suction tubing
9. With the sterile h<strong>and</strong>, pick up the package with the suction catheter <strong>and</strong><br />
attach the suction catheter to the suction tubing.<br />
10. Remove the protective covering from the suction<br />
catheter with your non-sterile h<strong>and</strong>. DO NOT<br />
touch anything but the catheter with your sterile h<strong>and</strong>.<br />
11. Coil the catheter around the gloved h<strong>and</strong> making<br />
sure to protect the tip <strong>of</strong> the catheter with your<br />
gloved h<strong>and</strong>.<br />
12. Disconnect the patient from the ambu bag<br />
13. Gently insert the catheter into the trach tube<br />
until resistance is met. Do not jam the catheter<br />
into the trach. Do not apply suction as you<br />
are inserting the catheter.<br />
14. Apply suction as you withdraw the suction<br />
catheter from the airway. DO not suction<br />
longer than 10-15 seconds.<br />
15. Reconnect the patient to the ambu bag <strong>and</strong><br />
ventilate the patient for 30 seconds. Do not<br />
touch the ambu bag with the sterile h<strong>and</strong>.<br />
16. Repeat the suctioning <strong>and</strong> ventilating procedure,<br />
give several deep breaths with the ambu bag.<br />
17. If the patient has trouble swallowing, you may<br />
use the same catheter <strong>and</strong> glove to suction the<br />
mouth <strong>and</strong> around the trach.<br />
Note: Remember once you have suctioned<br />
the mouth or around the trach tube, you<br />
cannot re-suction the trach until you have<br />
replaced the suction catheter with a new one.<br />
18. If the patient is on a ventilator, reconnect them<br />
to the ventilator.<br />
19. Rinse the suction tubing until it is clear by using<br />
the tip <strong>of</strong> the catheter in the sterile water with<br />
the suction turned on.<br />
20. Discard the disposable suction kit supplies.
Clean Suction Procedure:<br />
A clean suction technique utilizes clean gloves,<br />
but not sterile gloves each time the patient<br />
is suctioned.<br />
Instructions:<br />
1. Wash your h<strong>and</strong>s before starting<br />
the procedure<br />
2. Plug in the suction machine, connect<br />
the tubing to the suction canister.<br />
3. Set the vacuum gauge to the proper<br />
suction pressure.<br />
• Adult: -80 to -120mmHg 120mmHg<br />
• Children: -80 80 to -100mmHg<br />
• Infants: -60 to --80mmHg<br />
4. Put on clean gloves.<br />
5. Attach a clean suction catheter to the<br />
suction tubing.<br />
6. Connect the patient to an ambu bag<br />
<strong>and</strong> ventilate for 30 seconds<br />
7. Gently insert the catheter into the<br />
trach tube until resistance is met. Do<br />
not apply suction as you with withdraw the<br />
catheter from the airway. Never<br />
suction<br />
longer than 10-15 15 seconds.<br />
8. Reconnect the patient to the ambu bag<br />
<strong>and</strong> ventilate for 30 seconds.<br />
9. Repeat suctioning until the airway is<br />
clear.<br />
10. You may clear the mouth <strong>and</strong> around the<br />
trach with the same cat catheter <strong>and</strong> glove<br />
if needed. It is important to remember<br />
you can not re-suction suction the trach until you<br />
replace the catheter with a new one.
11. Place the patient back on the ventilator<br />
<strong>and</strong> ensure that he or she is comfortable.<br />
12. Rinse the catheter <strong>and</strong> suction connecting tube<br />
with distilled water until it is clear <strong>of</strong> mucus.<br />
13. Wash your h<strong>and</strong>s
Guidelines For <strong>Care</strong>giver Training<br />
<strong>Care</strong>giver training will be into sections that will require successful completion <strong>of</strong> a section <strong>of</strong><br />
training; the caregiver will continue to be involved, on a weekly basis, with the care <strong>of</strong> the<br />
patient.<br />
The caregiver will complete each individual section <strong>of</strong> the training record with instruction from<br />
<strong>Breath</strong> <strong>of</strong> <strong>Life</strong> staff <strong>and</strong> then will return demonstrate each task without assistance <strong>and</strong> then will<br />
return demonstrate each task without assistance <strong>and</strong>/or verbal cues from the staff. The staff<br />
will be present at the bedside to observe.<br />
Section One:<br />
� <strong>Care</strong>giver will begin learning care<br />
� Staff will be teaching trach care, trach changes, suctioning <strong>and</strong> manual resuscitation<br />
� <strong>Care</strong>giver will demonstrate 2 independent trach changes<br />
� <strong>Care</strong>giver will demonstrate 5 independent suctioning<br />
� <strong>Care</strong>giver will be required to do trach changes <strong>and</strong> suctioning on a weekly basis<br />
� Patient will have a pulse oximeter on at all times<br />
� <strong>Care</strong>giver will be independent in use <strong>of</strong> manual resuscitator<br />
Section Two:<br />
� Completion <strong>of</strong> section one<br />
� CPR module<br />
� Education will be started on the ventilator <strong>and</strong> the circuit<br />
� <strong>Care</strong>giver will be able to recognize signs <strong>and</strong> symptoms <strong>of</strong> respiratory distress after a<br />
discussion with the attending physician <strong>and</strong>/or staff member<br />
� <strong>Care</strong>giver will complete ventilator <strong>and</strong>/or CPAP training. Patient will have a pulse<br />
oximeter on at all times<br />
Section Three:<br />
� Completion <strong>of</strong> section two<br />
� <strong>Care</strong>giver will review CPR<br />
� <strong>Care</strong>giver will independently change 2 circuits on ventilator. (No Cues)<br />
