EMT here. Fresh out of school with little (no) experience of trach care. Not something they teach you in school, but something they expect you to know in the field !! Moved my first trach pt yesterday, very very overwhelming, could feel my heart in my stomach while helping this gentlemen. I guess it’s something that comes with time; but definitely a helpful video in making me feel more comfortable while interacting with trach patients. Thank u!!
Thank you SO much for this! I’m a new grad nurse going into in home care for medically complex children, many of whom have trachs, GTubes, and Vents. I was so worried I didn’t remember exactly how to do trach care and this helped refresh my memory SO much. I cannot thank you enough, seeing a visual example helped so much more than reading my skills book, I just couldn’t visualize it on my own. I owe you!
Good luck in your new endeavor and congrats on becoming a nurse! In this video, I demonstrated reusable inner cannulas, but most folks are using disposable ones. So just skip that step (because you'd throw away the old one and get a new one). - Ellis
@abigailmoten2875 Hello. How do you like pediatric home care ? I am thinking of working also in pediatric home care. Is it a good start to work in home care as a new graduate ? Hope you are doing well. Thank you
Appreciate you sharing knowledge to nurses! A couple small tips from an RT. When setting your suction pressure, measure it by occluding the suction tubing and not to open air. This measures how much potential suction pressure you're using on their airway to limit damage. Usually suction pressures are 80-100 for neonates, 100-120 for pediatrics, and 120-140 for adults. Lastly, once you've passed your catheter down and hit resistance or they cough, pull back slightly* and then begin suctioning. This prevents accidental suctioning near the carina.
Hello. Just wondering how suctioning upon insertion causes potential injury? Are there any resources that can be shared? I am a home care provider, my client insists on being suctioned upon inserting the catheter, and does not believe me when I say suctioning upon withdrawal is best practice to avoid damage.
I'm a stage 4 Larynx cancer survivor. And I've had this cleaning and suctioning many, many times during my year in hospital, and since of course. But I now do this myself. I' will be celebrating my 8 year cancerversay Oct 25th. All of you nurses and respiratory techs are amazing. Thank you all,,you're angels ❤❤oh and I cannot tell the way that suctioning feels,especially if you have to put saline in the stoma,the coughing is scary I'll be honest
Im here to refresh my knowledge on how to perform proper trache suctioning and care because soon im going to apply a job in an LTC for the first time and i probably encounter some patients on traches so thank you for this demonstration it's really helpful.
Hi quick question, Wouldn't it be easier to use clean gloves to pour on the saline and h2o2 into the tray, remove the old dressing and throw it away, remove the inner cannula and place it in the tray, discard the clean gloves and THEN set that sterile drape first? Just so when you don sterile, you wouldn't need to break sterile to removing the old dressing
I really appreciate these videos! Even though I have been a nurse since 2011, I love to brush up on my skills. You can never know everything, I always say.Thank you!
I'm a newer nurse that started in a clinic, I am now a classroom nurse and one of my cases has a trach so needless to say I need to refresh, so I that I can provide quality care. Thank you so much for this. I will be watching this and follow along with my kit from school.
Placement of canula was wrong. And dropping stuff on floor is a nono because guaze is dirty. Plus I would never use my elbow to pull down gown. Pull it down slightly before putting on sterile gloves
Great how-to while using the kit. However i wish it were across the board of RN and RT to agree to consider this a "very clean" technique, not "sterile".
I appreciate this comment! We talk about this a lot, actually - especially with "sterile wound change". This seems to be stressed in school, but at best we follow clean technique at the bedside. If something needs to be "sterile" then it needs to be done in the OR. - Ellis
Good educational video in terms of content and instructions. The camera could have bee zoomed to close up on certain pieces, parts, and areas mentioned from time to time. Kudos 🎉
I am in my final year of Nursing school, this is one of the procedures we are learning in our Foundations 3 class....I found your video to be most helpful. Thank you so much!
