ET Tube Care,

Tracheostomy Care and

Suctioning
PERFORMING ENDOTRACHEAL
TUBE CARE

Observe for signs and symptoms of need to

perform ET tube care: soiled or loose tape;
pressure sore or naris, lips, or corner of
mouth; and excess nasal or oral secretions.
Observe for factors that increase risk of
complications from ET tube: type and size of
tube, movement of tube up and down trachea
(in and out), duration of tube placement, cuff
overinflation or underinflation, presence of
facial trauma, malnutrition, and neck or
thoracic radiation.
Assess client's knowledge of procedure.

Obtain another nurse's assistance in this
procedure.
Explain procedure and client's participation,
including importance of the following: not
biting or moving ET tube with tongue; trying
not to cough when tape is off ET tube;
keeping hands down and not pulling on
tubing; removal of tape from face can be
uncomfortable.
Assist client to assume position comfortable for
both nurse and client (usually supine or semi-
Fowler's).

Place towel across chest.
Wash hands. Apply face shield if indicated.
Administer endotracheal, nasopharyngeal, and
oropharyngeal suction.
Connect oral suction catheter to suction
source.
Prepare tape. Cut a piece of tape long enough
to go completely around client's head from
nares to nares plus 6 inches: adult 24-48 cm
(1 to 2 feet). Lay tape adhesive side up on
bedside table. Cut and lay 8 to 16 cm (3 to 6
inches) of tape, adhesive sides together, in
center of long strip to prevent tape from
sticking to hair. Smaller strip of tape should
cover area between ears around back of
head.
Apply gloves. Instruct helper to apply pair of
gloves and hold ET tube firmly at client's lips
or nares. Note the number marking on the ET
tube at the gum line.
Carefully remove tape from ET tube and
client's fact.
Use adhesive remover swab to remove excess
adhesive left on face after tape removal.
Wash adhesive remover from face.
Remove oral airway or bite block, if present,
and place on towel. Do not remove oral
airway if client is actively biting ET tube.
Clean mouth, gums, and teeth opposite ET
tube with non-alcohol-based mouthwash
solution and sponge-tipped applicators. Brush
teeth as indicated
Oral ET tube only: Remembering "cm" ET tube
making at lips or gums, with help of assistant
move ET tube to opposite side or center of
mouth. Do not change tube depth.
Repeat oral cleaning on opposite side of
mouth.
Clean face and neck with soapy washcloth,
rinse, and dry. Shave male client as
necessary.
Pour small amount of skin protectant on clean
2 X 2 inch gauze and dot on upper lip (oral ET
tube) or across nose (nasal ET tube) and
cheeks to ear. Allow to dry completely.

Slip tape under client's head and neck,
adhesive side up. Take care not to twist tape
or catch hair. Do not allow tape to stick to
itself. It helps to gently stick tape to tongue
blade, which serves as a guide. Then slide
tongue blade under client's neck. Center tape
so that double-faced tape extends around
back of neck from ear to ear.
On one side of face, secure tape from ear to
naris (nasal ET tube) or over lip to ET tube
(oral ET tube). Tear remaining tape in half
lengthwise, forming two pieces that are 1/2 to
3/4 inches wide. Secure bottom half of tape
across upper lip (oral ET tube) or across top
of nose (nasal ET tube) to opposite ear. Wrap
top half of tape around tube and up from
bottom. Tape should encircle tube at least two
times for security.
Gently pull other side of tape firmly to pick up
slack and secure to opposite side of face and
ET tube the same as the first piece.
Discard soiled items in appropriate receptacle.
Remove towel and place in laundry.
Reposition client.
Remove gloves and face shield, discard in
receptacle, and wash hands. Place clean
items (e.g., tincture of benzoin, mouthwash,
access swabs) in place of storage.
Compare respiratory assessments before and
after ET tube care.

Observe depth and position of ET tube
according to physician recommendation.
Assess security of tape by gently tugging at
tube.
Assess skin around mouth and oral mucous
membranes for intactness and pressure
areas.
Note or Kardex with pencil: appropriate depth
of ET tube, frequency of ET tube care,
pressure sore care needed, and designated
intervals.
Record in nurses' notes: assessments before
and after care, supplies used, client's
tolerance of procedure, and frequency and
extent of ET tube care.

OROPHARYN
GEAL
SUCTIONING
1. Assess indications for
suctioning:
Audible secretions during
respiration
Adventitious breath sounds
(auscultated)
2. Position:
Conscious: Semi-Fowler’s
position
Unconscious: Lateral
position
3.Pressure of suction equipment, to
prevent trauma to mucous
membrane of airways:
Wall unit:
Adult: 100-120mmHG
Child: 95-110mmHg
Infant: 50-95mmHg

Portable unit:
Adult: 10-15mmHG
Child: 5-10mmHg
Infant: 2-5mmHg

4. Appropriate size of sterile
suction catheter, to prevent
trauma to mucous membrane
of airways:
Adult: Fr. 12-18
Child: Fr. 8-10
Infant: Fr. 5-8

5. Don sterile gloves. Sterile technique
prevents introduction of
microorganisms into the respiratory
tract.

6 . Le n g th o f ca th e te r:
- measure from the tip of the
clie n t's n o se to th e e a rlo b e o r a b o u t
1 3 cm ( 5 in ) in a d u lt
7. Lubricate catheter, to
reduce friction
Oropharyngeal tip- sterile water or NSS
8. Apply suction during
withdrawal of the suction
catheter (never during
insertion) to prevent
trauma to the mucous
membrane.
9. Apply suction for 5-10
seconds (maximum 15
seconds). Over
suctioning causes
hypoxia.
10. Hyperventilate client
with 100% oxygen before
and after suctioning to
prevent hypoxia,
11. Allow 20-30 second
interval between each
suction to bring up mucous
secretions into the upper
airways, and prevent
hypoxia.
12. Provide oral hygiene.
13. Dispose contaminated
equipments/articles safely.
To prevent contamination to
the environment
Use one sterile suction catheter for each
episode of suctioning
14. Assess effectiveness
of suctioning
Auscultate chest for clear breath sounds


15. Document relevant
data.