Suctioning a tracheostomy tube clears mucus from the airway so the person can breathe comfortably. The basic process involves inserting a suction catheter into the trach tube, applying vacuum pressure, and withdrawing the catheter, all within about 5 to 15 seconds per pass. While the steps are straightforward once you’ve practiced them, getting the pressure, depth, and timing right is what keeps the procedure safe.
When Suctioning Is Needed
Suctioning should be done when there are signs that mucus is blocking or narrowing the airway. You’ll typically notice one or more of these: audible rattling or gurgling sounds during breathing, visible mucus bubbling at the trach opening, increased effort to breathe (pulling in at the neck or ribs), a drop in oxygen saturation on a pulse oximeter, restlessness or agitation, or a change in skin color. Some people need suctioning several times a day, others only occasionally. The goal is to suction when it’s needed rather than on a rigid schedule, since unnecessary suctioning irritates the airway lining.
Equipment You’ll Need
Before you start, gather everything within arm’s reach. You’ll need:
- Portable suction machine with tubing and a collection canister
- Suction catheters in the correct size (your care team will specify the French size based on the trach tube’s inner diameter)
- Sterile or distilled water for rinsing the catheter
- Respiratory saline (small vials, typically 3 mL) if prescribed for loosening thick secretions
- Clean gloves (sterile gloves for open suctioning in a hospital setting, non-sterile procedure gloves for most home care)
A shallow suctioning device (sometimes called a “Little Sucker”) is also useful for quickly clearing mucus from just the top of the tube without a full deep-suction pass. Keep backup supplies, including extra catheters and a second set of tubing, accessible at all times.
Setting the Right Suction Pressure
Suction pressure that’s too high can damage the airway lining, cause bleeding, or pull air out of the lungs and lead to small areas of lung collapse. Pressure that’s too low won’t clear mucus effectively. The safe ranges by age are:
- Neonates: 60 to 80 mmHg
- Infants: 80 to 100 mmHg
- Children: 100 to 120 mmHg
- Adults and adolescents: 100 to 150 mmHg
Turn the suction machine on and check the gauge before inserting the catheter. You can test that suction is working by placing your thumb over the catheter’s suction control port and watching the gauge needle respond. Start at the lower end of the range and increase only if secretions are too thick to clear.
Shallow, Pre-Measured, and Deep Suctioning
There are three depth options, and the one you use matters. Most routine home suctioning falls into the first two categories.
Shallow Suctioning
Insert the catheter only to the depth of the trach tube’s connector (the hub at the outer end of the tube). This clears mucus from the top portion of the tube without reaching into the lower airway. Apply suction as you withdraw, and keep the entire pass under 5 seconds. This is the gentlest option and works well when mucus is sitting near the opening.
Pre-Measured Suctioning
Use the obturator (the guide that came with the trach tube) or the inner cannula to measure the exact length of the tube. Mark or note that length on the catheter before inserting it. Then pass the catheter to that pre-measured depth, apply suction, and withdraw within 5 seconds. This clears the entire length of the trach tube without going beyond its tip, and it’s the standard method for thorough routine suctioning.
Deep Suctioning
Deep suctioning means advancing the catheter past the end of the trach tube until you feel resistance, then pulling back slightly before applying suction. This reaches into the lower airway itself. Because it carries a higher risk of tissue damage, coughing spasms, and drops in heart rate from stimulating the vagus nerve, deep suctioning is generally reserved for emergencies when the other methods fail to clear a dangerous blockage.
Step-by-Step Procedure
Once your equipment is ready and the suction machine is set to the correct pressure, follow these steps:
1. Wash your hands and put on gloves. If you’re using sterile technique (as instructed by your care team), keep your dominant hand sterile and use the other hand to handle the suction tubing connection.
2. If the person is on supplemental oxygen, give a few extra breaths of oxygen before starting. This pre-oxygenation builds a buffer so that oxygen levels don’t drop dangerously during the seconds the catheter is in the airway. Your care team will tell you whether to increase the oxygen flow or use a manual resuscitation bag for several breaths beforehand.