The way I was instructed to clean the stoma and keep the field sterile was a double wipe system with the gauze. Use a mix of sterile water and hydrogen peroxide on the first pass, always moving from the stoma outward, then the second pass sterile water only. Use the gauze, fold it so there’s always a clean surface on the neck. Soak the inner tube in the sterile water/H2O2 solution, scrub with brush, rinse in the sterile water, then re-insert. I may have to use the included tie when changing the neck band, because I’ve already had one incident where he coughed the whole trach tube out. (he didn’t hold onto it as instructed)
you should check with your hospital's policy for trach care, most do not use hydrogen peroxide anymore during trach care. It is very caustic to the skin. If it is a non-disposable inner cannula that is crusty then you can soak it in a mixture of this, only if the brush didn't remove the dried secretions. the mixture, if you must use it, should be 1 part H2O2 to 3 parts water but try not to get it on the skin.
Ashley, there are cases where that is possible depending on the equipment being used. I do generally leave the mask closer to their trach than I did in this video so the view would not be blocked. However, we cannot leave the mask on as we do not want to touch it and break sterility. - Ellis
@@LevelUpRN you should increase the Pts oxygen amount to 100% prior to Sx the Pt so when you do remove the mask to Sx they are less likely to desaturate. This is what is taught to Respiratory Students in their clinicals. When I teach trach care to RNs I tell them to do this as well.
Insertion of the inner cannula direction is definitely not correct. You may want to correct this or update your video to note this is not the correct direction to insert. Usually you insert with the curve upward direction and rotate as your anatomy would have the cannula curving down.
Yes, you are right - it is inserted upward and rotated down. If I didn't rotate it, it's because the manikin is very stiff and does not allow for that movement.
WOW, thank you for sharing, but watch your videos before posting, you contaminated your gloves, and your trach cannula was facing upwards, Students watch these very closely, they take all of it to heart. Don't rest your sterile hand on the patient's Chest. Only teach the way you practice in real life.
Hello, I just was wondering when she inserted the trach did she insert it facing up or down? I was trying to rewatch it over and over but couldn't detect what she did. Please advise!
For nurses who wants to take an nclex exam, this is highly recommended RUclips channel. This group are made up of nursing preceptors. Thanks for the effort of LEVEL UP RN
Anyone have experience with the Passy Muir Speaking Valve? After a few short months my 77-year-old sister is hardly able to use it anymore because it irritates her throat. Sad. Could this have been due to treatment shortcomings? Such as insufficient humidification or suctioning. Or is this to be expected with frequent use over a few months? I really miss our phone calls.
Hi! Looks like I forgot to pull the gown down before donning my sterile gloves so I was trying to pull it down so you could better see what I was doing :)
No that's not the current and best evidenced based practice guideline Saline instillation can make a patient cough but the introduction of the suction catheter will make people cough so saline is not necessary and not considered best evidence based practice
If they had a velcro tie but the kit doesn't come with a velcro tie do you reuse the velcro tie or make do with the non velcro tie? What if velcro is preferred?
its nice to have those tray packet wherein everything u need is in it.,,, nhs where I work? they dont have those😂😂😂😂 u have to prepare one by one, so most of the time sterility is broken, also most of the time u need to rush and suction the patient before they choked with their secretions😂😂😂😂😂
I've seen a movement in facilities where they don't use trays for procedures (like trach, CVC, or wounds) because of the waste that was occurring when not all of the tray equipment was being used (or even necessary). I agree that sterility is a goal, but is often not accomplished. - Ellis
Some trach kits have two sterile field (paper). One for sterile and the other one can be used for used/unsterile items. I think its more hygienic and infection control is followed if we drop or put the used items on the other field (paper) or to the sterile part of the cover of sterile gloves than drop it on the floor cause there is instances that it will not shoot on the garbage can. Thanks.
