Which of the following is the correct method of suctioning?

Suctioning removes secretions that you cannot cough out or clear from your airway. It keeps your airway open and helps you breathe better.

Supplies you will need

• Suction catheter (keep the package)
• Connection tubing
• Suction machine
• Clean tap water
• Steps to suction

Steps to suction a tracheostomy

1. Turn on the suction machine with the pressure set on the low-to -medium setting.
2. Connect the suction catheter to the tubing on the suction machine.
3. Dip the suction catheter tip into the clean tap water.
4. Take 4 to 5 deep breaths.
5. Gently put the suction catheter into the tracheostomy tube as far as you can without forcing it. Do not cover the suction control vent with your thumb while putting the catheter into your tracheostomy tube.
6.  Pull the suction catheter back out a little bit before you start to suction.
7. Cover the suction control vent with your thumb to start suctioning. Do not suction for more than 10 seconds each time. Turn or twist the suction catheter as it is taken out.
8. Remove your thumb from the suction control vent if you feel the catheter pull during suctioning.
9. Wait 20 to 30 seconds between each suction try. After 3 tries, wait 5 to 10 minutes before suctioning again.

Put the suction catheter into the trachestomy tube.

Cover the suction control vent with your thumb to start suctioning.

Cleaning and storing suction supplies

Rinse the suction catheter and connection tubing with clean tap water after each use. Store the catheter in the original package until the next use. Do not reuse the catheter if it touches anything else.

One suction catheter should be used for as long as your medical supply company tells you, unless you have an infection. If you have an infection, the suction catheter needs to be changed more often. The suction machine needs to be kept clean. Empty and clean the bottle and tubing with hot, soapy water each day. Always rinse with clean tap water and let it air dry.

‹ Problems with a tracheostomy up Tracheostomy safety ›

Suctioning is a method of removing mucous from the lungs. People with a spinal cord and/or brain injury may have problems breathing due to congestion. The muscles that help with breathing and coughing may not work well. Suctioning will help keep the airway clear. Only use clean technique with your doctor’s approval.

When Should I Suction?
A person should be suctioned when any of the following happens:

• "Rattling" breathing sounds are heard
• Mucous bubbles up in the throat or airway tube (trach tube)
• When a hand placed on the chest can feel a vibration or "rattling" from congestion
• When the person tells you it is needed (when it is hard to breathe)

Try having the person cough first (or perform an assist cough). Sometimes the person may not need to be suctioned if he/she is able to remove the mucous with a good cough. Please click here for Shepherd Center's DOs and DON'Ts of suctioning.

How to Suction

Step 1: Gather the supplies. Click here for comprehensive chart of supplies.

• Portable suction machine
• Clean suction catheter
• Sterile normal saline
• Resuscitator bag (also known as the Ambu Bag)
• One helper

See the recipe for making sterile saline at the end of this lesson.

Step 2: Wash your hands.
Wash your hands with soap and water. Dry them with a clean towel.

Step 3: Check portable suction equipment.
Make sure all tubing connections and collection jar have a tight seal.

Step 4: Place portable suction unit on a flat, dry and safe surface.
Plug suction unit to an electrical outlet. Turn unit on.

Step 5: Set the suction pressure.
The portable suction pressure should not be set higher than 15 mm/Hg.

Check pressure by turning the machine on and covering the open end of the suction line with one hand.

Look at the pressure dial. It should rise but not go any higher than the 15 marker on the dial.

If the pressure does not go up, re-check all tubing connections or adjust to the correct pressure.

Step 6: Pick up clean suction catheter.

Step 7: Put on gloves.

Step 8: Connect the tubing to the suction catheter.
Pick up the long connecting tubing that comes from the suction machine and attach it to the suction catheter.

Step 9: Turn on the suction machine.         

Step 10: "Bag" the person.

The person must receive extra breaths during suctioning. This is done by using the Ambu Bag. Attach the bag to the person's airway (trach tube) and squeeze the bag to give extra breaths. Each person will be different in respect to how many times he/she needs to be "bagged." Follow the directions you were given from your doctor or therapist.

A person will need to be bagged before, during and after each suctioning.

Step 11: Place the catheter into the trach tube.

Place the catheter into the opening of the trach. Be careful not to let it touch anything before entering the opening. Please remember that the inner cannula must always be in place when a person is suctioned.

The inner cannula is the tube that fits into the trach at the neck plate. It can be reusable or disposable depending on your specific situation. The photo below shows the suction catheter entering through the inner cannula. Never suction without it in place.

Slowly move catheter down into the trach until resistance is felt. Do not force the catheter down.

Step 12: Cover the suction port.

Cover the suction port with your thumb. Slowly pull the suction catheter up and out. Do not leave the suction catheter in the trach tube for more than 10 seconds.

Suction Off (port open)

Suction On (port closed)

Step 13: Bag the person.

Repeat steps 10, 11 and 12 until the mucous is gone.

If you notice that the mucous is thick, you can use normal saline to make it thinner. Squirt a small amount into the trach tube and then bag the person with the Ambu Bag. This will help loosen up the mucous and make it easier to suction. Now you may insert the suction catheter and repeat Step 11.

Step 14: Disconnect the catheter from the suction tubing.
Set it aside for washing.

Step 15: Rinse the suction tubing.

