Manual Resuscitation With Tracheostomy

<< RESPIRATORY


Considerations:

Attempt to provide the student with as much privacy as possible, given the urgency of the situation


Supplies:

Emergency Travel Bag Equipment:

The essential equipment to be kept with the student at all times is as follows:

  • gloves
  • portable oxygen with appropriate sized Ambu-bag
  • appropriate size Ambu-bag facemask (for emergencies when unable to reinsert a new tracheostomy tube)
  • portable suction machine that can operate with battery or electricity
  • sterile suction catheters
  • sterile saline vials
  • water-based lubricant
  • two spare tracheostomy tubes — one the size the student currently uses and one that is a size smaller in the event that the tube needs to be changed and there is difficulty passing it through the stoma
  • obturator, if applicable
  • spare tracheostomy ties
  • blunt scissors
  • emergency phone numbers
  • pulse oximeter — may be optional if student is not on oxygen or mechanical ventilation
  • Stethoscope

Additional needed supplies:

  • Oxygen source with appropriate tubing (if ordered)
  • Manual resuscitator
  • Adaptor for tracheostomy tube
  • Stethoscope
  • Personal protective equipment
    • gloves
    • goggles
    • mask

procedure download skill competency

  1. Reassure student
  2. Explain procedure to the student at a level that he/she will understand
  3. Wash hands, if student’s condition permits
  4. Assemble equipment as student’s condition permits or utilize equipment in emergency travel bag
  5. If ordered, place pulse oximeter on student’s finger, toe or ear lobe during and after the procedure
  6. Check function of resuscitator bag
    • Function test one
      • Squeeze the bag to ensure that it deflates and inflates
    • Function test two
      • Place finger over the patient port
      • Squeeze air out of the bag
      • Check for movement of the pressure pop off
    • Function test three
      • Place finger over the patient port
      • Occlude the pressure pop off
      • Squeeze the bag, no air should escape
  7. Connect the bag to the tracheostomy tube
  8. If student is able to breathe on their own, squeeze the resuscitator bag as soon as the student begins to inhale
  9. If the student does not breathe on his or her own squeeze the bag at the same rate as the ventilator
  10. As you squeeze the bag, watch student’s chest rise
  11. As soon as your student’s chest rises, release the bag
  12. Repeat this cycle of squeezing and releasing until the student is back to their baseline
  13. If the student has oxygen ordered, use it when hand ventilating the student at the flow of 4 to 6 liters per minute
  14. Remove resuscitator bag from tracheostomy tube
  15. Wash hands
  16. Document assessment, procedure, and outcomes in student’s healthcare record
  17. Report any concerns to parents/guardian and healthcare provider

References:

Children’s Hospital of Wisconsin.  (2012).  Health Facts for You.  Manual Resuscitator Bag.  Available at: http://www2.chw.org/applications/TeachingSheets/1119EN.pdf

Tribby, R. & Dreier, C.  (2010).  Oxygenation and Manual Ventilation.  Available at: http://www.uwppc.org/educational-resources/trach/section4/L4_OxygenationManual.pdf


Acknowledgment of Reviewers:

Cynthia C. Griffith, RN, BSN
Nurse Clinician
Tracheostomy/Home Ventilator Program
Children’s Hospital of Wisconsin

Cecilia Lang, MSN, CCRN, PNP-BC
Tracheostomy/Home Ventilator APN
Children’s Hospital of Wisconsin


Page last updated: April 6, 2015
Page last reviewed: November 10, 2015