This is so so helpful...I have my check off tomorrow
Thank you!
sterile dummy you mean.😎
www.youtube.com/@NURSINGcarely
www.youtube.com/@NURSINGcarely
EMT here. Fresh out of school with little (no) experience of trach care. Not something they teach you in school, but something they expect you to know in the field !! Moved my first trach pt yesterday, very very overwhelming, could feel my heart in my stomach while helping this gentlemen. I guess it’s something that comes with time; but definitely a helpful video in making me feel more comfortable while interacting with trach patients. Thank u!!
Thank you SO much for this! I’m a new grad nurse going into in home care for medically complex children, many of whom have trachs, GTubes, and Vents. I was so worried I didn’t remember exactly how to do trach care and this helped refresh my memory SO much. I cannot thank you enough, seeing a visual example helped so much more than reading my skills book, I just couldn’t visualize it on my own. I owe you!
Good luck in your new endeavor and congrats on becoming a nurse! In this video, I demonstrated reusable inner cannulas, but most folks are using disposable ones. So just skip that step (because you'd throw away the old one and get a new one). - Ellis
Where are you working
@@LevelUpRN do you need to hyperoxygenate before cleaning and suctioning the tracheotomy
@abigailmoten2875 Hello. How do you like pediatric home care ? I am thinking of working also in pediatric home care. Is it a good start to work in home care as a new graduate ? Hope you are doing well. Thank you
Appreciate you sharing knowledge to nurses! A couple small tips from an RT.
When setting your suction pressure, measure it by occluding the suction tubing and not to open air. This measures how much potential suction pressure you're using on their airway to limit damage. Usually suction pressures are 80-100 for neonates, 100-120 for pediatrics, and 120-140 for adults.
Lastly, once you've passed your catheter down and hit resistance or they cough, pull back slightly* and then begin suctioning. This prevents accidental suctioning near the carina.
We love interdisciplinary support! Thanks so much for these great tips, and for all you do as an RT!
Indeed!
Great!
Hello. Just wondering how suctioning upon insertion causes potential injury? Are there any resources that can be shared? I am a home care provider, my client insists on being suctioned upon inserting the catheter, and does not believe me when I say suctioning upon withdrawal is best practice to avoid damage.
@@Mike-tw2mwStick to your practice protocol and direction. You are OYO when anything regrettable results.
Thank you! I have a trach. patient at clinical today and I wanted to solidify my skills before aiding in care in real-time. I appreciate you guys :)
Canula appeared to go in upside down. Should be pointed towards the lungs when reinserted (not up the throat)
I saw that too
Thank you. I saw that too
I had to quickly run into comment section to confirm am not the only one who saw that. Almost thought anatomy had played tricks on me.
I'm a stage 4 Larynx cancer survivor. And I've had this cleaning and suctioning many, many times during my year in hospital, and since of course. But I now do this myself. I' will be celebrating my 8 year cancerversay Oct 25th. All of you nurses and respiratory techs are amazing. Thank you all,,you're angels ❤❤oh and I cannot tell the way that suctioning feels,especially if you have to put saline in the stoma,the coughing is scary I'll be honest
Get well
Your amazing!
@@Ann-qh3kb Thank you so much. I'm just a survivor. Ive been very blessed. I appreciate your kind comment
@@candiceyoung8244you are not “JUST” a survivor!!! You are amazing, congratulations on 8 years!!! You were meant to be here❤️
@@maddiehill5726 that's very sweet of you, Thank you so much 💕
Im here to refresh my knowledge on how to perform proper trache suctioning and care because soon im going to apply a job in an LTC for the first time and i probably encounter some patients on traches so thank you for this demonstration it's really helpful.
Hi quick question,
Wouldn't it be easier to use clean gloves to pour on the saline and h2o2 into the tray, remove the old dressing and throw it away, remove the inner cannula and place it in the tray, discard the clean gloves and THEN set that sterile drape first? Just so when you don sterile, you wouldn't need to break sterile to removing the old dressing
www.youtube.com/@NURSINGcarely
Invaluable information in caring for my Dad. Thank you for sharing this.
