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
Shallow
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
Pre-measured
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
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
Suctioning
Suctioning removes mucus from the windpipe so that the windpipe stays clear. This should be done every morning, at bedtime, and as needed. For the first few days after surgery, your child may need to be suctioned a lot. By the time your child is ready to go home he or she will need less suctioning.
The following are signs that can let you know when your child needs suctioning:
Mucus can be heard or seen bubbling from the tracheostomy tube.
Breathing may be faster and/or harder.
Nostrils flare out.
Mucus can be felt or heard ‘rattling’ in the chest.
The child may seem irritable, restless or frightened.
The mouth or lips look pale, grey or blue.
Coughing
Helpful hints: The pulse oximeter that reads your child’s oxygen level will make a loud noise (alarm) when mucus blocks the windpipes and prevents air from moving in and out of the tracheostomy tube. But do NOT depend on on alarms. Always look at your child for signs of difficulty breathing.
Supplies needed for suctioning include:
Suction machine
Suction catheter
Tap water
Gloves or freshly washed hands
Basin or bowl
Normal saline drops (as needed)
Types of suction catheters:
Single use catheters are often used in the hospital for suctioning, and come in a sterile package with a suction catheter, gloves, and a small basin for water. Single use catheters can only be used once and then thrown away.
Closed system catheters are contained in a sheath to keep them clean, and can be used more than one time. Closed system catheters can be used for 24 hours.
Depending on your insurance, you will be using one of these types of suction catheters at home.
How to pre-measure suction depth:
The obturator is used as a guide for measuring how far to push the catheter into the tracheostomy tube for suctioning.
Measure the obturator from top to bottom, along the curve.
Helpful hints:
Measuring suction depth (or pre-measured suctioning) beforehand allows the entire length of the tracheostomy tube to be cleared of mucus. The goal is to suction the tube, not the airway.
A cough is the best suction, so whenever possible allow your child to naturally remove mucus from his or her windpipes.
The shallow suctioning method can also be used if the child is able to cough, but not able to completely clear mucus from the tracheostomy tube. Shallow suctioning is used to clear the top portion of the tube only, as opposed to pre-measured suctioning.
Deep suctioning (just slightly past the length of the tracheostomy tube) should only be used in an emergency. Deep suctioning on a regular basis will cause injury to the airway.
Steps for suctioning:
Gather supplies and set up a clean area for them.
Wash hands with soap and water to prevent infection.
Turn suction machine on.
Attach catheter to suction machine.
If needed, put 2 to 3 drops of normal saline down the tracheostomy tube to loosen mucus.
Gently push the suction catheter into the tracheostomy tube to the pre-measured depth.
Cover the thumb hole on the suction catheter to begin suctioning.
Gently pull the suction catheter back out of the tracheostomy.
Each suctioning pass should take about 5-10 seconds.
If more suctioning is needed, rinse suction catheter with water or normal saline and repeat.
Pay attention to the color and/or smell of your child’s mucus because it could be giving you clues:
White/Clear: Normal
Yellow: Could be a virus (common cold)
Dark Yellow: Common cold or possible infection (pneumonia or bronchitis). Increase humidity.
Red/Brown: Blood stained mucus can be warning of an irritated throat.
Green: Possible bacterial infection, but can be due to poor humidification. Increase humidity and encourage your child to drink fluids.
Call the doctor for a visit if your child looks ill, or if mucus is particularly foul smelling.
Helpful hints: Suction only as you pull the suction catheter back out of the tracheostomy tube. Keep suction times shorter than 10 seconds. Don’t forget that during suctioning, you are suctioning out air as well as mucus. Allow your child to rest in between each pass with the suction catheter. Use normal saline only if mucus is very thick.
Mucus traps:
During an emergency, or when suction is not available, the mucus trap can be used.
Carry the mucus trap with you when you leave home.
In an emergency, hold the mucus trap upright, and place your mouth securely around the mouthpiece. Suck in to create suction as you gently pull the catheter out. The mucus will not enter your mouth, but will drop into the bottle.
