Tracheostomy Suctioning

What is tracheostomy suctioning?

Tracheostomy suctioning is a procedure that clears mucus from your trach tube when coughing doesn’t work. A tracheostomy tube fits through and keeps the surgically made hole (stoma) in your windpipe (trachea) open. This allows for alternative breathing when you can’t breathe naturally. People with tracheostomies typically have secretions or mucus. A strong cough is the best way to clear these secretions, but there may be times when you can’t get rid of mucus no matter how hard you try. Trach suctioning can help in these instances.

Healthcare providers can do tracheal suctioning in a hospital or office setting. But they can also teach you how to suction your trach (or your child’s trach) at home. This is important in helping to open the tube so you can breathe effectively.

Why do you suction a tracheostomy tube?

Tracheostomy suctioning removes thick mucus and secretions from your trachea (windpipe) and lower airway that you can’t clear by coughing. When you have a tracheostomy — or you’re caring for somebody with one — it’s important to look for the following signs that indicate a trach needs suctioning:

• A moist cough.
• Inability to clear secretions from your throat.
• Difficulty breathing or feeling like you can’t get enough air.
• Visible mucus (secretions or bubbles at the trach opening).
• Rattling sounds.
• Flaring nostrils.
• Gasping or fast breathing.
• A whistling noise coming from the trach tube.
• Sinking in of your chest (retractions).
• A bluish color around your mouth (cyanosis).
• Clammy skin.
• Irritability or restlessness.
• Any time you think that there’s a blockage in the trach tube.

How should I prepare for trach suctioning?

First, you’ll need to gather all your supplies:

• Tracheostomy suction machine.
• A clean suction catheter.
• Connection tubing.
• A cup of clean, distilled water.
• Gloves.
• Bowl or basin.

What happens during this procedure?

Whether you need to suction your own trach or someone else’s, you can do so safely by following a few guidelines.

Steps for tracheostomy suctioning

1. Wash your hands thoroughly. Use antibacterial soap and running water. Dry your hands with a clean towel.
2. Sit or lie down comfortably. Your head and neck should be well-supported.
3. Turn on the tracheostomy suction machine and set the pressure to low or medium. Pressure for suctioning tracheostomy is 80 to 120 mmHg (millimeters of mercury). Exceeding 120 mmHg can cause damage to your windpipe, so ask your healthcare provider before starting if you have questions.
4. Put on your gloves. Clean, boxed gloves are fine. Sterile gloves aren’t necessary.
5. Connect the clean suction catheter to the end of the tubing. Be sure to firmly connect the other end of the tubing to the machine.
6. Take a couple of deep breaths. You won’t be able to breathe well when the catheter is in your trach, so this will help you prepare. You may also cough during the suctioning process, and this is normal.
7. Gently place the suction catheter into your trach tube as far as instructed. Different tracheostomy tubes have different lengths. Generally, you should only go slightly past the length of the tracheostomy tube but don’t force it. If you feel resistance, stop. Be sure your finger isn’t covering the suction vent. You shouldn’t apply suction while you’re positioning the catheter.
8. Pull the catheter back just a little bit before you begin suctioning. This will give it room to work properly.
9. Begin suctioning when you’re ready. To do this, place your thumb over the suction control vent. If you feel discomfort while you’re suctioning, remove your thumb from the vent. Don’t suction for more than 10 seconds each time.
10. Remove the suction catheter from your trach tube. Gently twist the catheter as you pull it out.

If you don’t see or hear any more mucus near the trach opening, you’re done. But you might need to suction more than once. If this is the case, you should wait at least 30 seconds before suctioning again. If your suction is clogged, you can use water to help clear it or simply replace the suction catheter with a new one.

If you’ve tried to suction three times with no success, wait 10 minutes before trying it again. However, if you’re in distress and feel short of breath, you may want to call for help or call 911 (or your local emergency services number).

How long should the procedure take?

It shouldn’t take long to suction a trach. But it really depends on your comfort level and how many times you need to suction to get rid of all the mucus.

How often should a tracheostomy be suctioned?

You should routinely suction your tracheostomy twice every day — once when you wake up in the morning and again before you go to bed in the evening. You should also do trach suctioning before you eat and after any respiratory treatments you receive.

What happens after the procedure?

Once you’re done suctioning, you’ll need to clean the equipment. To do this:

1. Fill the bowl or basin with clean, distilled water.
2. Use the suction catheter to flush the water through the connection tubing.
3. Turn off the suction machine.
4. Disconnect the suction catheter from the tubing. If it’s disposable, throw it in the wastebasket. If it’s not disposable, rinse it and set it aside for disinfection later.
5. Hang the tubing on the suction machine with the tip pointing up.
6. Wash the bowl or basin with antibacterial soap and warm running water.
7. Take your gloves off and throw them away.
8. Wash your hands thoroughly with antibacterial soap and running water. Dry your hands with a clean towel.

What are the benefits of this procedure?

Learning how to do tracheostomy suctioning at home can reduce office visits and give you the flexibility to maintain your trach tube whenever necessary. Sometimes, thicker secretions or mucus can cause respiratory distress, and suctioning is necessary to improve breathing.

What are the complications of trach suctioning?

Complications aren’t common but they can occur. Possible risks include:

• Bleeding.
• Infection.
• Vagal nerve stimulation, which can lower your heart rate and oxygen levels.
• Pain or discomfort.

When should I call my healthcare provider?

Call your healthcare provider any time you have questions about tracheostomy suctioning. Let them know immediately if you notice foul-smelling mucus or mucus that’s yellow, green, red or brown. These things could indicate a possible infection.

If you were unable to successfully suction your mucus or feel short of breath despite suctioning, you should call your healthcare provider immediately or call 911 (or your local emergency services number) to be evaluated in your nearest emergency room. Occasionally, if mucus is too thick and can’t be suctioned, your trach tube may need to be replaced.

A note from Cleveland Clinic

Living with a tracheostomy comes with certain challenges. Keeping your trach tube free of mucus is one of them. Learning how to suction your trach at home can cut down on office visits and give you more freedom to do the things you love. To find out more about tracheostomy care and suctioning, talk to your healthcare provider.