A tracheostomy involves a surgical opening in the neck to place a tube into the windpipe (trachea). Suctioning gently removes mucus and secretions from this tube and the upper airway using a flexible catheter. The main purpose is to maintain a clear passage for air, fundamental for effective breathing and oxygen exchange. This clearing also helps prevent infections. For many individuals, this procedure is a routine part of daily home care, making safe technique paramount.
Essential Equipment and Preparation
Before beginning, gather all necessary supplies for a smooth and hygienic process. A portable or wall-mounted suction machine provides the negative pressure needed. Select the correct size sterile, flexible suction catheter; its outer diameter should be no more than half the inner diameter of the tracheostomy tube to prevent airway occlusion during insertion.
Set up the suction unit by connecting the catheter kit to the tubing and verifying the machine is operational by feeling the pull. Check the negative pressure setting, often 80 to 120 mmHg for adults (lower for children). This setting ensures effective secretion removal without causing trauma to the tracheal lining.
Preparation requires sterile gloves, a disposable basin, and normal saline solution or sterile water. The saline lubricates the catheter tip before insertion and rinses the catheter and tubing between passes. Place a clean towel or moisture-resistant pad on the patient’s chest to maintain a clean field and protect clothing.
Recognizing the Need for Suctioning
Suctioning should only be performed when specific signs indicate the airway is compromised by secretions, never on a fixed schedule. Common indicators include audible obstruction signs, such as wet, gurgling, or noisy breathing (coarse breath sounds). Visible mucus plugs or thick secretions at the tracheostomy tube opening also signal the need for intervention.
Physical signs of respiratory distress necessitate immediate suctioning. These include increased breathing rate (tachypnea), flaring of the nostrils, or use of accessory muscles in the neck and chest. Behavioral changes, such as restlessness, anxiety, or confusion, may suggest decreased oxygen levels due to blockage, demanding prompt airway clearance.
A patient’s attempt to cough that sounds weak or ineffective, failing to bring up secretions, is a strong indication that mechanical removal is necessary. Performing the procedure only when clinically required minimizes trauma to the tracheal mucosa and reduces the risk of introducing infection.
Step-by-Step Guide to the Suctioning Procedure
Begin the procedure with meticulous hand hygiene, washing hands or using an alcohol-based sanitizer. Don sterile gloves on both hands, as this sterile procedure prevents introducing pathogens into the lower airway. Open the suction catheter package carefully, maintaining sterility, and attach it to the suction tubing.
If the patient is receiving supplemental oxygen, hyperoxygenation is often performed before inserting the catheter. This involves briefly increasing the oxygen flow to maximize the patient’s oxygen reserve, counteracting the temporary oxygen desaturation that can occur during the suction pass.
The catheter tip is lubricated by dipping it into the sterile saline solution before insertion into the tracheostomy tube opening. The suction control port must remain open during insertion, meaning no suction is applied while advancing the catheter down the trachea. This technique prevents damage to the tracheal lining and minimizes oxygen removal before clearance begins.
The catheter is typically advanced until the patient coughs or until slight resistance is felt, indicating the carina (the point where the trachea splits) has been reached. Once the appropriate depth is achieved, the caregiver closes the suction control port, applying negative pressure, and immediately begins to withdraw the catheter. The withdrawal should be a continuous, rotating motion to ensure the suction collects secretions from all sides of the tracheal wall.
The entire duration of suction application, from closing the port to complete withdrawal, must be strictly limited to no more than 10 to 15 seconds. Exceeding this time limit can lead to serious complications, including significant drops in the patient’s heart rate and oxygen saturation levels. If secretions remain, the patient must be allowed to rest and recover for at least 30 to 60 seconds between passes.
During this recovery period, the catheter and tubing are cleared by suctioning a small amount of sterile saline solution through the line. This prepares the equipment for a potential second or third pass, which should only be attempted if the initial pass was ineffective or if the patient’s distress persists. The patient should be monitored closely for color and breathing effort during this break.
After each pass, the caregiver must assess the effectiveness of the procedure by listening to the patient’s breath sounds and observing respiratory effort. Signs of successful suctioning include quieter breathing, reduced visible secretions, and a calming of the patient’s appearance. No more than three passes should generally be performed during a single session to minimize trauma and irritation to the airway.
Post-Procedure Monitoring and Equipment Care
Immediately following the procedure, observe the patient to ensure breathing has stabilized and comfort has improved. Check the patient’s pulse and respiratory rate to confirm they are within their normal range, indicating a successful return to baseline oxygenation. The patient should appear calmer, with clear and effortless breathing sounds.
After patient assessment, proper cleaning of the equipment is necessary to prevent bacterial growth and maintain functionality. Flush the suction catheter and connecting tubing thoroughly by suctioning sterile water or saline through the system until the tubing runs clear. Store reusable equipment in a clean, dry location, following specific guidelines for disinfection.
A healthcare professional should be contacted immediately if the patient experiences persistent bleeding from the tracheostomy site, or if the caregiver is unable to clear the secretions after three attempts. Any sign of significant or worsening respiratory distress, such as blue discoloration of the lips or extreme anxiety that does not resolve after the procedure, warrants urgent medical attention.