A tracheotomy is a procedure done on patients in need of immediate airway opening. This is done by making a surgical incision to open the trachea. A tube called, a tracheostomy tube, is then passed through the trachea slightly downward. An article by, Krans, B. states, ” A tracheostomy is a medical procedure — either temporary or permanent — that involves creating an opening in the neck in order to place a tube into a person’s windpipe. The tube is inserted through a cut in the neck below the vocal cords. This allows air to enter the lungs. Breathing is then done through the tube, bypassing the mouth, nose, and throat. A tracheostomy is commonly referred to as a stoma. This is the name for the hole in the neck that the tube passes through. A tracheostomy is performed for several reasons, all involving restricted airways. It may be done during an emergency when your airway is blocked. Or it could be used when a disease or other problem makes normal breathing impossible.” (Healthline, February 23, 2016, para 1, 2, 3, and 4). A tracheotomy is not only used on unconscious or paralyzed patients, it is used on anyone having difficulty breathing due to airway obstructions. A mobile person may have the for a tracheostomy tube, which can be permanent or temporary due to their condition at the time and how fast they improve if at all.

Discussion
A tracheostomy tube is used to bypass the upper airway due to possible obstruction. This allows proper removal of tracheal secretions by suctioning using a thin plastic tube, known as a suction catheter. These procedures are done numerous times to prevent airway plugging and

possible pneumonia. Even with a tracheostomy tube in place, a patient sometimes can still cough to clear his or her airway, but this isn’t always enough to allow proper passage of oxygen. Tracheostomy tubes(trach) are usually a last resort procedure.
Steps to take for suctioning a patient with a tracheostomy tube should be carefully followed to prevent airway damage, and oxygen saturation level decrease. According to the
insight of a family member, “If I don’t suction my husband the right way, he will get really full of secretions and sometimes get trach infections. I do my best to prevent any issues at all cost” (S. Gray, personal communication, May 22, 2018). Before suctioning begins, the procedure is to be sterile and the person administering the procedure must do the following:
1. Gather all necessary equipment needed according to the doctor’s orders and status of the patient. Equipment usually needed and should be available is: correct size suction catheter kit per order, ambu bag, saline ampules for lavage if needed, supplemental
oxygen in case of sudden drop in oxygen saturation percentage, suction machine, oxygen level monitor, and if possible an extra able-bodied assistant nearby for help if needed.
2. After all equipment has been gathered, assess the patient’s stability and airway making sure the tracheostomy tube is inline, heart rate within normal limits, and no other emergency actions should be taken.
3. If the patient is on a ventilator, disconnect the circuit from the trach and proceed to pass the suction catheter slowly down the tracheotomy tube to the ordered depth. If the patient only has a trach and no ventilator, remove any external caps that may be over the trach.
4. Withdraw the catheter gently while applying continuous suction pressure by placing your thumb over the control port. This usually takes about ten seconds. While doing this

monitor the secretions being withdrawn for color, consistency, and amount. This step can be done up to a maximum of three passes to prevent respiratory distress.
5. Once done, if needed, use the abmu bag to give a few breaths to help the patient catch their breath. If oxygen levels have dropped, the ambu bag can be connected to
supplemental oxygen while breaths are being administered, or just reconnect the patient back on the ventilator that is programmed for proper breaths and oxygen delivery.
6. Once the patient has stabilized, clean the area, and make sure the patient is not in any need before leaving the beside.
7. Document the procedure and findings thoroughly.
8. If suctioning is needed again, follow steps one through seven.

Conclusion
The above steps should prevent any airway distress, damage, and infections. A seasoned Respiratory Therapist stated. “Tracheostomy tube suctioning is necessary to remove built up secretions that the patient is unable to remove, due to the lack of the cough mechanism. Unnecessary suctioning can cause bronchospasms and trauma to the tracheal mucosa. Such damage can cause scarring and the formation of scar tissue that can cause another obstructed airway where the patient will have to undergo surgery again to replace and reposition the tracheostomy tube.” (M. Smith, personal communication, January 2016). When taking precautionary steps, one can prevent issues mentioned above, saving not only the patient from being in distress and uncomfortable, but it saves the person caring for them time and extra extensive work.

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