Suctioning a Tracheostomy

The upper airway warms, cleans and moistens the air we breath. The trach tube bypasses these mechanisms, so that the air via the tube is cooler, dryer and not as clean. In response to these changes, the body produces more mucus. The trach tube is suctioned to remove mucus from the tube and trachea to allow for easier breathing. Generally, the child should be suctioned every 4 to 6 hours and as needed. There may be large amounts of mucus with a new tracheostomy. This is a normal reaction to an irritant (the tube) in the airway. The heavy secretions should decrease in a few weeks. While a child is in the hospital, suctioning is done using sterile technique, however a clean technique is usually sufficient for most children at home. If your child has frequent respiratory infections, trach care and suctioning techniques may need to be addressed. Frequency of suctioning will vary from child to child and will increase with respiratory tract infections. Try to avoid suctioning too frequently. The more you suction, the more secretions can be produced. 

Care Techniques

The size of the suction catheter depends on the size of the tracheostomy tube.  Size 6, 8 or 10 French are typical sizes for neonatal and pediatric trach tubes. The larger the number, the larger the diameter of the suction catheter.  Use a catheter with an outer diameter that is about half the inner diameter of the artificial airway this will allow air to enter around it during suctioning.  You can also compute the catheter size with this formula:  Multiply the artificial airways diameter in millimeters by two. For example, 8 mm X 2 = 16, so a 16 French catheter.  Also see Tracheostomy Sizing Chart for recommended catheter sizes for specific Bivona and Shiley pediatric tracheostomy tubes.

Older children may be taught to suction themselves.

Suction Depths

Signs That a Child Needs Suctioning

Equipment

Suction 

Illustration courtesy of the Department of Otolaryngology, Cincinnati Children's
Hospital Medical Center, Cincinnati, Ohio

Suctioning a Tracheostomy

Procedure

Ambu bad 

Illustration Source:
The Center for Pediatric Emergency Medicine (CPEM), Teaching Resource for Instructors in Prehospital Pediatrics.  Illustrations by Susan Gilbert. http://www.cpem.org/html/giflist.html

Sleeved Catheter

Bard Medical Division Tracheal Suction Catheter

Suction
Illustration Source:
The Center for Pediatric Emergency Medicine (CPEM), Teaching Resource for Instructors in Prehospital Pediatrics.  Illustrations by Susan Gilbert. http://www.cpem.org/html/giflist.html

Other Suctioning Devices

In-line catheter

ballard

BallardŽ in-line catheter

DeLee Suction

DeLee Suction Trap

CoughAssist

CoughAssist

Res-Q-Vac

Hand-powered Suction Device

Encourage your child to cough; this also helps to clear the airway and lungs. Using chest P.T., postural drainage and percussion as needed to maximize airway clearance. 

This page updated 03/03/10