I'm glad I found your site to help me refresh on rarely used skills. Thank you Ellis.
Welcome!
Great Video but the inner cannula was upside down when you removed and reinserted. Was it not?
I was looking for this comment it definitely was.
Yes. Need to twist it then locked
Great video!! Also you're a wonderful teacher, Ellis, and I appreciate you clarifying teaching moments vs real life moments.
You are so welcome!😊
As a “covid” nurse with no clinicals - this is GOLD! Thank you so much!
Very welcome!
Thanks have to do clinical check off and this helped with my cards
Great! Thanks for watching.
I'm not a nurse but this info will be helpful for caring for my dad. Until his regular caregiver starts coming to his house, I'll be doing the honors.
I really appreciate these videos! Even though I have been a nurse since 2011, I love to brush up on my skills. You can never know everything, I always say.Thank you!
The trach tube is in upside-down. It should be pointed down toward the lungs not up
Hi there! Unfortunately, this particular mannikin's throat does not allow for the rotation of the trach tube. But good looking out!
I wondered this same thing!
I'm a newer nurse that started in a clinic, I am now a classroom nurse and one of my cases has a trach so needless to say I need to refresh, so I that I can provide quality care. Thank you so much for this. I will be watching this and follow along with my kit from school.
You should be monitoring his O2 during the suction....
Is the direction of the tracheal tube correct? Why does it bend towards the pharynx? Shouldn't it bend towards the trachea?
It was not
I noticed that too
Very helpful. Thank you.
You're welcome!
isn't the cannula supposed to be facing downward
Yes
Very well explained. Even a slow learner could understand. You spoke slowly and that was very good. GREAT JOB. KEEP IT UP.
Yay! So glad it was helpful! Fee free to share a link to our channel with your classmates and friends in nursing school. ❤️
I think you shout still monitor his spo2
Helpful 🙂
Placement of canula was wrong. And dropping stuff on floor is a nono because guaze is dirty. Plus I would never use my elbow to pull down gown. Pull it down slightly before putting on sterile gloves
Great how-to while using the kit. However i wish it were across the board of RN and RT to agree to consider this a "very clean" technique, not "sterile".
I appreciate this comment! We talk about this a lot, actually - especially with "sterile wound change". This seems to be stressed in school, but at best we follow clean technique at the bedside. If something needs to be "sterile" then it needs to be done in the OR. - Ellis
Good educational video in terms of content and instructions. The camera could have bee zoomed to close up on certain pieces, parts, and areas mentioned from time to time. Kudos 🎉
Word of advice, suction the patient before cleaning him 😂. This video was awesome 👌
You inserted inner cannula pointing up towards mouth. Instead of down towards lungs. Why?
Hi! On the manikins, it only goes into their "stoma" when pointing up. We have to insert it upside down, then rotate it. - Ellis
Top 3 Nurse channels on youtube, thanks Ellis
Thank you for the amazing compliment!
How much should we insert the catheter into tracheostomy tube & endotracheal tube??? Is it same length or different??
You did it really well .maintaining sterility by guarding the sterile hand🎉🎉🎉🎉🎉
I am in my final year of Nursing school, this is one of the procedures we are learning in our Foundations 3 class....I found your video to be most helpful. Thank you so much!
You are so welcome!
The way I was instructed to clean the stoma and keep the field sterile was a double wipe system with the gauze. Use a mix of sterile water and hydrogen peroxide on the first pass, always moving from the stoma outward, then the second pass sterile water only. Use the gauze, fold it so there’s always a clean surface on the neck. Soak the inner tube in the sterile water/H2O2 solution, scrub with brush, rinse in the sterile water, then re-insert. I may have to use the included tie when changing the neck band, because I’ve already had one incident where he coughed the whole trach tube out. (he didn’t hold onto it as instructed)
you should check with your hospital's policy for trach care, most do not use hydrogen peroxide anymore during trach care. It is very caustic to the skin. If it is a non-disposable inner cannula that is crusty then you can soak it in a mixture of this, only if the brush didn't remove the dried secretions. the mixture, if you must use it, should be 1 part H2O2 to 3 parts water but try not to get it on the skin.
