Question 1

1.  Checks chart for order

Accepted Answer

2.  Review policy and procedure

Question 2

3.  State goals
  a.  patient’s airway will be patent
  b.  patient will be free of respiratory tract infection from retained secretions or cross contamination
  c.  sterility  will be maintained

Accepted Answer

4. Gather equipment **Put stethoscope around neck**

Question 3

5.  Provides privacy for the patient

Accepted Answer

6.  Perform hand hygiene

Question 4

7.  Prepares patient
1.  Identify 2 ways
 a.  name band &MR #
 b.  chart
2.  Checks patient allergies

Accepted Answer

7A. 
3. Explains procedure to patient
4. Establish method of communication during procedure
5. Allow patient verbalization (using established method of communication)

Question 5

8.  Raise bed to working height, rail up on the opposite side

Accepted Answer

9. Correctly positions patient and drapes accordingly, usually Semi-Fowlers or Fowlers

Question 6

*** May put PPE on before assessment in case of splash

Accepted Answer

10. Assessment:
 a.  s/sx of obstructed airway (↑RR, ↑HR, ↓LOC, presence of cough, secretions,restlessness, cyanosis)
 b.  auscultate breath sounds for rales/rhonci, ↓breath sounds

Question 7

11. Turns on and adjusts suction machine to the appropriate range:
 a.  portable:  7-15 in/hg
 b.  wall – 100-120 mm/hg

Accepted Answer

STEPS
12. Opens bottle of sterile saline and places connection tubing within reach

Question 8

13. Applies face shield (verbalize gown if splash risk)

Accepted Answer

Aseptically opens suction kit on over-bed table

Question 9

Removes basin
   a.  pours sterile NS into basin

Accepted Answer

* APPLIES STERILE GLOVES CORRECTLY
   b.  picks up sterile catheter with dominant, sterile hand

Question 10

With non-dominant hand, picks up and attaches connection tube to suction catheter w/o contaminating catheter

Accepted Answer

*MAINTAINS STERILITY OF SUCTION CATHETER AND STERILE HAND HOLDING CATHETER THROUGHOUT TRACH SUCTIONING

Question 11

Tests suction by occluding the port with non-dominant contaminated hand, wrapping catheter around dominant, sterile hand to maintain sterility until ready to suction (this also moistens the catheter tip).

Accepted Answer

IMPLEMENTATION OF PROCEDURE
* HYPEROXYGENATES BEFORE SUCTIONING USING AMBU 3-5 BREATHS WITH 100% OXYGEN

Question 12

Without applying suction, gently but quickly inserts catheter into trachea until resistance is met, using dominant sterile hand.  Pulls catheter back 1 cm.

Accepted Answer

* VERBALIZES NOT TO EXCEED 10 SECOND LIMIT ON SUCTIONING

Question 13

Applies intermittent suction by placing and releasing non-dominant, contaminated thumb over vent on catheter

Accepted Answer

Withdraws catheter while rotating between thumb and forefinger of dominant, sterile hand

Question 14

* HYPEROXYGENATES PATIENT AFTER SUCTIONING WITH 3-5 BREATHS 100% OXYGEN.

Accepted Answer

Rinses catheter with sterile saline

Question 15

Assesses need for repeat suctioning by listening for presence of secretions.

Accepted Answer

Repeat above steps if necessary with one full minute between suction passes for ventilation and reoxygenation

Question 16

STEPS
Replaces patient oxygen if in use.

Accepted Answer

Suction nasal/oropharyngeal airways last:  verbalize not to reenter trach at this point

Question 17

Disconnects catheter from connection tubing and rolls catheter around fingers of dominant hand

Accepted Answer

Pulls glove off so that catheter remains in glove.  Removes other glove, careful not to contaminate skin

Question 18

Removes face shield/gown

Accepted Answer

Discards and clean equipment according to policy and turns off machine

Question 19

Post-Procedure Follow-up and Education

Accepted Answer

Follow Up Care:
  a.  auscultate breath sounds to evaluate effectiveness of suctioning
 b.  mark intercom at nurse station
 c.  ask if breathing is easier
 d.  oral/lip care
 e.  continue assess suction PRN; perform trach care if needed

Question 20

Follow-up education:
  a.  instruct patient to call if difficulty breathing occurs or if suctioning or mouth care is needed
  b.  encourage patient to turn, cough, and deep breath every 2 hours to promote clear airway.

