How to perform deep suctioning

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Your child may need deep suctioning to remove secretions beyond the tracheostomy tube. Find out how to perform deep suctioning on a child with a tracheostomy tube.

At the end of this chapter, you will be able to:

  • understand when you need to perform deep suctioning
  • demonstrate how to perform deep suctioning
illustration showing tracheostomy tube in the trachea and how far to suction for deep suctioning

Deep suctioning is done to clear secretions (mucus) from beyond the level of the tracheostomy tube if a child is unable to clear it on their own through coughing or if the child is in respiratory distress and tube suctioning does not resolve the secretion issues.


Deep suctioning is done in urgent situations. Frequent deep suctioning can injure the airway. If you have to deep suction your child more often, it should be brought to the attention of their health-care provider.

  1. Gather your equipment and supplies, including oxygen, if available.

  2. An oxygen saturation monitor on a child's foot providing an accurate reading

    Make sure the oximeter is on and provides an accurate reading.

  3. Settings on a portable suction machine

    Make sure the suction machine is at the correct setting.

  4. Caregiver washing their hands

    Wash your hands​ well. Deep suctioning is done in urgent situations so to save time, you may choose to use hand sanitizer instead of soap and water. Parents and caregivers do not need to wear gloves, although you may choose to do so if you have them. If you have a home nurse visiting, they will bring their own gloves and wear them.

  5. A sterile water bottle and a labelled cup of sterile water for suctioning

    Fill a clean container with sterile, distilled water or saline.

  6. Child with a tracheostomy lying comfortably

    Make sure your child is in a comfortable position (lying or sitting).

  7. Put on clean gloves, if using (see above).

  8. Opening a tracheostomy suction catheter package

    Verify catheter size. Next, open the catheter by pushing the base through the paper packaging.

  9. Attaching suction tubing to a tracheostomy suction catheter

    Attach the suction tubing to the correct size suction catheter.

  10. Slowly pull a tracheostomy suction catheter from its package

    Withdraw the catheter from the package slowly just before use. Hold it four to six inches from the end.

  11. Do not touch the end of the catheter that goes into the tracheostomy tube. Keep the catheter inside the packaging until you use it.

  12. Remove any ventilator connector, tracheostomy mask, Airvo tracheostomy connector, tracheostomy cap, heat and moisture exchanger (HME) or speaking valve from the tracheostomy tube. If necessary, manually ventilate the child with the manual resuscitation bag.

  13. Keeping thumb off the suction control port insert the suction catheter into the tracheostomy tube

    Gently insert the suction catheter into tracheotomy tube with your thumb off the suction control port. If needed, stabilize the tube. Controlling the suction port with your non-dominant hand and suctioning with your dominant hand is often helpful.

  14. Thumb over the suction control port

    Once you meet resistance or your child starts to cough, pull the suction catheter back a small amount and then apply suction by holding your thumb over the suction control port.

  15. Suction catheter slowly being removed from the tracheostomy tube
    Most of the suction catheter has been removed from the tracheostomy tube
    Suction catheter completely removed from the tracheostomy tube

    Slowly remove the suction catheter to remove mucus (10 seconds max).

  16. Apply suction and assess the secretions in the thumb port region

    Apply suction and watch the thumb port region to assess the secretions obtained.

    Take note of the quality (colour and consistency) of secretions and the quantity of secretions.

  17. Person dipping a tracheostomy catheter into sterile water to clear the suction catheter

    Clear the suction catheter if needed by dipping it in the sterile water or saline and suctioning.

  18. Give your child a break of at least 30 seconds before repeating deep suctioning.

  19. A child with a tracheostomy tube

    Assess and tend to your child’s respiratory status and oxygen needs after each suction pass. Give your child some manual breaths using the manual resuscitation bag if needed. In the event of oxygen desaturation, use oxygen as prescribed by your child’s health-care team.

  20. When done, replace the tracheostomy adjunct your child uses: ventilator connector, tracheostomy mask, Airvo tracheostomy connector, tracheostomy cap, heat and moisture exchanger (HME) or speaking valve.

  21. Once you are finished, suction up sterile water or saline in the catheter (called flushing) to rinse the suction tubing. Discard the catheter. Discard water.

  22. Turn off the suction unit.

  23. Empty and clean the suction drainage bottles and containers, if needed.

  24. Wash hands well.

  25. Prepare the suction equipment and supplies for the next use.


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

Last updated: November 10th 2023