TRACHEAL SUCTIONING

Purpose:
Tracheal suctioning is a means of clearing the airway of secretions or mucus. This is accomplished by using a vacuum-type device through the tracheostomy. Tracheal suctioning is performed when a child cannot adequately clear secretions on his or her own. Indications for suctioning include: Noisy, rattling breathing sounds Secretions (mucus) visible and filling opening of tracheostomy Signs of respiratory distress: difficulty breathing, agitation, paleness, excessive coughing, cyanosis (blueness), nasal flaring, retracting. No air moving through tracheostomy (listen for sounds) Before eating or drinking if congested After respiratory treatments (inhalation therapy, assisted breathing with a self-inflating manual resuscitator), chest percussion and drainage Depending on the childs age, he or she may be able to request suctioning when needed or assist with the procedure.

Suggested Settings for Non-Emergency Situations:

Designate a clean area for suctioning outside the classroom, if possible. Suctioning can be a noisy procedure and may be distracting and disruptive to the rest of the class. If an electrically powered suction machine is used, the setting must have an accessible, working grounded electric outlet.

Suggested Personnel and Training:

A registered nurse or a respiratory therapist with proven competency-based training in appropriate techniques and problem management should perform tracheal suctioning unless state medical and nursing practice standards specify otherwise. If the trained caregiver and back-up personnel are unable to be available on a given school day, the student should not attend school. However, an optional arrangement may be made between the school and the family, where the parent would be available to attend school to function as the caregiver for the child. Any school personnel with regular contact with a student who requires tracheal suctioning must receive general training, covering the childs special health care needs and potential problems as well as how to implement the established emergency plan. A basic skills checklist can be used as a foundation for competency-based training in appropriate techniques. It outlines procedures step-by-step. Once the procedures have been mastered, the completed checklist serves as documentation of training.

The Health Care Plan: Issues for Special Consideration

Each students Health Care Plan must be tailored to individual needs. The following section covers the procedure for tracheal suctioning and possible problems and emergencies that may arise. It is essential that this section be reviewed before writing the Health Care Plan. For a student who requires tracheal suctioning, the following items should receive particular attention: The students underlying condition and possible problems associated with the condition or treatment. The students baseline status (color, respiratory rate, pulse, color and consistency of secretions, usual frequency or suctioning, usual indications for suctioning) The childs ability to request suctioning Backup equipment (bulb syringe or DeLee catheter) Accessibility of equipment Signs and symptoms of respiratory distress shown by the student (cyanosis, agitations, etc.) Need for saline installation

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