Accepted Answer

Leave patient safe and comfortable:
  a.  side rails up
  b.  call light in reach
  c.  bed in lowest position
  d.  positioned comfortably

Question 21

Performs hand hygiene

Accepted Answer

Documents: descriptive analysis
  a.  date and time
  b.  respiratory before/after
  c.  type of suctioning performed and equipment used
  d.  secretions obtained (amount, color, consistency)
  e.  patient tolerance
  f.  patient education
  g.  si

Trach suction

Lab Skills #4

Question	Answer
1. Checks chart for order	2. Review policy and procedure
3. State goals a. patient’s airway will be patent b. patient will be free of respiratory tract infection from retained secretions or cross contamination c. sterility will be maintained	4. Gather equipment Put stethoscope around neck
5. Provides privacy for the patient	6. Perform hand hygiene
7. Prepares patient 1. Identify 2 ways a. name band &MR # b. chart 2. Checks patient allergies	7A. 3. Explains procedure to patient 4. Establish method of communication during procedure 5. Allow patient verbalization (using established method of communication)
8. Raise bed to working height, rail up on the opposite side	9. Correctly positions patient and drapes accordingly, usually Semi-Fowlers or Fowlers
*** May put PPE on before assessment in case of splash	10. Assessment: a. s/sx of obstructed airway (↑RR, ↑HR, ↓LOC, presence of cough, secretions,restlessness, cyanosis) b. auscultate breath sounds for rales/rhonci, ↓breath sounds
11. Turns on and adjusts suction machine to the appropriate range: a. portable: 7-15 in/hg b. wall – 100-120 mm/hg	STEPS 12. Opens bottle of sterile saline and places connection tubing within reach
13. Applies face shield (verbalize gown if splash risk)	Aseptically opens suction kit on over-bed table
Removes basin a. pours sterile NS into basin	* APPLIES STERILE GLOVES CORRECTLY b. picks up sterile catheter with dominant, sterile hand
With non-dominant hand, picks up and attaches connection tube to suction catheter w/o contaminating catheter	*MAINTAINS STERILITY OF SUCTION CATHETER AND STERILE HAND HOLDING CATHETER THROUGHOUT TRACH SUCTIONING
Tests suction by occluding the port with non-dominant contaminated hand, wrapping catheter around dominant, sterile hand to maintain sterility until ready to suction (this also moistens the catheter tip).	IMPLEMENTATION OF PROCEDURE * HYPEROXYGENATES BEFORE SUCTIONING USING AMBU 3-5 BREATHS WITH 100% OXYGEN
Without applying suction, gently but quickly inserts catheter into trachea until resistance is met, using dominant sterile hand. Pulls catheter back 1 cm.	* VERBALIZES NOT TO EXCEED 10 SECOND LIMIT ON SUCTIONING
Applies intermittent suction by placing and releasing non-dominant, contaminated thumb over vent on catheter	Withdraws catheter while rotating between thumb and forefinger of dominant, sterile hand
* HYPEROXYGENATES PATIENT AFTER SUCTIONING WITH 3-5 BREATHS 100% OXYGEN.	Rinses catheter with sterile saline
Assesses need for repeat suctioning by listening for presence of secretions.	Repeat above steps if necessary with one full minute between suction passes for ventilation and reoxygenation
STEPS Replaces patient oxygen if in use.	Suction nasal/oropharyngeal airways last: verbalize not to reenter trach at this point
Disconnects catheter from connection tubing and rolls catheter around fingers of dominant hand	Pulls glove off so that catheter remains in glove. Removes other glove, careful not to contaminate skin
Removes face shield/gown	Discards and clean equipment according to policy and turns off machine
Post-Procedure Follow-up and Education	Follow Up Care: a. auscultate breath sounds to evaluate effectiveness of suctioning b. mark intercom at nurse station c. ask if breathing is easier d. oral/lip care e. continue assess suction PRN; perform trach care if needed
Follow-up education: a. instruct patient to call if difficulty breathing occurs or if suctioning or mouth care is needed b. encourage patient to turn, cough, and deep breath every 2 hours to promote clear airway.	Leave patient safe and comfortable: a. side rails up b. call light in reach c. bed in lowest position d. positioned comfortably
Performs hand hygiene	Documents: descriptive analysis a. date and time b. respiratory before/after c. type of suctioning performed and equipment used d. secretions obtained (amount, color, consistency) e. patient tolerance f. patient education g. si

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