How to Suction a Tracheostomy Tube in Children

A tracheostomy tube or trach tube is a tube that is surgically placed into the airway (trachea) to help with breathing. A tracheostomy (trach) allows your child to breathe without using his or her nose or mouth. Your child may need a trach tube if lung problems or another medical condition makes breathing difficult. Sometimes children with lung problems have a lot of mucus that collects in their lungs. This mucus can build up in the tube, making it harder for your child to breathe. You may need to suction the mucus from the tube to keep your child’s airway clear.

Suctioning mucus from the trach tube is especially important for the first few weeks after it has been placed. This is because a new trach produces more mucus. Over time, you will need to suction less often. Typical times to suction the tube include in the morning, at bedtime, before meals, and before changing the tube. You will also need to suction the tube whenever mucus is blocking the tube. Signs that you need to suction your child’s tube include:

• Restlessness.
• Increased coughing.
• Trouble breathing.
• Rattling in the chest.
• Difficulty eating or feeding.
• Mucus bubbles at the tube opening.
• Clammy or pale skin.
• Bluish lips or nails.

There are several types of trach tubes. These are general guidelines. Follow your health care provider’s instructions on how to suction your child’s tube.

General recommendations

Work with your child’s health care provider before you suction your child’s trach tube at home. Make sure you know:

• How to suction properly and safely.
• How to give your child oxygen if needed.
• How to change the tube if it becomes blocked.
• When to suction and how often.
• When to call for help.

Supplies needed:

Gather all the equipment you need. This will include:

• The suction catheter kit. Be sure you know what size catheter to use.
• The suction machine.
• Connection tubing.
• Saline.
• A cup.
• Sterile gloves.
• Self-inflating bag.

How to suction the trach tube

Before suctioning the trach tube

1. Wash your hands with soap and water. Dry your hands.
2. Pour the saline into the cup.
3. Turn on the suction machine.
4. Provide oxygen with a self-inflating bag, if told by your health care provider.
5. Put on the gloves.
6. Remove the catheter from its package. Do not touch the suctioning end that will go into the tube.
7. Connect the catheter to the suction tubing that goes to the suction machine. Check the suction gauge to make sure it is at the proper level.
8. Grab the catheter with your fingers at the number on the catheter that you have been taught to use. This number determines the size and length of the catheter.
9. Place the catheter into the saline cup. Place your thumb over the hole in the catheter to suction some saline. Make sure the suction is working properly.

Suctioning the trach tube

1. Remove your thumb that was over the opening and insert the catheter into the tube opening. Insert the catheter until your fingers are at the rim of the opening.
2. Place your thumb over the opening to start suctioning as you slowly pull out the catheter. Move your thumb on and off the opening to create suction.
3. Suction for no longer than 5 seconds before removing the catheter.
4. Suction some saline to clear mucus from the catheter and tube.
5. After a short rest period (at least 30 seconds), you can repeat the suctioning, if needed, until your child is breathing easily. If you need to suction more than 3 times, consider changing the tube.
6. If needed, suction your child’s mouth, then nose. Do not use the same catheter to suction the tube. Use a new catheter if you have to suction the tube again.

Your child may cough during suctioning. This is normal. Your child may also feel distress during this procedure. Provide encouragement and comfort for your child.

After suctioning the trach tube

1. Provide oxygen with a self-inflating bag if told by your health care provider.
2. Observe your child’s breathing for a few minutes to make sure your child is breathing easily.
3. Throw away the catheter, tubing, and gloves after you finish suctioning.

Contact a health care provider if:

• Your child is not breathing easily after suctioning.
• Your child’s mucus becomes thick and discolored or has an odor.
• You have any questions about how to care for your child’s tracheostomy.
• Your child has a fever.
• The skin around the tracheostomy is red, tender, or weepy.

Get help right away if:

• Your child is struggling to breathe. This may include rapid breathing, flared nostrils, noisy breathing, clammy skin, restlessness, or blue lips.
• Your child’s tube comes out and you cannot replace it.
• Your child has bright red blood coming from the tube or there is bright red blood inside the suction catheter after suctioning.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).

Summary

• Suctioning your child’s trach tube clears mucus and helps your child breathe more easily.
• Work with your child’s healthcare provider to learn how to suction the tube properly and safely.
• Suction your child’s tube at normal times and whenever there are signs of mucus blocking the tube.
• Contact your child’s health care provider if your child is not breathing easily after suctioning.