A tracheostomy (trach) is a small opening that goes through the front of the neck into the windpipe (trachea). This opening helps a person breathe if their airway (breathing passage) is narrowed or blocked. The opening in the skin over the windpipe is called a stoma. A small plastic tube called a trach tube is placed through the stoma to help the person breathe.
Watch this video to learn how to suction a tracheostomy (trach).
Benefits of suctioning a trach
If your child has a trach, mucus can build up in the tube. This can make it hard for your child to breathe. Suctioning is a process to remove mucus from the trach so that your child can breathe easier.
When to suction a trach
Suction your child’s trach tube every morning and evening. Also suction when your child shows any of these signs:
Coughing
Noisy breathing
Mucus that you can see in the trach tube
Acting restless
Trouble breathing
Pale or bluish skin color
Always follow the instructions given by your respiratory therapist.
Supplies needed to suction a trach
Suction kit (contains sterile gloves and suction catheter)
Suction machine
Normal saline vials (if applicable)
Self-inflating bag
Emergency suction
Cup of water (if applicable)
Emergency supplies, including same-size and size-smaller trach tube and obturator. An obturator is part of the device that helps guide the trach tube in the airway.
Keep emergency supplies available at all times.
How to suction a trach
Steps 1-4
1. Clean your hands with soap and water or use an alcohol-based hand sanitizer.
2. Open the sterile suction kit.
3. Put a sterile glove on the hand you will use to suction the trach tube. Usually, this is your dominant hand. Learn how to put on a sterile glove.
4. Turn the suction machine on with your ungloved hand. Check the gauge for the correct setting. Your respiratory therapist will tell you what this setting should be.
Step 5
5. Attach the suction catheter to the end of the suction tubing. Do not touch your ungloved hand to the end of the suction catheter.
Step 6
6. Insert the suction catheter into the trach tube to the pre-measured depth. Your care team will show you what the depth should be.
Step 7
7. Place the thumb of your ungloved hand over the opening in the suction catheter to create suction.
Steps 8-10
8. While gently rotating the suction catheter between your thumb and forefinger, slowly pull it out. Do not leave the catheter in the trach tube for more than 5 seconds.
9. The catheter might get blocked with mucus. If so, use your ungloved hand to squirt normal saline into the suction kit tray. Then, place the catheter end in the saline and apply suction. If you cannot clear the blockage, throw the catheter away and get a new one.
10. Allow your child to take several breaths after each pass of the suction catheter. If your child is on oxygen, you can replace the trach collar or ventilator between suctions. You could also give your child breaths using the self-inflating bag after each suction.
After you suction the trach
Watch your child to see if more suctioning is needed. It might take 2–3 times to clear the mucus.
If the mucus is thick or looks dry, you can put 2–3 drops of saline down the trach tube. Then, give your child 2 or more breaths with the self-inflating bag before suctioning again.
Remove the catheter from the suction tubing to clean or throw away. You can clear the suction tubing by placing the end in a cup of water.
Turn off the suction machine.
Wash your hands.
Safety reminders for suctioning a trach
Measure the catheter suction depth against the obturator length.
Always follow the instructions given by your respiratory therapist.
Important: If your child’s trach tube size changes, the pre-measured or shallow suctioning depth will change. Make sure you measure the obturator any time a tube size changes.
If shallow or pre-measured suctioning does not clear the mucus:
Gently insert the suction catheter until you feel resistance.
Pull the catheter back 1/4 inch.
Apply suction.
This process is called deep suctioning. Use it only when shallow suctioning does not clear the mucus.
If you have questions about suctioning a trach, talk to your child’s respiratory therapist.
When to call your care team
Call your care team if:
The mucus smells foul.
Your child looks ill.
You are unable to remove mucus after deep suctioning.
Your child struggles to get air in and out after suctioning.
You have questions about how to suction the trach.
Bright red blood comes out of the trach site and does not stop flowing.
Key points about suctioning a trach
Suctioning mucus from the trach tube helps your child breathe easier.
Suction your child’s trach every morning, every evening, and whenever your child shows signs of having too much mucus.
Follow the steps for suctioning the trach as instructed.
If shallow suctioning does not clear all the mucus, you might need to try deep suctioning.
Talk to your child’s respiratory therapist if you have questions about suctioning a trach.
