The eleven steps of closed suctioning with Kimberly-Clark* Trach Care* 72
1. Washing your hands according to your unit protocol.
2. Determining the correct catheter sizing and configuration.
3. Removal of Trach Care from its package and connection of the flex tube
4. Attachment of the day change sticker.
5. Connection of the wall suction line to the Trach Care and setting the vacuum level.
6. Insertion of Trach Care into the ventilation circuit.
7. Observation of ventilator parameters and assessing the patient’s need of suctioning.
8. The full suctioning procedure.
9. Repositioning of the suction tubing.
10. Checking the ventilator and patient observations.
11. Hand washing and glove disposal.
1. Wash hands according to unit protocol
Wash your hands according to your unit protocol.
Whilst working with Trach Care, we recommend that
you wear examination gloves and facial protection.
Other protective measures might be needed
according to your unit protocol.
2. Determining the correct catheter sizing and
configuration.
To obtain the correct French size of your
TrachCare72, multiply the ET diameter by 2, then use
<new Close-up with Microcuff>
the next smallest size of catheter. So; if you are using
an 8 mm ET tube, multiply by 2. and you get 16.
Then use the next smallest catheter size. In this
case, 14 French.
Using a catheter size that is too large may effect the
ventilator function and cause Auto-PEEP.
3) Removal of Trach Care from its package and
connection of the flex tube
Open the package and attach the flex tube to the
15mm port of the Trach Care Double Swivel Elbow.
Remove the red wedge plug from the TrachCare.
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4) Attachment of the day change sticker
The day change sticker indicates the day when the
next Trach Care change is due. For example, on a
Tuesday, you would attach the Friday sticker to the
valve, which is when the catheter must be changed.
This sticker makes it easy for your colleagues to
verify the change date.
5) Connection of the wall suction line to the
Trach Care and setting the vacuum level
Attach the suction connection tube from the Trach
care suction valve to the negative pressure
manometer and collection jar. With the suction valve
unlocked, depress the valve completely and adjust
the manometer to reach a negative pressure of 15.9
kPa or 120 mm Hg. for an adult patient,
6) Insert Trach Care into ventilation circuit
(humidified or HME) with gloved hands and
masks
Remove the old flex tube and elbow connector. If this
is tight, use the red wedge plug to help with prizing
them apart . Connect the Trach Care flex tube to the
Y-piece of the ventilator and the double swivel elbow
to the 15 mm endotracheal tube.
7) Observation of ventilator parameters and <ventilator picture here> or
assessing the patient’s need of suctioning
Use the ventilator to hyperoxygenate and
hyperventilate the patient if indicated by clinical signs
or by hospital protocol.
The mode selection while using Closed-Suctioning is
very important. See the Directions for use and always
use a mode which has gas flowing through the circuit
or one that responds to negative pressure.
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8) Full suctioning procedure (7 steps)
1. Lift up the thumb valve cap to unlock it, then
depress and hold the valve and simultaneously
adjust the vacuum regulator to the desired level.
Depress the valve completely and adjust the
manometer reading to reach the required
pressure. For adult patients, we suggest a range
of 80 to 120 mm Hg or 10.6 -15.9kPa.
2. Open the cap on the irrigation port and attach a
saline vial so that the system flushes clean
automatically.
3. To carry out the suctioning, stabilize the manifold,
and ET tube with one hand, then, with the thumb
and forefinger of the other hand, advance the
catheter down the ET tube to the desired depth.
Measured depth suctioning is explained in more
detail shortly.
4. Suctioning needs to be applied for two seconds
before starting to withdraw the catheter. Depress
and continuously hold the thumb valve whilst
withdrawing the catheter slowly. Do not depress it
intermittently. Twirling the catheter as it is
withdrawn is not necessary and has no beneficial
effect.
5. Stop withdrawal when the black marker ring
appears inside the sleeve and release the thumb
valve. Do not pull too far or you will stretch the
sleeve. Withdrawal of the catheter too far will
cause leakage of ventilator gas into the sleeve
causing it to inflate. If this happens, the
performance of the Trach Care will be
compromised and you must replace the Trach
Care with a new one immediately.
6. The irrigation port should be used to clean and
rinse the catheter when the suction procedure is
completed. Be sure that the black marker ring is
visible in the sleeve. Simultaneously depress the
thumb control valve, you will have a dynamic
active cleaning of the catheter. Continue to
irrigate until the catheter is clean.
7. Lift up the thumb valve cap and turn it to lock the
valve.
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9) Repositioning of the suction tubing.
Replace the suction tubing in the support out of the
way.
10) Check ventilator and observe patient
Now assess the patient's vital signs, breath sounds
and oxygen saturation.
11) Wash hands and dispose of gloves
Once the suctioning procedure is completed, take
your gloves off and dispose of them, and wash you
hands.
