A tracheostomy (trach) is a surgically created opening in the neck leading into the trachea, kept open by a specialized tube to provide an alternative pathway for breathing. The body naturally produces mucus and secretions within the airway. For a person with a tracheostomy, the normal ability to clear these secretions through coughing is often compromised. Tracheostomy suctioning is a procedure performed to mechanically remove this accumulated mucus from the tube and the lower airway. This action maintains a clear, open airway and supports effective respiration. This guide provides informational steps for the procedure, but it is not a replacement for professional medical instruction.
Recognizing When Suctioning is Necessary and Preparation
The need for suctioning is indicated by specific physical signs suggesting airway obstruction. A caregiver should look for visible secretions bubbling from the tracheostomy tube or listen for loud, wet, or gurgling sounds coming from the chest or tube. The patient may also display signs of respiratory distress, such as a rapid respiratory rate, flaring of the nostrils, or cyanosis (a bluish discoloration around the mouth or fingertips) signaling low oxygen saturation. Restlessness or agitation can also be a behavioral sign of air hunger due to a blocked airway.
Proper preparation minimizes the risk of infection and complications during the procedure. Before touching the patient or any equipment, rigorous hand hygiene must be performed, followed by establishing a clean or sterile field to maintain aseptic technique. The necessary equipment includes:
- A functional suction machine.
- A sterile suction catheter of the appropriate size.
- Sterile gloves.
- A container of sterile water or saline for rinsing.
- A manual resuscitation bag (Ambu bag) with an oxygen source.
The suction machine pressure should be checked and set within the safe operating range, typically between 80 and 120 mmHg for adults, to prevent damage to the delicate tracheal lining.
Performing the Suctioning Procedure
The procedure begins by ensuring the patient is positioned comfortably, usually in a semi-Fowler’s position, to maximize lung expansion. If the patient is prone to oxygen desaturation, they may require hyperoxygenation by providing several deep breaths using the manual resuscitation bag or asking the patient to take deep breaths before catheter insertion. The suction catheter is connected to the suction tubing, and the caregiver dons a sterile glove on the hand that will handle the catheter to maintain sterility within the airway.
The correct insertion depth is determined by pre-measuring the length using the tracheostomy tube’s obturator or inner cannula. This ensures the catheter reaches just beyond the end of the tube to clear secretions without causing trauma. The catheter is gently advanced through the tracheostomy tube to the pre-measured depth, or until a light resistance is felt, without applying any suction. Suction is only applied while the catheter is being withdrawn, achieved by placing a thumb over the control vent on the catheter connector.
Suction Duration and Technique
The duration of suction application must be limited to no more than 10 to 15 seconds per single pass to prevent hypoxemia, as the procedure removes air along with the mucus. As the catheter is pulled out, it should be rotated gently to ensure the suction port contacts the entire inner surface of the tube, clearing secretions from all sides.
Post-Pass Recovery
After the pass is complete, the catheter is cleared by suctioning sterile water or saline through it. The patient must be allowed to rest for 20 to 30 seconds to recover oxygen levels before any subsequent passes are attempted. The process of suctioning, resting, and re-suctioning should be repeated until the airway sounds clear and the secretions are effectively removed.
Managing Complications and Post-Procedure Care
Immediate post-procedure care involves monitoring the patient’s physiological response to the suctioning. The heart rate, respiratory rate, and oxygen saturation (SpO2) should be checked to confirm that the patient has returned to their baseline status. A slight, temporary drop in SpO2 is common but should quickly resolve, and the patient’s breathing should appear less labored.
Addressing Acute Complications
If a patient experiences violent coughing or a significant drop in oxygen levels that does not quickly recover, the procedure must be immediately stopped. The patient should be hyperoxygenated with the manual resuscitation bag. The presence of a small amount of blood in the secretions may result from minor trauma to the tracheal lining, often resolved by adjusting the suction pressure or technique.
When to Seek Medical Help
Persistent or significant bleeding requires immediate medical consultation, as it may signal a more serious underlying issue. If the airway cannot be cleared after three sequential passes, or if the patient remains in severe respiratory distress, emergency medical services or a healthcare professional must be contacted immediately.
Infection control is the final step. All disposable materials, including the catheter and gloves, must be discarded in a designated waste receptacle. The suction tubing should be rinsed thoroughly with sterile water or saline to clear remaining secretions and prevent bacterial growth or blockages. The caregiver must wash their hands again to complete the procedure safely.