� <strong>Care</strong>giver will demonstrate getting the child <strong>and</strong> the equipment in <strong>and</strong> out <strong>of</strong> the care<br />
independently a minimum <strong>of</strong> one (1) time<br />
� <strong>Care</strong>giver will have completed all training records <strong>and</strong> have records signed
Section Four:<br />
� <strong>Care</strong>giver will complete total independent care <strong>of</strong> their patient as ordered by the<br />
attending physician<br />
Section Five:<br />
� Completion <strong>of</strong> section four<br />
� <strong>Care</strong>giver will have a pulse oximeter at all times<br />
I have read the above guidelines for the caregiver <strong>and</strong> underst<strong>and</strong> that I will required to<br />
participate with the <strong>Breath</strong> <strong>of</strong> <strong>Life</strong> staff to have training completed.<br />
<strong>Care</strong>giver Signature: __________________________________________________________<br />
BOL Staff Signature: __________________________________________________________<br />
Date: __________________________
HOME NEBULIZER TREATMENTS<br />
Many medications are most effective when inhaled directly into lungs. To be<br />
inhaled into the airways <strong>of</strong> the lungs, medication must be changed from a liquid<br />
to a fine mist. To create this fine mist at home, you need a nebulizer <strong>and</strong> an air<br />
compressor. A nebulizer is a plastic container that changes liquids into a fine<br />
mist using a jet <strong>of</strong> air. The compressor, runs by electricity or battery, provides<br />
the jet <strong>of</strong> air to the nebulizer.<br />
How is the home nebulizer used?<br />
1. Place the compressor on a hard surface. Make sure the filter is free <strong>of</strong> dust<br />
<strong>and</strong> dirt. If it is dirty, rinse it with water <strong>and</strong> then dry it. Plug in the<br />
compressor.<br />
2. Place the prescribed amount <strong>of</strong> medication(s) into the nebulizer with a<br />
dropper or a syringe. Two medications can usually be mixed together. If you<br />
have any questions please contact your physician or <strong>Breath</strong> <strong>of</strong> <strong>Life</strong>.<br />
3. Some asthma medicines come premixed with saline. Other medications<br />
need saline added. You can buy sterile normal saline in two ways: in unit<br />
dose plastic vials or a pressurized canister (Bronchosaline). Two squirts from<br />
the canister should be enough. Never put a homemade saline solution into a<br />
nebulizer.<br />
4. Attach the nebulizer to the compressor tubing. Turn the power on. (The<br />
medication will immediately begin to nebulizer) Place the mouthpiece in the<br />
mouth <strong>and</strong> breathe in <strong>and</strong> out slowly through the mouth until the medication<br />
is gone. If the patient is able, tell them to take an extra deep breath every 10<br />
breaths or so, hold that breath for 10 seconds, <strong>and</strong> then breathe out slowly.<br />
This technique permits the medication to stay in the lungs longer for better<br />
effect.<br />
If the patient can’t use a mouthpiece, use a mask. The mask can be secured loosely over the<br />
nose <strong>and</strong> mouth if needed.<br />
Most nebulizers must be held in an upright position to work well. If the mixture has coated the<br />
sided <strong>and</strong> isn’t being nebulized, gently shake the nebulizer occasionally during the treatment.<br />
An average treatment takes 10-15 minutes. The treatment is over when all medication is gone<br />
<strong>and</strong> the nebulizer makes a constant sputtering noise.<br />
Some patients cough up mucus after breathing treatments. Observe the mucus color <strong>and</strong><br />
thickness. Normal secretions are usually thin <strong>and</strong> white or clear. Thick <strong>and</strong> sticky mucus that is<br />
yellow or green may indicate an infection. Call your physician to report a change.<br />
If the patient needs more treatments than prescribed by your doctor, or if the treatments do<br />
not improve the symptoms, call your physician.
HUMIDIVENT OR “ARTIFICIAL NOSE”<br />
Purpose: To provide humidification for the respiratory system, to assist<br />
in keeping secretions manageable, <strong>and</strong> to prevent airway damage due to<br />
dryness.<br />
When to use a humidivent: When the patient is disconnected from<br />
bedside, water humidity source.<br />
How to use: The humidivent is placed between the trach tube under the patient’s chin <strong>and</strong> the<br />
ventilator tubing attachment. If the patient has a trach, but not a ventilator, the humidivent<br />
sits directly on the trach opening.<br />
How it works: There is moisture in our exhaled air. The tiny, rolled fiber inside the humidivent<br />
collects the moisture from the patients exhaled air, holds it in the paper, <strong>and</strong> uses that moisture<br />
to humidify the next breath taken in.<br />
NOTE: The humidivent helps add moisture to each inhaled breath, but doesn’t do as thorough<br />
<strong>of</strong> a job as the heated humidifier used at the patients bedside. IF the patient will be away from<br />
the bedside humidification system for several hours, or the air is particularly dry, it may be<br />
helpful to place three or four drops <strong>of</strong> normal saline on the rolled fiber areas <strong>of</strong> the humidivent.<br />
REMEMBER: The humidivent is disposable <strong>and</strong> is not to be cleaned. For infection control<br />
purposes, it would be wise to discard the used humidivent daily. If the inside <strong>of</strong> the humidivent<br />
is saturated with secretions, discard it <strong>and</strong> use a new humidivent.