Question: should we be hyperoxgenating the patient throughout the care?
Ashley, there are cases where that is possible depending on the equipment being used. I do generally leave the mask closer to their trach than I did in this video so the view would not be blocked. However, we cannot leave the mask on as we do not want to touch it and break sterility. - Ellis
@@LevelUpRN you should increase the Pts oxygen amount to 100% prior to Sx the Pt so when you do remove the mask to Sx they are less likely to desaturate. This is what is taught to Respiratory Students in their clinicals. When I teach trach care to RNs I tell them to do this as well.
Great Demonstration! I am learning a lot by watching these Level Up RN videos🫶🏾🩺
Great to hear!
Anytime you're working with vulnerable people the #1 priority is safety and sterile or clean work field. Thank you for the presentation.
www.youtube.com/@NURSINGcarely
Insertion of the inner cannula direction is definitely not correct. You may want to correct this or update your video to note this is not the correct direction to insert. Usually you insert with the curve upward direction and rotate as your anatomy would have the cannula curving down.
Yes, you are right - it is inserted upward and rotated down. If I didn't rotate it, it's because the manikin is very stiff and does not allow for that movement.
🤣 just witnessed 😳 u broke sterile field. But thank you for the video.
My tracheostomy was cleaned to much to that extent that I am having some heartburn even when am talking
Question about suction in between I read in ATI IS 10 sec suppose to be.
Great question! Best practice is just less than 15 seconds. - Ellis
Just wondering, why the curve of the inner tube is upward? should it be down ward as per anatomy
they probably put it in wrong tbh but it should be curved downward
It is inserted upward and rotated to face down.
WOW, thank you for sharing, but watch your videos before posting, you contaminated your gloves, and your trach cannula was facing upwards, Students watch these very closely, they take all of it to heart. Don't rest your sterile hand on the patient's Chest. Only teach the way you practice in real life.
The inner cannula is inserted facing up then rotated to face down.
So you suction after you clean the tube
Thank you for the video.
Big help for new acute nurses.
Glad it was helpful!
You need an assistance to help use his or her hand secure the trach tube when changing the ties.
Have u worked with a Montgomery T-Tube?
Oh god bless.my dad also same your situation. But last yr he pass away
Can I remove the cut piece of gauze around the trach, before I create a sterile field?
Yes, you can remove the soiled dressing before setting up your field. Just don't remove the tie until you're ready to replace it. - Ellis
Hello,
I just was wondering when she inserted the trach did she insert it facing up or down? I was trying to rewatch it over and over but couldn't detect what she did. Please advise!
You need to be gentle with patient when changing the ties
I was taught to place tube facing down in shape of the throat. Here it was shown pointed up in the throat. Not sure that is correct. Am I wrong?
She keeps saying "mucosa" instead of "mucus." Mucosa is the tissue type, not the secretion.
For nurses who wants to take an nclex exam, this is highly recommended RUclips channel. This group are made up of nursing preceptors. Thanks for the effort of LEVEL UP RN
Hey. Please hold tight to the faceplate when ever you manipulate the inner cannula or change trach ties.
Very helpful, only please bring the camera closer so we can see what you are doing, thanks!
at what point is it ok to become 'non-sterile-?
But this is not a sterile way
i had my experience for pantient last 3yrs ago.
Anyone have experience with the Passy Muir Speaking Valve?
After a few short months my 77-year-old sister is hardly able to use it anymore because it irritates her throat. Sad.
Could this have been due to treatment shortcomings?
Such as insufficient humidification or suctioning. Or is this to be expected with frequent use over a few months?
I really miss our phone calls.
you are so funny still lots of learning happened.Cheers !!!
Where is the playlist of clinical skills?
What about removing old tie first if the cuff inflated then can fix the new one, it's working or not.just asking and thanks for your great knowledge
It's best practice to ensure there is a tie on at all times.
