Respiratory Care Delegation Services

Respiratory care delegation enables trained caregivers to provide essential airway management for patients with tracheostomies, neuromuscular diseases, and chronic respiratory conditions. Our comprehensive delegation services cover oral suctioning, tracheal suctioning, and cough-assist machine operation—ensuring patients receive timely respiratory support in adult family homes, assisted living facilities, and private residences throughout the greater Seattle area.

Understanding Respiratory Care Delegation

Patients with respiratory conditions often require frequent suctioning and airway clearance to maintain adequate breathing. According to the American Lung Association, millions of Americans live with chronic respiratory conditions that may require ongoing airway management. For many of these patients, community-based care is preferred over institutional settings.

Under Washington State WAC 246-840 regulations, registered nurses can delegate specific respiratory care tasks to trained nursing assistants and home care aides when patients meet stability criteria. Our experienced RN delegators carefully assess each patient, provide thorough caregiver training, and maintain ongoing supervision to ensure safe, effective respiratory care delegation.

Respiratory care delegation requires particular attention to safety due to the potential for serious complications. Our RN delegators have extensive experience in respiratory care and provide comprehensive protocols to address both routine care and emergency situations.

Oral Suctioning Delegation Services

Oral suctioning is the least invasive form of airway suctioning and is often the first respiratory care task delegated to caregivers. It involves removing secretions from the mouth and upper throat using a rigid suction catheter.

Yankauer Suction Catheter Use

The Yankauer catheter is the standard device for oral suctioning. Our caregiver training covers:

• Proper catheter handling and positioning
• Suction pressure settings appropriate for the patient
• Technique for reaching secretions without causing trauma
• Duration limits to prevent hypoxia
• Patient positioning during suctioning
• Communication with patients during the procedure

Oral Secretion Management

Beyond suctioning technique, caregivers learn comprehensive oral secretion management:

• Assessment of secretion volume, color, and consistency
• Factors that increase secretion production
• Positioning techniques to promote drainage
• Oral hygiene practices that reduce secretion buildup
• When to increase suctioning frequency
• Documentation of secretion characteristics

Equipment Cleaning and Maintenance

Proper equipment care is essential for infection prevention. Training includes:

• Daily cleaning procedures for suction equipment
• Catheter replacement schedules
• Tubing and canister maintenance
• Troubleshooting suction pressure problems
• Proper storage of clean equipment

Tracheal Suctioning Delegation Services

Tracheal suctioning is a more complex procedure that removes secretions directly from the trachea through a tracheostomy tube. The American Association for Respiratory Care provides clinical practice guidelines that inform our training protocols.

Tracheostomy Suctioning Technique

Proper technique is critical for safe tracheal suctioning. Our comprehensive training covers:

• Hand hygiene and preparation before suctioning
• Appropriate suction catheter size selection (typically half the inner diameter of the tracheostomy tube)
• Correct insertion depth to avoid tracheal damage
• Duration limits (typically 10-15 seconds per pass)
• Suctioning motion during catheter withdrawal
• Number of passes and rest periods between
• Patient oxygenation before, during, and after suctioning

Sterile vs. Clean Technique Protocols

The appropriate technique depends on the patient's setting and condition. Training addresses:

• When sterile technique is required versus clean technique
• Proper sterile field setup when needed
• Clean technique procedures for home settings
• Glove use and contamination prevention
• Catheter handling to maintain appropriate technique

Suction Catheter Sizing and Depth

Using the correct catheter size and insertion depth prevents complications:

• Calculating appropriate catheter size based on tracheostomy tube
• Measuring appropriate insertion depth for each patient
• Recognizing when the catheter meets resistance
• Adjusting technique for different tracheostomy types

Pre and Post-Oxygenation

Suctioning temporarily removes air from the airways, making oxygenation crucial:

• Pre-oxygenation techniques before suctioning
• Monitoring oxygen saturation during procedures
• Post-oxygenation to restore normal levels
• When supplemental oxygen is indicated
• Recognizing hypoxia signs during suctioning

Secretion Assessment and Documentation

Careful documentation helps track respiratory status:

• Describing secretion color (clear, white, yellow, green, bloody)
• Assessing secretion consistency (thin, thick, tenacious)
• Documenting secretion volume
• Noting changes that may indicate infection or other problems
• Reporting concerns to the delegating RN

Emergency Tracheostomy Care

Caregivers must be prepared for tracheostomy emergencies. Training covers:

• Recognizing signs of tracheostomy obstruction
• Emergency suctioning procedures
• Inner cannula removal and cleaning
• When to call 911 versus the delegating RN
• Basic tracheostomy troubleshooting
• Keeping emergency supplies accessible

Cough-Assist Machine Delegation (Mechanical Insufflation-Exsufflation)

Cough-assist machines help patients who cannot generate an effective cough due to weak respiratory muscles. These devices are essential for patients with conditions like ALS, muscular dystrophy, and high-level spinal cord injuries. The Muscular Dystrophy Association provides resources on respiratory care for neuromuscular disease patients.

