Tracheal Suctioning

A tracheostomy tube can potentially impair our lungs ability to cough and effectively clear secretions. Suctioning the airway is therefore an essential part of routine care of tracheotomised patient.

Indications for suctioning

  • Audible or visible secretions

  • Increased effort to breathe in self-ventilating patients

  • When a patient is unable to clear their own secretions or is only able to clear them into the tracheostomy tube

  • To maintain airway patency and prevent tracheostomy tube blockage

Risks of suctioning

Many patients find the experience of being suctioned painful and anxiety inducing. Always explain the procedure to your patent and provide reassurance. 

  1. Hypoxia-Suctioning can cause hypoxia due to the suction catheter obstructing the tracheostomy. If the patient is not pre-oxygenated, the risk of hypoxia is high, so preoxygenate the patient and promptly remove the tube.

  2. Trauma - Bleeding can occur if there is trauma from the suction catheter to the tracheal wall.

  3. Infections may result from the possible introduction of bacteria into the respiratory tract if proper suctioning techniques are not performed.

  4. Bradycardia can occur if the the vagal nerve is stimulated by the suctioning.

  5. Pain and discomfort can result from suctioning.

How to Suction - equipment required:

  • Wall/portable suction

  • Oxygen and saturation monitoring

  • Correct sized suction catheters: To calculate = 2x (size of tracheostomy tube -2)

  • Personal protective equipment (FFP3 mask and visor)

  • Sterile bowl

  • Sterile water for cleaning tubing post suctioning

Suctioning technique:

  • Wash hands

  • Monitor oxygen saturations

    Monitor oxygen saturation to establish a baseline. You will need to monitor oxygen saturation throughout the procedure

  • Pre-oxygenate

    Pre oxygenate your patient by increasing FiO2 at least 20% higher than their baseline for 30 seconds

  • Prepare the suction catheter

    Peel back the suction catheter wrapper (trache size -2x2) and attach to suction tubing. This is a clean procedure, so care needs to be taken to ensure you do not contaminate the suction catheter tubing.

  • Turn on suction

    Make sure the pressure is no greater than 20kpa when the suction tubing is occluded

  • Remove suction catheter

    Using a clean technique, place the sterile glove on the hand which you will use to insert the suction catheter, then withdraw the catheter from the wrapping. Care must be taken to ensure the catheter does not touch anything as you remove it from its wrapping.

  • Insert suction catheter

    Remove oxygen from the patient

    Advance the catheter until resistance is felt, then withdraw 0.5-1cm and apply suction. The Catheter should be withdrawn slowly whilst maintaining suction. It should not take longer than 10-15 seconds.

    Only apply suction pressure on withdrawal of the catheter.

    Reapply oxygen to your patient post procedure

    Dispose of your sterile glove and suction catheter in the yellow clinical waste.

  • Re-assess the patient

    Reassess your patient and determine if there is a need for a repeat suction.

    Ideally only allow 3 suction passes per procedure and allow your patient recovery time of 2-3 minutes between section catheter passes, unless the airway is compromised.

    Reassess your patient post procedure

  • Document

    Document the amount, colour and consistency of the secretions.