Tracheal Suction Guidelines

A suction machine has been prescribed by your doctor to help remove secretions and mucus from your airways. The instructions in this handout will help you and your caregiver correctly perform the suction procedure and operate the equipment safely.

What is the purpose of tracheostomy suctioning?
Tracheostomy suctioning removes thick mucus and secretions from the trachea and lower airway that you are not able to clear by coughing. Suctioning is done when you wake up in the morning and right before you go to bed in the evening. Suctioning is also done after any respiratory treatments.

In addition, suctioning may be needed when you:

• Have a moist cough.
• Are unable to effectively clear secretions from the throat.
• Are having difficulty breathing or feel that you can not get enough air.

What supplies do I need?
You will need the following supplies:

• One gallon of distilled water
• One bottle of hydrogen peroxide
• Small paper cups (4- or 6-ounce size)
• One box of non-sterile gloves
• One bottle of white vinegar
• One box of cotton-tipped swabs

Will suctioning hurt?
No. Suctioning should not cause pain. You may feel short of breath and you may cough, but these are normal reactions and should not be painful.

Where should the suction machine be used?
The suction machine should be used in a well-lit area. Place the machine on a sturdy surface that will support the weight of the suction machine, such as a table or desk.

Care of tracheostomy equipment

1. Keep enough supplies available at all times.
2. Replace collection canisters, connecting tubing, and suction catheters that are hard or cracked.
3. Empty the canister every night or when it becomes half-full.
4. Disinfect reusable equipment (the canister, canister lid, and suction tubing). 
   --Every night, soak the equipment for 15 minutes in a basin or sink filled with warm water and dish detergent. 
   --Every third night, soak the canister, the lid, and the suction tubing for 30 minutes in a solution of three parts water and one part vinegar.
5. Rinse the equipment completely.
6. Dry the equipment with clean towels.
7. Reassemble the equipment.

Tracheal suction guidelines for caregivers

1. Gather the following equipment and supplies:

• Suction machine
• Connecting tubing
• Disinfected suction catheter
• One non-sterile, clean glove
• Distilled water
• Clean, small paper cup
• Clean basin

2. Position the patient comfortably with his or her head and neck well-supported.

3. Wash your hands with soap and water and dry with a clean towel.

4.  Fill the small paper cup about half-way with distilled water.

5. Place the clean glove on your dominant hand (if you are right-handed, place the glove on your right hand).

6. If the patient has a cuffed tracheostomy tube, check to see if the cuff is properly inflated  (See the 'Step 6' illustration to the right).

7.  Open the suction catheter package.

8. Pick up the hard plastic end of the catheter with your gloved hand and attach it to the connecting tubing. (Only touch the connecting tubing with your ungloved  hand since it is not sterile).  (See the 'Step 8' illustration to the left).

9. Wrap the catheter around your gloved hand when not in use to avoid contamination of the catheter.

10.  Turn on the suction machine with your ungloved hand.

11.  Expose the patient's tracheostomy opening.

12. With your finger off the suction vent (so that you are not applying suction), gently insert the suction catheter into the tracheostomy opening. Slowly advance the catheter a maximum of  6 inches or until you feel resistance. (See the 'Step 12' illustration to the right).

13. Cover the suction vent with the thumb of your ungloved hand to apply suction. (See the Step '13' illustration to the left).

14. Withdraw the catheter and rotate, using a slow and even motion. Roll the catheter between the thumb and forefinger of your gloved hand. Apply suction as you withdraw the catheter.

15. Do not apply suction for longer than 10 seconds.

16. Clean the catheter and connecting tubing between each suction pass: dip the catheter into the small paper cup, place your finger over the suction vent and draw up small amounts of distilled water through the catheter. Empty the contents of the catheter into the collection basin.

17. Allow the patient 20 to 30 seconds to rest between suction passes.

18. When the patient's airway is clear and you are finished suctioning, fill a clean basin with distilled water. Thoroughly flush the distilled water through the catheter and connecting tubing.

19. Turn off the suction machine.

20. Slide the catheter back into the package and disconnect it from the connecting tubing.

21. Hang the connecting tubing on the suction machine with the tip pointing up.

22. Rinse the suction catheter and store it with the other equipment to be disinfected.

23. Wash the basin with soap and warm water. Dry it with a clean towel and put it away.

24. Take off your glove and discard it properly, along with the paper cup.

25. Wash your hands with soap and water and dry with a clean towel

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health/. This document was last reviewed on: 9/22/2005