Tracheostomy suctioning is a medical procedure performed to clear accumulated mucus and secretions from the artificial airway, ensuring the patency of the tube and the trachea below. This procedure is necessary because the tracheostomy tube bypasses the body’s natural defense mechanisms, such as the effective cough reflex and the filtering function of the upper airway. Maintaining a clear airway is paramount, and the precision of catheter insertion determines both the efficacy and the safety of the procedure. Incorrect depth of insertion is the most significant factor, risking damage to the delicate tracheal lining and causing severe complications.
Pre-Procedure Assessment and Preparation
Before introducing a suction catheter, a careful assessment must confirm that the procedure is genuinely required. Signs indicating the need for suctioning include audible or visible secretions, a rattling noise during breathing, or signs of respiratory distress. Respiratory distress signs include an increased breathing rate or a drop in oxygen saturation readings on a pulse oximeter. Suctioning should only be performed when these specific indicators are present, as unnecessary passes can cause irritation.
Preparation involves gathering all necessary equipment, including the suction machine, connection tubing, and the appropriate-sized catheter. The selection of the catheter size minimizes trauma; its outer diameter should be no more than half the inner diameter of the tracheostomy tube. Using a catheter that is too large can block the airway during suction application, causing a sudden lack of oxygen. The suction pressure should also be set correctly, typically between 80 and 120 mmHg for adults, to provide effective clearance without causing excessive tissue damage.
Calculating the Safe Insertion Distance
The measured technique for determining insertion depth is a precise method that seeks to clear the entire length of the tracheostomy tube and the immediate area just beyond its tip. This approach provides an exact number, allowing the operator to suction to the full limit of the tube without unnecessarily entering the lower airways. The goal is to remove secretions resting at the very end of the tube, which cannot be reached by a shallower pass.
To establish this safe limit, the exact length of the tracheostomy tube must be known, a measurement often printed on the tube’s flange or adapter. Using a new, sterile catheter, the operator measures this length against the catheter, marking the point of safe insertion with a finger or tape. For full clearance, the catheter is inserted to the measured length of the tube plus a small allowance, typically about 0.5 cm. This small extra distance ensures that secretions clinging to the end of the tube are reached, while insertion is carefully controlled to prevent accidental deep passage into the trachea.
The Shallow Suctioning Approach
The shallow suctioning approach is an alternative method often preferred for routine or preventative care. This technique limits the catheter’s insertion depth strictly to the tip of the tracheostomy tube, without intentionally advancing it into the windpipe below. The primary purpose of shallow suctioning is to remove secretions collected within the tube itself, particularly those coughed up from the lower airway and resting near the opening.
The operator inserts the catheter until a slight resistance is felt, indicating the catheter tip has reached the end of the tracheostomy tube, or until the patient coughs. Unlike the measured technique, this approach does not require pre-measurement of the tube length, as the physical resistance acts as the stop signal. The reduced depth of insertion is considered safer, especially for untrained caregivers, as it significantly lowers the risk of damaging the sensitive tracheal mucosa.
Potential Complications from Deep Insertion
Inserting the suction catheter too far past the end of the tracheostomy tube into the lower trachea can result in several serious complications. One of the most common issues is trauma to the tracheal mucosa, the delicate lining of the windpipe. This trauma causes bleeding and inflammation, which paradoxically leads to increased secretion production, worsening the problem the suctioning was meant to solve.
A deep pass also increases the risk of hypoxemia, or low blood oxygen levels. This occurs because the catheter temporarily obstructs the airway, and the suction removes oxygen along with the mucus, especially if the procedure is prolonged beyond the recommended limit of 10 to 15 seconds. Furthermore, advancing the catheter deep into the trachea can stimulate the vagal nerve. Vagal nerve stimulation triggers a reflex that slows the heart rate, a condition known as bradycardia, which can quickly escalate into a cardiac dysrhythmia or cardiac arrest.