Tracheal suctioning is a procedure designed to clear the airway of a person with a tracheostomy, a surgically created opening into the windpipe. The primary goal is to remove built-up mucus and secretions that the individual cannot clear effectively by coughing. This maintains a clear path for breathing and ensures proper oxygenation. Determining how often to suction is not based on a routine schedule, but rather on an “as needed” basis, dependent on the patient’s individual signs and symptoms. The frequency naturally varies, often decreasing as the body adjusts to the tracheostomy tube.
Recognizing the Need for Suctioning
The decision to suction is guided solely by observable indicators that secretions are obstructing the airway. Caregivers must be vigilant in monitoring for specific audible, visual, and physical cues that signal the need for intervention.
Audible signs often include a wet, rattling cough, gurgling sounds heard from the tube, or noisy, congested breathing. Visual confirmation is also important, such as seeing visible mucus or secretions bubbling at the opening of the tracheostomy tube.
Physical cues are the most serious indicators that immediate suctioning is required to prevent complications. These signs include an increased or rapid respiratory rate, obvious difficulty breathing (dyspnea), or the use of neck and chest muscles to breathe (accessory muscle use).
Other concerning physical indicators include restlessness, anxiety, or irritability, which can be early signs of low oxygen levels. If a pulse oximeter is available, a reading of decreased oxygen saturation serves as an objective measurement confirming respiratory compromise. A change in skin color, such as a pale or bluish tint around the lips or fingernails (cyanosis), is a late and serious sign that the patient needs immediate airway clearance.
Essential Steps for Safe Suctioning
Once the need for suctioning is established, following a precise, methodical procedure is necessary to ensure safety and effectiveness. Preparation involves gathering all supplies, performing thorough hand hygiene, and confirming that the suction unit is functioning correctly. The appropriate suction pressure for an adult typically falls between 80 and 120 millimeters of mercury (mmHg), as exceeding this range risks causing damage to the tracheal lining.
Before inserting the catheter, pre-oxygenation is often performed, which involves providing extra oxygen to the patient for a short period. This step helps mitigate the risk of hypoxia (oxygen depletion), which can occur during the suction process when the catheter temporarily blocks the airway. The suction catheter size should be selected carefully, ideally having an external diameter no more than half the inner diameter of the tracheostomy tube. This allows air to pass around it during insertion.
The catheter is gently inserted into the tube, and suction is not applied during insertion to prevent trauma and conserve oxygen. Suction is applied by covering the thumb control vent only as the catheter is being steadily withdrawn, often with a gentle rotating motion. The entire process—from insertion to complete withdrawal—must be limited to a maximum duration of 10 to 15 seconds to minimize the risk of serious side effects.
If the airway is not clear after the initial attempt, the patient must be allowed a brief recovery period, typically 30 to 60 seconds, to re-oxygenate before another pass is attempted. Caregivers should limit the total number of passes to between one and three to prevent excessive irritation and trauma to the trachea. After the procedure is complete, an assessment of the patient’s breathing, heart rate, and oxygen saturation confirms the effectiveness of the suctioning.
Risks Associated with Improper Suctioning Frequency
Deviating from the “as needed” principle carries distinct risks, both from performing the procedure too often and not often enough. Over-suctioning, or suctioning without clinical indication, can cause mechanical trauma to the delicate tracheal lining. This may lead to bleeding, swelling, and long-term complications like the formation of granulation tissue. Repeatedly interrupting the breathing cycle unnecessarily also increases the risk of hypoxia and can stimulate the vagus nerve, which may slow the heart rate (bradycardia).
Conversely, under-suctioning, or failing to clear secretions when signs of obstruction are present, is extremely dangerous and can lead to severe respiratory distress. The build-up of thick secretions can quickly cause the tracheostomy tube to become plugged, resulting in a life-threatening airway obstruction. Infrequent suctioning allows secretions to pool and stagnate, which increases the likelihood of respiratory infections like tracheitis and pneumonia. Adhering to the patient’s individual clinical needs is the most effective strategy for minimizing risks.