Tracheostomy Suctioning

Tracheostomy suctioning is a critical procedure performed to maintain airway patency in patients with a tracheostomy tube. This technique is essential for removing secretions, preventing airway obstruction, and minimizing the risk of infection. Whether in the intensive care unit, long-term care settings, or at home, effective tracheostomy suctioning is a cornerstone of patient safety and comfort. This guide explores the indications, equipment, procedure, complications, and best practices associated with tracheostomy suctioning.

Understanding Tracheostomy

A tracheostomy is a surgical opening created in the trachea (windpipe) through the neck, into which a tube is inserted. This provides a direct airway for patients who cannot breathe adequately through their nose or mouth due to obstruction, injury, neuromuscular dysfunction, or prolonged mechanical ventilation. Tracheostomies can be temporary or permanent, and their care involves specialized interventions—among them, suctioning.

Indications for Tracheostomy Suctioning

Suctioning is performed when a patient is unable to clear tracheobronchial secretions independently. Common indications include:

• Visible or audible secretions in the tracheostomy tube
• Increased respiratory rate or effort
• Reduced oxygen saturation or cyanosis
• Crackles or rhonchi on auscultation
• Restlessness or agitation (signs of hypoxia)
• Decrease in tidal volume or ventilator alarms indicating high pressure
• Risk of aspiration or infection due to retained secretions

Equipment Required

Before beginning tracheostomy suctioning, gather the following sterile and non-sterile supplies:

• Suction catheter (appropriate size for tracheostomy tube)
• Suction machine with adjustable pressure
• Sterile gloves
• Sterile saline for rinsing and instilling (if required)
• Personal protective equipment (mask, goggles, gown)
• Waterproof drape or towel
• Pulse oximeter (for patient monitoring)
• Resuscitation equipment (in case of adverse reaction)

Preparation for Suctioning

Preparation is crucial for reducing complications and ensuring patient comfort.

• Explain the procedure to the patient to reduce anxiety.
• Position the patient comfortably, usually in a semi-Fowler’s or upright position.
• Assess vital signs and baseline oxygen saturation.
• Perform hand hygiene and don personal protective equipment.
• Set suction pressure to the recommended setting (typically 80–120 mmHg for adults; lower for children and infants).

Suctioning Technique: Step-by-Step

A structured approach helps minimize trauma and hypoxia. The following steps outline a typical suctioning procedure:

1. Preoxygenation: If necessary, administer supplemental oxygen before suctioning to prevent hypoxia.
2. Maintaining Sterility: Use sterile gloves and handle the catheter only by the tip that will enter the tracheostomy tube.
3. Catheter Insertion: Gently insert the suction catheter into the tracheostomy tube without applying suction. Advance until resistance is felt or the patient coughs, but do not force beyond this point.
4. Suction Application: Withdraw the catheter slowly while intermittently or continuously applying suction (using your thumb to control the suction port). Limit suction duration to 10–15 seconds to minimize hypoxia.
5. Catheter Removal: Remove the catheter completely, discarding it in a sterile container. Monitor the patient for improvement in breath sounds and oxygenation.
6. Repeat as Needed: If secretions persist, repeat the suctioning procedure after allowing the patient to recover for 30–60 seconds.
7. Rinse Catheter: Use sterile saline to rinse the catheter between suctions if using a reusable system.

Frequency of Suctioning

Suctioning should be performed only as needed, not on a fixed schedule. Over-suctioning can damage airway mucosa and increase infection risk. Assess the patient frequently and suction only when clinically indicated.

Complications of Tracheostomy Suctioning

While suctioning is often life-saving, it carries potential risks:

• Hypoxia: Prolonged suctioning removes oxygen along with secretions.
• Trauma: Repeated or forceful insertion of the catheter can injure the airway mucosa.
• Infection: Non-sterile technique introduces pathogens into the lower airways.
• Arrhythmias: Vagal stimulation during suctioning may cause bradycardia or cardiac arrest.
• Atelectasis: Removal of excessive secretions can collapse portions of the lung.
• Bleeding: Mucosal injury may result in blood-tinged secretions.

