Tracheostomy: How to suction your child's tracheostomy tube

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What is tracheal suctioning?

Tracheal suctioning clears your child’s airway and allows your child to breathe more easily. It is required when secretions (mucus) build up inside your child’s tracheostomy tube​.

Why does my child’s tracheostomy tube need to be suctioned?

Mucus is produced by the lungs. In children without a tracheostomy tube, coughing brings the mucus up the trachea until it reaches the epiglottis. From there, the mucus can be coughed out of the mouth or swallowed into the esophagus, where it then passes through the digestive system.

A person with a tracheostomy tube cannot clear their own mucus. The mucus reaches their tracheostomy before it reaches their epiglottis, so it cannot be swallowed into the esophagus. As a result, it must be suctioned or coughed out through the tube.

When does my child need suctioning?

At a minimum, your child should have routine suctioning every day at the following times:

  • when they wake up and before they go to sleep
  • before meals
  • before their tracheostomy tube is changed.

Your child will need additional tracheal suctioning if they cannot cough up mucus that may be blocking their tracheostomy tube. If your child is having difficulty clearing mucus on their own:

  • their cough becomes more frequent or more congested than usual
  • you can hear a gurgling sound as they are breathing
  • you can see mucus in their tracheostomy tube
  • their oxygen saturations drop
  • they seem to be struggling to breathe (sucking in neck and chest muscles)
  • their lips or extremities (fingers and toes) turn blue.

What type of suctioning can I perform?

There are three main types of tracheostomy tube suctioning, depending on your child’s needs.

  • Tip suctioning allows you to remove mucus or fluids at the very front of the tracheostomy tube.
  • Tube suctioning allows you to remove mucus or fluid from the full length of the tracheostomy tube, including just past the far end of the tube.
  • Deep suctioning lets you remove mucus or fluid from your child’s airway beyond the tube. You should only perform deep suctioning if your child continues to have difficulty breathing after tube suctioning.

What equipment do I need?

Tracheostomy kit

  • Tracheostomy tube of the same size with ties attached and obturator
  • One size smaller tracheostomy tube with ties attached and obturator (store in a small, well-labelled, clear bag)
  • Normal saline nebules
  • Water soluble lubricant
  • Extra inner cannula, if needed
  • Round ended-scissors
  • Pre-cut clean tracheostomy gauze (dressing)
  • Manual suction device: 20 mL syringe with feeding tube attached (in case the suction machine does not work)
Tracheostomy kit
Images of emergency tracheostomy supplies  

Additional equipment and supplies

  • Suction machine and adjuncts (Yankauer stick handle or tip adaptor)
  • Disposable suction catheters and suction tubing
  • Sterile, distilled water 
  • Clean container for flushing solution
  • Clean disposable gloves (to avoid direct contact with secretions or organisms from your child; sterile gloves are not needed)
  • Good light source
  • Oximeter and probes
  • Manual resuscitation bag with tracheostomy adaptor and the appropriately sized mask
  • Oxygen, if needed
  • Plastic bag
Additional tracheostomy equipment and supplies
Images of additional tracheostomy equipment listed above  

How deeply to suction your child’s tracheostomy tube

Your child’s healthcare provider will review with you what type of tube and suction catheter your child needs, how deeply to insert the suction catheter and which setting to use for the suction machine.

Tracheostomy tube size:
Suction catheter size:
Depth of suction catheter insertion for tube suction:
Suction machine setting:
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Tip suctioning

  1. Gather your equipment and supplies.

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An oxygen saturation monitor on a finger  
  1. Make sure the oximeter is on and providing an accurate reading.
  1. Have oxygen available.

Settings on a portable suction machine  
  1. Make sure the suction machine is at the correct setting.
Caregiver washing their hands  
  1. Wash your hands​ well.
A sterile water bottle and a labelled cup of sterile water for suctioning  
  1. Fill a clean container with sterile, distilled water or saline.
Child with a tracheostomy tube sitting comfortably  
  1. Make sure your child is in a comfortable position. If your child wears an HME, a tracheostomy cap, a speaking valve or a mask, remove it. 
  1. Put on clean gloves.

