A tracheostomy involves a surgically created opening in the front of the neck, leading into the trachea, also known as the windpipe. This opening, called a stoma, allows a tube to be inserted, providing an alternative pathway for air to reach the lungs. Individuals with a tracheostomy breathe through this tube instead of their nose and mouth. Tracheostomy suctioning removes excess mucus and secretions from this artificial airway, maintaining clear breathing.
Why Tracheostomy Suctioning is Necessary
The upper airway typically warms, moistens, and filters the air we breathe. A tracheostomy tube bypasses these natural mechanisms, causing the air entering the lungs to be cooler, drier, and less filtered. In response to these changes, the body often produces more mucus. Individuals with a tracheostomy may also have an impaired cough reflex or other conditions that prevent them from effectively clearing these secretions.
The accumulation of mucus within the tracheostomy tube and airways can lead to blockages, which may obstruct airflow and compromise breathing. Suctioning removes this buildup, ensuring the airway remains open and preventing respiratory distress or infection. Maintaining a clear airway is crucial for proper breathing.
Recognizing the Need for Suctioning
Recognizing specific signs indicates when tracheostomy suctioning is necessary. A common indicator is visible mucus or bubbles at the tracheostomy opening. Audible cues, such as rattling sounds or gurgling in the tube or airway, also suggest a need for suctioning.
Individuals may experience difficulty breathing, a feeling of not getting enough air, or an increased respiratory rate. Other signs include flaring nostrils, gasping, a whistling noise from the tube, or increased work of breathing. Restlessness, irritability, or changes in skin color, such as a bluish tint around the mouth or fingernails, can also indicate a need for immediate attention.
Safe Suctioning Duration and Frequency
The duration of each suctioning pass is a key safety consideration. A single suction pass should not exceed 5 to 10 seconds. Some guidelines extend this to 15 seconds, but shorter durations are preferred to minimize complications. This time limit prevents a decrease in oxygen levels, as the suction catheter temporarily blocks the airway and removes air with secretions.
Between each suction pass, allow 30 to 60 seconds for the individual to rest and recover. This allows for re-oxygenation and prevents adverse reactions. Suctioning should be performed only as needed, based on observed signs of secretion buildup, not on a fixed schedule. While some may initially require more frequent suctioning, the need often decreases over time as the body adapts.
Potential Issues from Improper Suctioning
Improper tracheostomy suctioning can lead to complications. One risk is hypoxia, a condition where the body is deprived of adequate oxygen supply. Prolonged suctioning can lead to a rapid drop in oxygen levels, as air is removed from the lungs with mucus.
Another issue is trauma to the tracheal lining. Inserting the catheter too forcefully, suctioning for too long, or using an inappropriately sized catheter can cause irritation, bleeding, or damage to the tracheal tissues. Vagal stimulation is also a concern, which can cause a sudden decrease in heart rate and oxygen levels. Improper technique or inadequate hygiene can introduce bacteria, increasing the risk of respiratory infections.