Endotracheal suctioning
For various reasons, tracheotomised as well as laryngectomised patients generally have a limited cough output. At the same time, there is often increased secretion in the respiratory tract. The mechanical stimulus of the tracheostomy tube on its own, but also physiological causes, can change and increase secretion production. This constellation makes effective secretion management necessary to avoid sequelae such as infections of the lower airways, more difficult decannulation or even problems during weaning from ventilation.
After a tracheotomy or laryngectomy, the trachea is particularly affected by consequential changes. The so-called ciliated epithelium - the cilia - is of great importance for respiratory function. These cilia sit on the mucous membrane of the trachea and with their regular movements ensure that undesirable particles are transported towards the mouth to be eliminated via the gastrointestinal tract.
This process can also be described as a self-cleaning mechanism of the airways. However, the aforementioned cilia can only maintain their function under certain general conditions. At least 21‒22°C and 50‒55% relative humidity are necessary to provide functionality. In addition, other factors can also seriously disrupt cilia activity. Triggers for disturbed function of the ciliated epithelium can include smoking, cold or low humidity. Increased secretion production with increased coughing, resulting in interrupted sleep and consequently reduced performance often occur. Endotracheal suctioning consequently plays an important role in patient care.
Secretion management More information on the subject.
Professional suction management finds the right balance between indication and implementation according to needs as well as resource-oriented activation of self-cleansing processes. Medical aids such as heat & moisture exchangers (HMEs), which mimic lost functions of the nose, are a mandatory part in the care of tracheostomised and laryngectomised patients. Nevertheless, endotracheal suctioning forms an important supplement to this passive respiratory gas optimisation. For example, an audible or perceptible accumulation of secretions, increased coughing or unblocking of the tracheostomy tube can lead to a need for suctioning. In general, it is important to strictly check the frequency of suctioning for its necessity.
"As often as necessary, as little as possible."
This should be the guiding principle of application in practice. The choice of suction catheter size depends on the internal diameter of the tracheostomy tube or tracheal tube. As a rule, it should correspond to max. half of the inner diameter. In ventilated patients, it is mandatory to use sterile disposable gloves when performing suction. In patients with spontaneous respiration, pathogen-free disposable medical gloves meet the hygienic requirements, if necessary. Any changes to the current hygiene guidelines must be observed at all times.
The increased production of secretions after a tracheotomy or laryngectomy basically explains why endotracheal suctioning plays a central role in the care of these patients. This makes it all the more important to approach this procedure with the appropriate respect and sense of responsibility. And not only because complications such as cardiac arrhythmias or shortness of breath can occur, but the procedure is also quite stressful for the patient, especially if suctioning is performed by a "stranger". A feeling of being "at the mercy of others" is often described. It is therefore important to inform the patient before each suctioning procedure. During the procedure, do not exceed the maximum suction time of 10‒15 seconds (tip: holding your own breath illustrates the patient's respiratory situation).
The following video explains the procedure for nurses. You can find more videos on the subject of suction on our YouTube channel.