Best Practices and Safety Considerations

To ensure safe and effective suctioning:

• Monitor oxygen saturation and heart rate throughout the procedure.
• Use the smallest effective catheter size to reduce trauma.
• Limit suction pressure and duration to minimize complications.
• Allow recovery between suctioning passes.
• Maintain strict aseptic technique to prevent infection.
• Document the procedure, findings, and patient response in the medical record.

Special Considerations in Pediatrics and Long-term Care

Children and long-term tracheostomy patients require additional precautions:

• Use lower suction pressures (60–80 mmHg for infants and children).
• Be mindful of smaller airways and increased risk of trauma.
• Educate caregivers thoroughly in home settings.
• Monitor for growth of granulation tissue or tube obstruction.

Education and Training for Caregivers

Proper education empowers caregivers and patients in home settings:

• Training sessions on sterile technique and equipment use.
• Recognition of signs indicating need for suctioning (restlessness, cyanosis, noisy breathing).
• Emergency procedures for tube blockage or accidental decannulation.
• Routine tube and stoma care to prevent infection and skin breakdown.

Palliative and Chronic Care Perspectives

For patients with irreversible conditions requiring long-term tracheostomy, the suctioning approach may shift toward comfort and symptom management. Care should be individualized, balancing benefits with risks and patient preferences.

Documentation and Legal Considerations

Accurate documentation is essential for continuity of care and legal protection. Record the date, time, indications, procedure details, findings, and patient tolerance.

Nursing Care of Patient during Tracheostomy Suctioning

Tracheostomy Suctioning

Suctioning a tracheostomy is a vital nursing intervention that maintains airway patency, removes secretions, and prevents complications such as infection or respiratory distress. Safe and effective suctioning requires technical skill, vigilance, and sensitivity to the patient’s unique needs.

Assessment and Preparation

Begin by assessing the patient’s respiratory status—monitor for signs of distress, increased work of breathing, audible secretions, or decreased oxygen saturation. Explain the procedure in simple, reassuring terms, and encourage questions to alleviate anxiety. Gather sterile suction equipment, personal protective equipment, and ensure a source of oxygen is available.

Procedure Steps

• Perform hand hygiene and don appropriate protective gear, including gloves and (if necessary) eyewear and gown.
• Set the suction pressure to the recommended level (typically 80–120 mmHg for adults, lower for paediatric patients).
• Pre-oxygenate the patient if clinically indicated, especially if they desaturate easily or are anxious about the procedure.
• Using aseptic technique, insert the catheter gently and without applying suction until resistance is met or the patient coughs.
• Apply intermittent suction while slowly withdrawing the catheter, rotating it between your fingers. Limit each suction pass to no more than 10–15 seconds to prevent hypoxia.
• Allow the patient to rest and recover between passes, administering supplemental oxygen as needed.
• Repeat if indicated, but avoid excessive suctioning, which can cause trauma and increase secretion production.

Aftercare and Monitoring

• Monitor the patient for complications such as bleeding, bronchospasm, hypoxia, arrhythmias, or increased distress.
• Assess the colour, consistency, and amount of secretions—recording significant findings for the healthcare team.
• Ensure the tracheostomy tube and stoma remain clean, dry, and free from signs of infection.

Patient and Caregiver Education

Education is fundamental for long-term success. Involve patients and caregivers in demonstrations and return-demonstrations. Teach them about:

• Recognising signs of airway obstruction or infection
• Proper hand hygiene and equipment cleaning
• Safe suctioning technique, including equipment set-up and troubleshooting
• When to seek professional help

Documentation

Meticulously document all suctioning procedures, including indications, patient responses, complications, and teaching provided. This ensures continuity of care and serves as a legal record.

By combining technical skill, patient-centred education, and collaborative teamwork, nurses ensure safe, effective tracheostomy care and enhance the quality of life for patients with complex airway needs.

REFERENCES

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