Suctioning a trach involves inserting a thin, flexible catheter into the tracheostomy tube to pull out mucus that the person can’t cough up on their own. It’s one of the most important skills for anyone caring for a person with a trach, and while it can feel intimidating at first, it follows a consistent set of steps that become routine with practice.
When Suctioning Is Needed
Suctioning should be done based on signs that secretions are building up, not on a fixed schedule. The goal is to keep the airway clear without suctioning more often than necessary, since every pass of the catheter can irritate the lining of the airway. Watch for these signals:
- Visible mucus at the trach opening, including bubbling or secretions around the tube
- Rattling or gurgling sounds during breathing
- A moist, wet-sounding cough that doesn’t clear the secretions
- Difficulty breathing or a feeling of not getting enough air
- Restlessness or irritability, especially in children or people who can’t describe their symptoms
- Fast breathing, nasal flaring, or chest retractions (the skin pulling inward between the ribs)
- Whistling from the trach tube, suggesting a partial blockage
- A bluish tint around the lips, which signals low oxygen and requires immediate attention
If the person uses a pulse oximeter, a drop in oxygen saturation is another clear indicator. Any time you suspect the trach tube is blocked, suction right away.
Equipment You’ll Need
Before you start, gather everything so you’re not reaching for supplies mid-procedure. You’ll need a suction machine with connecting tubing, suction catheters in the correct size, a small container of clean water for rinsing the catheter, and gloves. If the person uses supplemental oxygen, have that ready to reconnect immediately after suctioning.
Choosing the right catheter size matters. The catheter should be no more than half the width of the trach tube’s inner opening. If the catheter is too large, it blocks airflow during suctioning and pulls too much air out of the lungs. Your healthcare team will tell you the correct size, and it’s worth writing it down and keeping it with your supplies.
Set the suction machine to the pressure your care team has prescribed. For adults, suction pressure is typically set between 80 and 150 mmHg. Children require lower pressures, often between 60 and 100 mmHg, and infants lower still. Using more pressure than recommended increases the risk of damaging the airway lining.
Step-by-Step Suctioning Process
Wash your hands thoroughly. In a hospital, sterile gloves and a sterile catheter are standard. At home, many care teams recommend a clean technique: wash your hands well, use a fresh catheter, and keep the part of the catheter that enters the trach from touching anything else. Your care team will clarify which approach to follow based on the person’s health and risk of infection.
If the person uses supplemental oxygen, give them a few extra breaths of oxygen before you begin. This builds up their oxygen reserve and helps prevent their levels from dropping during suctioning. Your care team will specify how long and at what setting.
Open the catheter package and connect it to the suction tubing. Turn on the suction machine but keep your thumb off the suction control port (the small hole near the end you hold). This keeps suction off while you insert the catheter. Gently guide the catheter into the trach tube. Insert it only to the length your care team has recommended, usually just past the end of the trach tube. Don’t force it. If you feel resistance, pull back slightly.
Once the catheter is in position, place your thumb over the control port to activate suction. Slowly withdraw the catheter using a smooth, rotating motion. The entire suction pass, from the moment you activate suction to the moment the catheter is out, should take no more than 10 seconds. Counting in your head helps. Going longer than 10 seconds pulls too much air out of the lungs and can cause oxygen levels to drop quickly.
After removing the catheter, let the person take several breaths and recover. Reconnect supplemental oxygen if they use it. Rinse the catheter by drawing clean water through it to clear the mucus from the tubing. If the secretions haven’t cleared and the person still shows signs of needing suctioning, you can make another pass, but allow at least 20 to 30 seconds of rest in between. Limit yourself to two or three passes per session when possible.
What to Watch for During and After
Monitor the person throughout. If you have a pulse oximeter, keep it on so you can see oxygen levels in real time. It’s normal for oxygen to dip slightly during a suction pass, but it should recover within a few breaths. If it doesn’t, provide supplemental oxygen and allow more time before attempting another pass.
Pay attention to what comes out. Normal trach secretions are thin to moderately thick and white or clear. Thick, sticky secretions may mean the person needs more humidity or fluids. Yellow or green mucus can indicate infection. Blood-tinged secretions sometimes appear if the airway lining has been irritated by the catheter, but persistent or significant bleeding warrants a call to your care team.
Suctioning does carry real risks. Studies monitoring patients during tracheal suctioning found that roughly 35% experienced brief changes in heart rhythm during the procedure, caused by the combination of reduced oxygen and stimulation of the airway. This is one reason the 10-second rule exists and why you should never suction longer than necessary. Repeated or aggressive suctioning can also damage the inner lining of the trachea over time, leading to inflammation or scarring. A gentle hand and the right-sized catheter go a long way toward preventing this.
After you finish, note whether the person’s breathing has improved. Signs of a successful session include clearer breath sounds, easier breathing, a stable respiratory rate, and improved oxygen levels. If breathing doesn’t improve after suctioning, or if the person seems to be getting worse, the trach tube itself may be blocked or displaced, which requires immediate help.
Keeping Equipment Clean at Home
Suction catheters used inside the trach tube should be discarded after each suctioning session. In a hospital, this is strict policy. At home, some families reuse catheters for financial reasons. If you do, rinse the catheter thoroughly after each use and discard it after no more than one hour. A fresh catheter for each session is always the safer choice.
The suction canister should be emptied into the toilet after each session. Give it a thorough wash with soap and water at least once a week, and leave a small amount of water in the bottom between uses to keep dried secretions from sticking. Replace the suction tubing weekly. The machine’s filter should be checked monthly and changed when it looks discolored or dirty, or at least every two months.
Wipe down the outside of the suction machine daily with a damp, soapy cloth. If your machine has a battery, check that it stays fully charged, and plan to replace the battery roughly once a year. Run a quick daily check: confirm the pressure is set correctly, look for cracks or holes in the tubing and canister, and make sure the filter is clean. A machine that fails when you need it is a genuine emergency for someone who depends on suctioning to breathe.
Keep the water you use for rinsing in a separate, clean container. Discard it after each suctioning session and use fresh water next time. If the container is disposable, replace it daily. If reusable, wash it daily with soap and water.