Proper Machine Setup and Settings

Correct machine configuration is essential for effective treatment:

• Understanding machine components and connections
• Setting appropriate inspiratory and expiratory pressures
• Adjusting timing parameters for the individual patient
• Interface selection (mask, mouthpiece, or tracheostomy adapter)
• Checking machine function before each use

Patient Positioning for Treatments

Proper positioning optimizes treatment effectiveness:

• Optimal body positions for different patients
• Adjustments for patients with limited mobility
• Supporting the chest during treatments
• Positioning modifications for tracheostomy patients

Treatment Administration Technique

Effective treatment delivery requires proper technique:

• Creating a proper seal with the interface
• Timing cough-assist cycles with patient breathing
• Providing manual assistance when needed
• Combining cough-assist with suctioning when appropriate
• Patient coaching and communication during treatments

Treatment Frequency and Duration

Treatment schedules are individualized based on patient needs:

• Scheduled treatment protocols
• Signs that additional treatments are needed
• Number of cycles per treatment session
• Rest periods between cycles
• Adjusting frequency based on secretion production

Equipment Cleaning and Maintenance

Proper equipment care prevents infection and ensures reliability:

• Daily cleaning of patient interface and tubing
• Filter replacement schedules
• Recognizing equipment malfunction
• When to contact equipment suppliers
• Backup equipment recommendations

Recognizing Treatment Effectiveness

Caregivers learn to assess whether treatments are working:

• Signs of successful secretion clearance
• When to modify treatment approach
• Documenting treatment outcomes
• Communicating concerns to the delegating RN

Comprehensive Caregiver Training Program

Our respiratory care delegation training is designed to ensure caregivers are thoroughly prepared for both routine care and emergency situations.

Respiratory Anatomy Education

Understanding the respiratory system helps caregivers perform care safely:

• Basic upper and lower airway anatomy
• How breathing works normally
• How respiratory conditions affect breathing
• Why secretion management is important
• Tracheostomy anatomy and function

Signs of Respiratory Distress Recognition

Early recognition of respiratory problems is critical. Training covers:

• Normal respiratory rate and pattern
• Signs of increased work of breathing
• Color changes indicating poor oxygenation
• Behavioral changes associated with respiratory distress
• Oxygen saturation monitoring interpretation
• Breath sounds that indicate problems

Infection Control for Respiratory Procedures

Respiratory procedures carry infection risks that require careful attention. The CDC's Infection Control Guidelines inform our training protocols:

• Hand hygiene before and after procedures
• Personal protective equipment use
• Preventing cross-contamination
• Proper disposal of contaminated materials
• Equipment disinfection procedures
• Recognizing signs of respiratory infection

Equipment Troubleshooting

Caregivers must be able to address common equipment issues:

• Suction machine troubleshooting
• Cough-assist machine problem-solving
• When to use backup equipment
• Contacting equipment suppliers
• Emergency equipment failure protocols

Emergency Response Procedures

Clear emergency protocols protect patient safety:

• Complete airway obstruction response
• Respiratory arrest procedures
• When to call 911 immediately
• When to contact the delegating RN
• Emergency contact information access
• Documentation of emergency events

Safety Considerations for Respiratory Care Delegation

Respiratory care delegation requires careful patient selection. Our RN delegators assess multiple factors before establishing delegation:

Patient Stability Assessment

• Respiratory condition stability over time
• Predictability of secretion management needs
• History of respiratory emergencies
• Current respiratory status and baseline
• Other medical conditions affecting respiratory care

Caregiver Competency Evaluation

• Prior experience with respiratory care
• Ability to learn and retain complex procedures
• Comfort level with respiratory emergencies
• Communication skills and judgment
• Physical ability to perform procedures

Care Setting Appropriateness

• Availability of backup equipment
• Emergency response access
• Communication system reliability
• Appropriate environment for respiratory care
• Support from facility administration

Common Patient Populations We Serve

Tracheostomy Patients

Patients with tracheostomies require ongoing airway management. We provide delegation for patients with tracheostomies due to various conditions including prolonged ventilator weaning, airway obstruction, and chronic respiratory failure.

Neuromuscular Disease Patients

Patients with ALS, muscular dystrophy, and other neuromuscular conditions often develop respiratory muscle weakness. Cough-assist machines and suctioning help maintain airway clearance as the condition progresses.

Spinal Cord Injury Patients

High-level spinal cord injuries can affect respiratory muscle function. Our delegation services support patients who require ongoing respiratory assistance.

Chronic Respiratory Condition Patients

Some patients with chronic respiratory conditions benefit from regular airway clearance techniques to manage secretions and prevent complications.

Post-Ventilator Patients

Patients transitioning from ventilator support may need continued respiratory care as they regain respiratory strength and independence.

Ongoing Supervision and Support

Respiratory care delegation includes comprehensive ongoing support:

• Regular on-site supervision visits (frequency based on patient needs)
• 24/7 phone availability for respiratory concerns
• Rapid response to reported respiratory changes
• Coordination with respiratory therapists and physicians
• Equipment supplier communication
• Annual competency re-verification
• Delegation updates as patient condition changes

Frequently Asked Questions About Respiratory Care Delegation