Once suctioning is complete, the canister tubing must be rinsed. This can be done with tap water or normal saline. With the suction machine still on, put the tubing in a container of water or squirt some normal saline into the tubing. Allow it to rinse through the tubing until it is cleared of mucous.

Step 16: Shut off suction unit.

Step 17: Remove all gloves.

Step 18: Wash your hands.

Step 19: Wash suction catheter.

Click here for saline and sterile water recipes.

The upper airway warms, cleans and moistens the air we breathe. The trach tube bypasses these mechanisms, so that the air moving through the tube is cooler, dryer and not as clean.  In response to these changes, the body produces more mucus.  Suctioning clears mucus from the tracheostomy tube and is essential for proper breathing. Also, secretions left in the tube could become contaminated and a chest infection could develop.  Avoid suctioning too frequently as this could lead to more secretion buildup.

Removing mucus from trach tube without suctioning

1. Bend forward and cough. Catch the mucus from the tube, not from the nose and mouth.
2. Squirt sterile normal saline solutions (approximately 5cc) into the trach tube to help clear the mucus and cough again.
3. Remove the inner tube (cannula).
4. Suction.
5. Call 911 if breathing is still not normal after doing all of the above steps.
6. Remove the entire trach tube and try to place the spare tube.
7. Continue trying to cough, instill saline, and suction until breathing is normal or help arrives.

When to suction

Suctioning is important to prevent a mucus plug from blocking the tube and stopping the patient's breathing.  Suctioning should be considered

• Any time the patient feels or hears mucus rattling in the tube or airway
• In the morning when the patient first wakes up
• When there is an increased respiratory rate (working hard to breathe)
• Before meals
• Before going outdoors
• Before going to sleep

The secretions should be white or clear. If they start to change color, (e.g. yellow, brown or green) this may be a sign of infection. If the changed color persists for more than three days or if it is difficult to keep the tracheostomy tube intact, call your surgeon's office. If there is blood in the secretions (it may look more pink than red), you should initially increase humidity and suction more gently. A Swedish or artificial nose (HME), which is a cap that can be attached to the tracheostomy tube, may help to maintain humidity. The cap contains a filter to prevent particles from entering the airway and maintains the patient's own humidity. Putting the patient in the bathroom with the door closed and shower on will increase the humidity immediately. If the patient coughs up or has bright red blood mucus suctioned, or if the patient develops a fever, call your surgeon's office immediately.

How to suction

EquipmentClean suction catheter (Make sure you have the correct size)Distilled or sterile waterNormal salineSuction machine in working orderSuction connection tubingJar to soak inner cannula (if applicable)Tracheostomy brushes (to clean tracheostomy tube)

Extra tracheostomy tube

1. Wash your hands.
2. Turn on the suction machine and connect the suction connection tubing to the machine.
3. Use a clean suction catheter when suctioning the patient. Whenever the suction catheter is to be reused, place the catheter in a container of distilled/sterile water and apply suction for approximately 30 seconds to clear secretions from the inside. Next, rinse the catheter with running water for a few minutes then soak in a solution of one part vinegar and one part distilled/sterile water for 15 minutes. Stir the solution frequently. Rinse the catheters in cool water and air-dry. Allow the catheters to dry in a clear container. Do not reuse catheters if they become stiff or cracked.
4. Connect the catheter to the suction connection tubing.
5. Lay the patient flat on his/her back with a small towel/blanket rolled under the shoulders. Some patients may prefer a sitting position which can also be tried.
6. Wet the catheter with sterile/distilled water for lubrication and to test the suction machine and circuit.
7. Remove the inner cannula from the tracheostomy tube (if applicable). The patient may not have an inner cannula. If that is the case, skip this step and go to number 8.

   a. There are different types of inner cannulas, so caregivers will need to learn the specific manner to remove their patient's. Usually rotating the inner cannula in a specific direction will remove it.

   b. Be careful not to accidentally remove the entire tracheostomy tube while removing the inner cannula. Often by securing one hand on the tracheostomy tube?s flange (neck plate) one can/ will prevent?accidental removal.

   c. Place the inner cannula in a jar for soaking (if it is disposable, then throw it out).

8. Carefully insert the catheter into the tracheostomy tube. Allow the catheter to follow the natural curvature of the tracheostomy tube. The distance to the location of catheter becomes easier to determine with experience. The least traumatic technique is to pre-measure the length of the tracheostomy tube then introduce the catheter only to that length. For example if the patient?s tracheostomy tube is 4 cm long, place the catheter 4 cm into the tracheostomy tube. Often, there will be instances when this technique of suctioning (called tip suctioning) will not clear the patient?s secretions. For those situations, the catheter may need to be inserted several mm beyond the end of the tracheostomy tube (called deep suctioning). With experience, caregivers will be able to judge the distance to insert the tracheostomy tube without measuring.
9. Place your thumb over the suction vent (side of the catheter) intermittently while you remove the catheter. Do not leave the catheter in the tracheostomy tube for more than 5-10 seconds since the patient will not be able to breathe well with the catheter in place.
10. Allow the patient to recover from the suctioning and to catch his/her breath. Wait for at least 10 seconds.
11. Suction a small amount of distilled/sterile water with the suction catheter to clear any residual debris/secretions.
12. Insert the inner cannula from extra tracheostomy tube (if applicable).
13. Turn off suction machine and discard catheter (clean according to step 3 if to be reused).
14. Clean inner cannula (if applicable).