The technique for a tracheostomy, a ventilated patient and simple oral removal of secretions will be covered here.
Generally, even though both hands are gloved, one will be considered non-sterile in order to handle things like the wall tubing, and the other hand (dominant) is used to handle the sterile catheter.
Depending on the kit, you may be able to easily grab the cup that will hold the normal saline solution without gloves and open it up by touching only the outside which will then be considered non-sterile. The inside is still sterile.
If not, you will have to use your gloved sterile hand to pick it out of the kit and open it, then use your non-sterile hand to pour saline from a bottle into the opened container.
Sterile technique can sometimes feel like playing chess. You have to think a few steps ahead to see what you need in terms of sterile vs non-sterile.
When you see the plastic lining sticking up out of the cup DO NOT be tempted to push it down with an ungloved finger or it is then contaminated. Pouring the saline into the cup slowly usually gets the lining to sink down enough to hold the NSS or use a gloved finger.
Do not underestimate the force that someone can exert coughing while you suction. If you are positioning yourself right in front of the patient by leaning over the bed, you can easily end up with some sputum splashing on you. So adhering to standard precautions by wearing gown, gloves and mask are a necessity.
If it is a brand new trach there is usually copious amounts of sputum. If it is older, it may be pretty dry depending on the situation.
The patients with a long time tracheostomy are used to the sensations involved. Some can even tell you when they think they have a mucus plug impinging on their breathing. Plugs are small thickened pieces of sputum that have become dry. Sometimes no bigger than 2 mm in diameter but when it is coughed up the patient feels better.
Patients may also request you continue to suction even though you have not gotten any sputum out due to their sensation of a mucus plug. While I usually am willing to give an extra pass or two, continuing too many times can lead to irritation of the bronchus and bleeding which should be avoided.
If the sputum is exceptionally dry, you can get an order from the physician to instill some NSS into the trach. It will cause coughing and sputtering but even a small amount like 3 mls can loosen secretions sufficiently to be able to bring sputum up and out.
In addition, you may want to ask the physician for an order to add humidity via a trach mask and mister / humidifier.
Remember to follow the floor of the nasal passage, not the roof. Expect our patient to tear, not necessarily because of pain, it is just a reflex reaction.
Here’s a cool gadget I’ve never seen but it sure looks like it makes things easier:
The rigid catheter is called a Yankauer. It has a small hole near the end attached to the tubing which must be covered with your thumb in order for it to actually suck anything out of the mouth.
Yankauer: rigid, hollow plastic tube used at the end of a suction device to remove oral secretions. (pronounced Yang-KOWER)