3. Open the catheter package and connect it to the suction tubing. Keep the catheter tip from touching any non-sterile surface.
4. Insert the catheter gently into the trach tube without applying suction. The suction control port on the catheter should remain open (thumb off) as you advance. Go to your target depth: the connector for shallow suctioning, the pre-measured mark for standard suctioning, or to resistance for emergency deep suctioning.
5. Apply suction by covering the control port with your thumb, then withdraw the catheter steadily. Rotate the catheter gently between your fingers as you pull it out. This rolling motion helps pick up secretions from all sides of the tube wall rather than just one spot. The entire suction pass, from the moment you cover the port to the moment the catheter is out, should take no more than 5 to 10 seconds. For adults, some protocols allow up to 15 seconds, but shorter is safer.
6. Let the person rest and breathe for at least 20 to 30 seconds. If they’re on oxygen, give them time to recover their oxygen levels. Watch their color, breathing effort, and oxygen saturation.
7. Rinse the catheter by suctioning sterile or distilled water through it. This clears mucus from inside the tubing so it’s ready for another pass if needed.
8. Repeat if secretions remain, but limit yourself to two or three passes in a row. If the airway still isn’t clear after that, allow a longer rest period before trying again.
Open vs. Closed Suction Systems
If the person is on a ventilator, you may be using a closed suction system instead of the open method described above. In a closed system, the catheter sits inside a protective sleeve that’s permanently connected to the ventilator circuit. You advance the catheter through the sleeve into the trach tube, apply suction, and withdraw, all without disconnecting the ventilator. This keeps oxygen delivery uninterrupted and reduces the risk of introducing bacteria.
With an open system, you disconnect the ventilator (or remove the humidity device or cap), insert a single-use catheter, suction, and then reconnect. Open suctioning is more common at home for people who aren’t on a ventilator, since there’s nothing to disconnect. The technique for catheter insertion and withdrawal is the same in both systems.
Avoiding Common Complications
Most suctioning problems come from going too deep, suctioning too long, or using too much pressure. Here’s how to stay safe:
Keep passes short. Every second the catheter is in the airway, it’s pulling out air along with mucus. Prolonged suctioning drops oxygen levels and can cause small areas of the lung to collapse (atelectasis). Stick to 5 to 10 seconds per pass.
Don’t force the catheter. If you feel resistance before reaching your expected depth, pull back slightly. Forcing the catheter can damage the airway lining and cause bleeding. A small amount of blood-tinged mucus occasionally isn’t unusual, but bright red blood or repeated bleeding means you should stop and contact your care team.
Never apply suction while inserting the catheter. Suction should only be applied during withdrawal. Suctioning on the way in can grab onto the airway wall and cause tissue damage.
Watch for drops in heart rate. The vagus nerve runs near the airway, and suctioning can stimulate it, causing the heart to slow down temporarily. If the person becomes pale, their heart rate drops noticeably on a monitor, or they seem to lose consciousness, remove the catheter immediately and provide oxygen.
Use saline sparingly. Instilling saline into the trach tube to loosen thick secretions is a common practice, but it can push mucus deeper into the lungs rather than loosening it. Follow your care team’s specific guidance on whether and how much saline to use. Keeping the person well hydrated and using a humidifier on the trach are more effective ways to keep secretions thin.
Keeping Equipment Clean at Home
Between uses, rinse the suction canister and tubing with warm soapy water, then rinse with clean water and allow everything to air dry. Replace suction catheters as directed. Most are single-use in clinical settings, but home care guidelines vary. The suction machine itself should be wiped down daily. Keep hydrogen peroxide and cotton-tipped swabs on hand for cleaning around the trach site (stoma care is separate from suctioning but often done in the same session). Store backup supplies, including extra catheters, tubing, and canisters, in a clean, dry location where you can grab them quickly.