• Audible rattling sounds or visible secretions in the tube
  • Decreased breath sounds on chest auscultation
  • Increasing respiratory effort or distress
  • Suspicion of blocked or partially blocked tracheostomy tube
  • patient requests suction

Consider suction prior to tracheostomy tube change, tape change, feeding, speaking valve use or after vomiting

Patient Factors & Considerations
  • Only remove devices as required to pass a suction catheter (e.g. a cap, cover, speaking valve, HME filter and the inner tube of a dual lumen tube if it is present). Other devices such as the outer tracheostomy tube or laryngectomy tube (if present) should not be removed at this stage. Do not attempt to remove tracheoesophageal puncture valves / voice prosthesis embedded in the posterior tracheal wall.
  • Pre-oxygenate the patient prior to aspirating the tracheostomy, and continuously monitor the patient’s condition.

When performing suction

  • Ensure the patient is connected to a cardiac monitor and SpO2 probe when aspirating.
  • Do not suction for more than 10 seconds in duration.
  • It is not necessary to rotate the catheter as the multiple eyelet catheters will remove secretions effectively.
  • To reduce the risk of infection:
      • Protect the catheter tip from contamination before and in between passes. Do not allow to come into contact with surfaces, hands and clothing – discard if contaminated and use a new catheter.
      • Whilst single-use suction tubing is preferable, provided no contamination to the suction catheter has occurred, it can be reused for multiple passes then discarded.
      • If required, the tubing can be cleared by suctioning tap water through the suction tubing to clear it of secretions. 

    Preparing for and performing suction

    • Position the patient, allowing access to the tracheostomy tube
    • Attach the suction catheter to suction tubing, remove packaging and turn on the suction
      • Insert catheter into tracheostomy tube to a maximum length of 15cm. If the patient is paediatric, please consult with carer or follow instructions on the patients Airway Profile for suction depth.
      • If the catheter does not pass easily into the tracheostomy tube, do not force - suspect a blocked or partially obstructed tube.
      • Suction should be applied on withdrawal of the suction catheter to minimise mucosal damage in the respiratory tract.

      For general instructions, see Clinical Skill – Suction.

      For further information, see article Tracheostomy in the Medical Library.

      • Assess the patient and the effectiveness of secretion clearance. Repeat as necessary.
      • Observe the patient during the procedure for signs of respiratory and cardiovascular instability and discomfort.
      • Frequent repeat suctioning may be required if there are copious secretions.
      • Consider other causes for respiratory distress if the stoma/tube is patent.
      • If the patient improves following the removal of a blocked inner tube, it can be flushed with normal saline and reinserted if required (e.g. to facilitate reattaching the patient to a ventilator or a BVM).

      Unable to pass suction catheter

      • The stoma or tube is likely to be totally blocked.
      • If a tracheostomy tube is present, the tube may be displaced. If the tracheostomy tube has a cuff, deflating the cuff without removing the tube may partially correct the displacement and allow for spontaneous ventilation and oxygenation.
      • Suction may be required following deflation as secretions collected above the cuff may be released into the lower airways.

      No improvement / deterioration

      • If unable to pass a suction catheter and cuff deflation has not led to improvement, the tracheostomy tube (if present) must be removed. Further attempts at troubleshooting are unlikely to be successful.
      Additional Information
      • Higher pressure may cause alveolar collapse, mucosal damage or catheter collapse, whilst inadequate suction pressure may not remove enough secretions resulting in increased number of catheter passes
      • Appropriate PPE should be worn for suctioning

      • Child and Adolescent Health Service (2020). Tracheostomy management. https://www.cahs.health.wa.gov.au/-/media/HSPs/CAHS/Documents/Community-Health/CHM/Tracheostomy-management.pdf
      • Royal Children’s Hospital. Tracheostomy Management. In: Clinical Nursing Guidelines, editor. Melbourne Australia: The Royal Children's Hospital Melbourne; 2018.
      • Perth Children's Hospital. Tracheostomy Management Guideline. In: Clinical Practice Manual, editor. Perth: Child and Adolescent Health Services; 2018.
      • Perth Children's Hospital. Tracheostomy Resuscitation Procedure. Clinical Practice Manual. Perth: Child and Adolescent Health Services; 2017.4.
      • Credland N. How to suction via a tracheostomy. Nurs Stand. 2016;30(28):36-8

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