PROCEDURES

• Consult with the patient’s caregivers for assistance.
• Assess tracheostomy tube. Look for possible causes of distress (DOPES) which may be easily correctable, such as a detached oxygen source.
• If the patient’s breathing is adequate but exhibits continued signs of respiratory distress, administer high-flow oxygen via non-rebreather mask or blow-by, as tolerated, over the tracheostomy.
• If patient’s breathing is inadequate, assist ventilations using bag-valve-mask.
• If on a ventilator, remove the patient from the ventilator prior to using bag valve device with high-flow oxygen. mask device as there may be a problem with the ventilator or oxygen source.
• Suction if unable to ventilate via tracheostomy or if respiratory distress continues.
• Use no more than 100 mmHg suction pressure.
• If the tracheostomy tube has a cannula, remove it prior to suctioning.
• Determine proper suction catheter length by measuring the obturator.
• If the obturator is unavailable, insert the suction catheter approximately 2 - 3 inches into the tracheostomy tube. Do not use force!
• 2 - 3 mL saline flush may be used to help loosen secretions.
• If the patient remains in severe distress, continue ventilation attempts using bag valve mask with high-flow oxygen via the tracheostomy. Consider underlying reasons for respiratory distress and refer to the appropriate protocol for intervention.