Tracheostomy suction tip adaptor  
  1. Attach the suction tubing to a clean tip adaptor or “little sucker”. Keep the tip adaptor in a clean casing until just before use. Do not touch the end of the connector that goes into the tracheostomy tube.
Suctioning a tracheostomy tube with a tip adapter  
  1. Use the tip adaptor at the front of the tracheotomy tube to remove any mucus your child has coughed up. The tip adaptor should not block the entire inner cannula. Only use it for up to 10 seconds at a time.
Pressing the thumb port on a tracheostomy suction tip adaptor  
  1. If there is thumb port on the tip, cover it during suctioning.
  1. Rinse the tip adaptor and tubing by dipping the adaptor into sterile water or saline and suctioning.

Replacing the cap on a trach suction tip adapterReplacing the cap on a tracheostomy suction tip adapter  
  1. If there is a cover, replace it on tip connector.
A child with a tracheostomy tube  
  1. Assess and tend to your child’s respiratory status and oxygen needs. Replace your child's HME, tracheostomy cap, speaking valve or mask​, if they use one. 
Person pressing the on and off switch on a suction machine  
  1. Turn off the suction unit.
  1. Empty and clean the suction drainage bottles and containers, if needed.

Caregiver washing their hands  
  1. Wash hands well.
  1. Prepare the suction equipment and supplies for the next use.

Tube suctioning

  1. Gather your equipment and supplies.

An oxygen saturation monitor on a finger  
  1. Make sure the oximeter is on and providing an accurate reading.
  1. Have oxygen available.

Settings on a portable suction machine  
  1. Make sure the suction machine is at the correct setting.
Caregiver washing their hands  
  1. Wash your hands​ well.
A sterile water bottle and a labelled cup of sterile water for suctioning  
  1. Fill a clean container with sterile water or saline.
Child with a tracheostomy tube sitting comfortably  
  1. Make sure your child is in a comfortable position (lying or sitting down).
Opening a tracheostomy suction catheter package  
  1. Open the catheter by pushing the base through the paper packaging.
Attaching suction tubing to a tracheostomy suction catheter  
  1. Attach the suction tubing to the correct size suction catheter.
Person holding the suction catheter four to six inches from the end  
  1. Slowly withdraw the catheter from the package just before use. Hold it four to six inches from the end. Do not touch the end of the catheter that goes into the tracheostomy tube. Place the catheter inside the packaging until you use it.
  1. Remove the ventilator, tracheostomy cap, HME, mask or speaking valve from the tracheostomy tube. If necessary, manually ventilate your child with the manual resuscitation bag.

Person dipping the tracheostomy catheter into sterile water before suctioning  
  1. Suction a small amount of sterile water or saline through the suction catheter to wet it and make it easier to insert.
Inserting a tracheostomy suction catheter  
  1. Insert the suction catheter into the tracheostomy tube to the length instructed by your healthcare team. Make sure your thumb is not touching the suction control port.
Person holding their thumb on a tracheostomy suction catheter suction control port  
  1. Hold your thumb over the suction control port.
Twirling the tracheostomy suction catheter  
  1. Slowly remove the suction catheter while “twirling” it between your fingers to remove mucus (10 seconds maximum).
Person dipping the tracheostomy catheter into sterile water before suctioning  
  1. Clear the suction catheter by dipping it in the sterile water and suctioning.
  1. Give your child a break of 30 to 60 seconds before repeating tube suctioning. Give your child some big breaths using the manual resuscitation bag if needed. If your child's oxygen levels drop, use oxygen as prescribed by your child’s healthcare team.

  1. When done, replace the tracheostomy cap, HME, speaking valve or ventilator, if your child uses one. 

A child with a tracheostomy tube  
  1. Assess and tend to your child’s respiratory status and oxygen needs.
  1. Once you are finished, discard the catheter and replace the tip connector on the suction tubing.

Person pressing the on and off switch on a suction machine  
  1. Turn off the suction unit.
  1. Empty and clean the suction drainage bottles and containers, if needed.

Caregiver washing their hands  
  1. Wash hands well.
  1. Prepare the suction equipment and supplies for the next use.

Deep suctioning

​​
  1. Gather your equipment and supplies.

​​
An oxygen saturation monitor on a finger  
  1. Make sure the oximeter is on and providing an accurate reading.
​​
  1. Have oxygen available.

