Why is suctioning of a tracheostomy tube needed?
Having a tracheostomy tube predisposes a person to an increased production of mucus and a decreased ability to rid themselves of that mucus. Suctioning promotes proper air flow by removing excess mucus that can block air from getting through the tracheostomy tube.
How often is suctioning needed?
This depends on the individual and their physical condition. For example, children who have had their trach since they were very young may have difficulty learning to cough and may need to be suctioned more often. Another factor is how long the person has had a tracheostomy. Over time the body adapts to the presence of the tracheostomy tube and there is a decreased need to be suctioned.
On average a child needs to be suctioned every 4 to 6 hours. Adults may only need to suction twice a day, first thing in the morning and then before going to bed. Because there are so many variables, this should be determined with the help of your health care team.
One mistake parents of a newly trached child may make is suctioning their child too often. Too much suctioning can actually irritate and dry out the sensitive tissue in the trachea, causing an increased production of mucus. This can set up a cycle of over-suctioning and increased mucus production. You should discuss any concerns with your health care provider.
How do I know if someone I am caring for needs to be suctioned?
If the person with the tracheostomy is an adult or an older child they can usually communicate a need for suctioning.
With a young child or a person who has trouble communicating their needs, it can be a little trickier. There are a number of signs you can look for that may indicate that a person needs to be suctioned. Among these are:
- Breathing becomes increasingly noisy (a rattling or the sound of mucus bubbling)
- Rate of breathing increases
- The person appears uncomfortable, fussy, agitated or restless
- Inadequate chest rise upon inhalation
- Nasal flaring
- Infant has difficulty sucking
- Mucus can be seen bubbling at the trach opening
- Nonproductive cough
- Blue color around the lips, mouth or fingernails
How do you determine what size suction catheter to use?
Catheter sizes normally range from 6 – 14 French. The general rule of thumb is the external diameter of the catheter should not be more than 1/2 the internal diameter of the trach tube. If the catheter is too large it fills up too much of the tracheostomy tube making it difficult for air to get through. Your health care provider will help you determine what size is appropriate.
How deep should I suction?
Your health care provider will help you determine the proper depth to suction. If a good cough reflex is present, it may only be necessary to suction the secretions at the opening of the tracheostomy tube.
If more aggressive suctioning is needed, „pre-measured suctioning“ is usually recommended. First the length of the tracheostomy tube is measured. Suctioning is performed to that depth using a catheter with pre-marked gradations. This form of suctioning helps avoid suctioning too deeply, which can cause tissue damage, or not suctioning deeply enough, which may leave mucus at the tip of the tracheostomy tube.
How long should I suction at one time?
Suctioning should be limited to 5 – 10 seconds at a time. Suctioning for too long can cause tissue damage and can leave the person oxygen starved.
When suctioning was done in the hospital, everything was sterile. Is this necessary at home?
It is generally accepted that a sterile technique is not necessary at home and that a clean technique (clean catheter, freshly washed hands) will suffice. Even though not sterile, it is important that the catheter and everything that comes into contact with it be clean. Cleaning instructions can be obtained from the catheter manufacturer or your health care provider.
If the patient has an increased susceptibility to infection your health care team may advise using a sterile technique. Always follow your health care provider’s advice.
Why is it advised to only suction as you withdraw the catheter from the tracheostomy tube and not as you enter?
The purpose of suctioning is to remove mucus from the tracheostomy tube. Unavoidably, oxygen will also be removed during the suctioning process. By only applying suction as you withdraw the catheter you are maximizing mucus removal and minimizing oxygen removal.
Is there a way to make suctioning the mucus easier and more productive?
Moisture is the key. If the secretions are too dry and thick they will stick to the sides of the tracheostomy tube and be difficult to suction. The following suggestions may help:
First increase the humidity in the air that is breathed in. This can be done in a number of ways.
- Employ a humidification system with a tracheal mask.
- Install a humidifier in your main living and sleeping areas.
- Wear a HME (Heat Moisture Exchanger), also referred to as a trach „nose“. The HME fits directly onto the trach. As air is breathed through the HME it is cleaned, warmed, and humidified. The HME device should only be used during the day and needs to be changed at least daily to avoid infection. Do not sleep with a HME on.
A second way to increase moisture in the secretions is to stay properly hydrated. Drinking plenty of water can go a long way in avoiding suctioning problems. This is particularly important during illness, especially if fever, vomiting and/or diarrhea are present.
Finally, many people find that instilling sterile normal saline into the trach tube prior to suctioning helps make the mucus easier to remove. However, this should only be done with the approval of your physician. Using an ampoule of normal saline or an eyedropper, place a few drops of sterile normal saline into the trach as you take in a deep breath. This should cause a cough reflex which will help loosen the mucus, making the suction procedure more productive. Sterile normal saline can be purchased at your local drugstore or through your home care dealer.
Are there any other reasons to suction besides the removal of mucus?
Though removal of mucus is the main reason for suctioning, there are a few other situations where suctioning may be necessary.
If a child with a tracheostomy is sick and vomiting they might not have the control to avoid contaminating their tracheostomy tube. If this happens suction immediately and contact your physician. Some precautions can be taken to help lessen the possibility of this occurring. If you are aware that your child is about to vomit have them turn their head to either side and then down away from their trach tube. Covering the trach with a HME (Heat Moisture Exchanger) or loosely with a bib or scarf can help keep vomit from getting into the trach tube. If your baby is susceptible to spitting up after eating, laying him/her on their side lessens the risk of the child choking.
Another time suctioning may be needed is if water gets accidentally splashed into the trach tube. To help avoid this make sure baths are taken in a shallow tub of water. Some people like to use a HME to lessen the likelihood of water going down the trach. There are also special „shower shields“ on the market that are made especially for persons with tracheostomies. Be sure to discuss any incidents of water in a tracheostomy tube with your health care team.
The mucus I suctioned is tinged with blood. Should I be worried?
It is not uncommon for suctioned mucus to be tinged with blood and it doesn’t necessarily indicate a problem. But if the blood is copious and either bright red (new blood) or dark brownish-red (old blood) this can indicate a potential problem.
In addition, mucus should normally be clear with no odor. A yellow or green color and a foul odor could indicate a possible infection.