Mucus vs mucosa...hopefully there is no mucosa in that inner cannula😂
What about when the tube is removed for cleaning and strong foul smell follows...
If this were to happen and we were not aware of infection then I would immediately inform the partitioner of that occurring.
Excellent refresh, thank you.
Thank you, i really need this ❤
Very good changing & suctioning video.
thanks alot for sharing doctor.
MUCUS, not mucosa....
😂😂
Lovely instrucitonal video. Why did you elbow your patient at 2:53?
Hi! Looks like I forgot to pull the gown down before donning my sterile gloves so I was trying to pull it down so you could better see what I was doing :)
WEAR UR PPE MISS, HOW CAN U PERFORM THIS PROCEDURE WITH OUT PRPTECTING URSLEF AND PATIENT
yeah corret ppe is a face shield/goggle and a mask
What does a lavage it...?
I studied nursing in a foreign country. This video really helped me to learn new ways of suctioning. Thank you very much for your help.
You're very welcome!
In reality, I saw some RT squeeze NS into the inner cannula prior to suctioning. Is it supposed to do it?
No that's not the current and best evidenced based practice guideline Saline instillation can make a patient cough but the introduction of the suction catheter will make people cough so saline is not necessary and not considered best evidence based practice
If they had a velcro tie but the kit doesn't come with a velcro tie do you reuse the velcro tie or make do with the non velcro tie? What if velcro is preferred?
If the trach ties need due to be replaced due to being soiled, then using the non-velcro tie is probably most appropriate.
www.youtube.com/@NURSINGcarely
the way she just lift the head 😂😂
Thank you!! Good video, I like that there was actually suctioning.
Glad it was helpful! :)
Thanks for the skill video I needed it
So happy to help!
Thank you for sharing the information. Your videos are very helpful
You are so welcome! Happy they are helpful. Please feel free to share a link to our channel with your classmates and friends in nursing school. :)
Thanks for sharing. Good demonstration.
OMG you have the "Rising Woman" symbol tattoed! ✨ Awesome !
I do!! You're the first person to recognize it! My wife has the same symbol on her forearm with Artemis' bow completing the circle. - Ellis
Thank you
Thank you so much for this video
www.youtube.com/@NURSINGcarely
Thank you for the video!! Very helpful. Well done ❤️
Thank you so much!
super helpful, thank you very much!!:)
Glad it helped!
Nice
😊
so helpful
thank you so much
You are welcome!
Great information
Glad you think so!
Please ship to Canada!
www.youtube.com/@NURSINGcarely
its nice to have those tray packet wherein everything u need is in it.,,,
nhs where I work? they dont have those😂😂😂😂 u have to prepare one by one, so most of the time sterility is broken, also most of the time u need to rush and suction the patient before they choked with their secretions😂😂😂😂😂
I've seen a movement in facilities where they don't use trays for procedures (like trach, CVC, or wounds) because of the waste that was occurring when not all of the tray equipment was being used (or even necessary). I agree that sterility is a goal, but is often not accomplished. - Ellis
Some trach kits have two sterile field (paper). One for sterile and the other one can be used for used/unsterile items. I think its more hygienic and infection control is followed if we drop or put the used items on the other field (paper) or to the sterile part of the cover of sterile gloves than drop it on the floor cause there is instances that it will not shoot on the garbage can. Thanks.
In my 36 years of nursing I have never seen teach tape/Tues applied like that…
9:50
The doll looks so realistic I keep thinking it could open its eyes at any moment
Yes... Thanks for watching!
Ty, this helps alot to refresh
Great!
I will be performing this skill today during my validation. Thanks a lot for coming through with this demo 🙌🏾🫶🏽💯 love your videos.
You're so welcome!
Why do you hyperoxygenate ?
Hyperoxygenation before suctioning reduces the chance of hypoxia.
@@LevelUpRN okay thank you ❤️❤️