​​
Settings on a portable suction machine  
  1. Make sure the suction machine is at the correct setting.
​​
Caregiver washing their hands  
  1. Wash yo​ur hands​ well.
​​
A sterile water bottle and a labelled cup of sterile water for suctioning  
  1. Fill a clean container with sterile, distilled water or saline.
​​
Child with a tracheostomy tube sitting comfortably  
  1. Make sure your child is in a comfortable position (lying or sitting down). If your child wears an HME, a tracheostomy cap, a speaking valve or a mask, remove it.
​​
  1. Put on clean gloves.

​​
Opening a tracheostomy suction catheter package  
  1. Open the catheter by pushing the base through the paper packaging.
​​
Attaching suction tubing to a tracheostomy suction catheter  
  1. Attach the suction tubing to the correct size suction catheter.
​​
Slowly pull a tracheostomy suction catheter from its package  
  1. Slowly withdraw the catheter from the package just before use. Hold it four to six inches from the end.
​​
Person holding the suction catheter four to six inches from the end  
  1. Do not touch the end of the catheter that goes into the tracheostomy tube. Keep the catheter inside the packaging until you use it.
​​
  1. Remove the ventilator, trach cap, HME or speaking valve from the trach tube. If necessary, manually ventilate your child with the manual resuscitation bag.

​​
Person dipping the tracheostomy catheter into sterile water before suctioning  
  1. Suction a small amount of sterile water or saline through the suction catheter to lubricate it.
​​
Inserting a tracheostomy suction catheter  
  1. Gently insert the suction catheter into the tracheostomy tube with your thumb off the suction control port.
​​
Person holding their thumb on a tracheostomy suction catheter suction control port  
  1. Once you meet resistance or your child starts to cough, pull the suction catheter back a small amount and apply suction by holding your thumb over the suction control port.
​​
Twirling the tracheostomy suction catheter  
  1. Slowly remove the suction catheter while “twirling” it between your fingers to remove mucus (10 seconds max).
​​
Person dipping the tracheostomy catheter into sterile water before suctioning  
  1. Clear the suction catheter by dipping it in the sterile water or saline and suctioning.
​​
  1. Give your child a break of 30 to 60 seconds before repeating deep suctioning. Give your child some big breaths using the manual resuscitation bag if needed. If your child's oxygen levels drop, use oxygen as prescribed by your child’s healthcare team.

​​
  1. When done, replace the tracheostomy cap, HME, speaking valve or ventilator, if your child uses one.

​​
A child with a tracheostomy tube  
  1. Assess and tend to your child’s respiratory status and oxygen needs.
​​
  1. Once you are finished, discard the catheter and replace the tip connector onto the suction tubing.​

​​
Person pressing the on and off switch on a suction machine  
  1. Turn off the suction unit.
​​
  1. Empty and clean the suction drainage bottles and containers, if needed.

​​
Caregiver washing their hands  
  1. Wash hands well.
​​
  1. Prepare the suction equipment and supplies for the next use.

Precaution

Only perform deep suctioning if your child continues to have difficulty breathing after tube suctioning.

What should I do if my child still has mucus after deep suctioning?

If you are unable to remove the secretions from your child’s tracheostomy tube and your child is having serious breathing difficulties, change your child’s tracheostomy tube. It is important to know how to respond in an emergency​ inside or outside the home.

What should I do if I cannot insert the suction catheter into the tracheotomy tube?

If you are unable to insert the suction catheter, perform an emergency tracheostomy tube change.

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Key points

  • Suctioning your child's tracheostomy tube helps clear your child's airway of mucus and lets your child breathe more easily.
  • Your child should have routine suctioning when they wake up, before meals, before their tracheostomy tube is changed and before bed.
  • Depending on the location of mucus, your child's tracheostomy tube may need tip, tube or deep suctioning.
  • If you are unable to remove the mucus after trying deep suctioning, change your child's tracheostomy tube.

​Michelle Carter, RN

Reshma Amin, MD, FRCPC, MSc

Evan Propst, MD, FRCPC, MSc

Faiza Syed, BHSc, RRT​​

Sara McEwan​, RN, MN​

8/9/2017




Notes: