Download Tracheostomy Suction information sheet (PDF)

Goal: to keep the tracheostomy tube free of thick mucus and secretions. Suctioning the tracheostomy tube removes mucus and secretions that are not able to be cleared by coughing.

A strong cough is the BEST suction:

  • Moving, sitting up or even changing positions will assist a cough
  • While a cough is the best suction, a suction machine will help clear the secretions that accumulate in the tracheostomy tube
    • Additional supplies include suction catheters and saline
      (The suction catheter used should be the largest size that easily fits into the tracheostomy tube)

Humidification and adequate fluids help maintain thinner secretions that are easily coughed and cleared from the tracheostomy tube or removed with suction

Signs that tracheal suction is needed:

  • Visible mucus that cannot be cleared from tracheostomy tube with a cough
  • If you can hear or see secretions
  • Pulse oximeter desaturations, difficulty breathing or pale/blue color around mouth or fingernails
  • Whistling noise from tracheostomy tube
    (This noise may mean the tracheostomy tube is coated with thick secretions)
  • Difficulty breathing, gasping or grunting in infants
  • If the child vomits
  • If you think the tracheostomy tube is blocked or partially blocked

Suction Techniques


  • Insert a suction catheter or little sucker™ to the depth of the tracheostomy tube connector, apply suction and withdraw catheter or little sucker™ within 5 seconds
  • Perform this suction technique if the child is able to clear airway with a cough but unable to clear the tracheostomy tube connector

little sucker


  • Use the obturator (or inner cannula if applicable) to “pre-measure” the depth of the catheter to be inserted into the tracheostomy tube
  • Pass the suction catheter to pre-measured depth, apply suction and withdraw catheter within 5 seconds
  • Perform this suction technique:
    • Every time suctioning beyond shallow is needed
    • Every morning and at bedtime with few drops of saline


Inner cannula

Deep suction (ONLY perform in an emergency):

  • Pass the suction catheter until you meet resistance, pull back slightly, apply suction and withdraw catheter within 5 seconds
  • Perform this suction technique ONLY in an emergency
    • This technique causes trauma to the airway

Saline drops

When to use

  • With pre-measured suctioning in the morning and before bed
  • During the day as needed if secretions are thick
    Tip: If secretions are thick – increase the time on warm mist humidification