How to Suction a Tracheostomy Tube in Newborn

A tracheostomy, or trach, is a surgically created opening in the trachea. A tracheostomy tube, or trach tube, is a flexible tube that is placed in a hole (stoma) in the trachea.

It is important to suction your baby’s trach tube two or more times a day. Suctioning the trach tube:

• Removes mucus and other fluids that build up in the trachea.
• Keeps the airway clear.
• Makes it easier to breathe.

You may need to suction your baby’s trach tube more than two times a day if:

• Your baby is breathing noisily.
• Your baby’s health care provider tells you to.

Supplies needed:

• Suction catheter.
• Clean gloves.
• Germ-free (sterile) gloves.
• Clean towel or paper drape.
• Electric suction machine.
• Manual suction device, if possible, in case your power goes out.
• Connecting tubing.
• Sterile container.
• 0.9% saline solution, sterile water, or tap water.
• Pulse oximetry machine. This monitors heart rate and blood oxygen level.

How to suction a tracheostomy tube

1. Have all supplies ready and available.
2. Wash your hands with soap and warm water.
3. Put on clean gloves.
4. Place the suction machine on a flat surface near your baby. Have another flat, clean surface close by.
5. Attach one end of the connecting tubing to the suction machine. Place the other end next to your baby.
6. Turn on the suction machine.
7. Set the vacuum regulator to the appropriate negative pressure.
8. Prepare the catheter:
   1. If you are using a one-time-use catheter:
      1. Lay a clean towel or paper drape next to your baby.
      1. Open or unwrap the suction kit or catheter.
      1. Place the wrapping on a clean towel, with the inside surface facing up.
      1. Place the catheter on the wrapping. Do not let the catheter touch any unsterile surfaces.
      1. Unwrap or open the sterile container.
      1. Put the container on the nearby flat surface.
      1. Pour 0.9% saline solution, sterile water, or tap water in half of the container.
      1. Remove your gloves by pulling them off inside out, starting at the wrist.
      1. Wash your hands well with soap and warm water.
      1. Put on clean gloves.
   1. If you are using a closed-suction catheter:
      1. Remove your gloves.
      1. Wash your hands well with soap and warm water.
      1. Put on clean gloves.
9. Pick up the suction catheter with your dominant hand and the connecting tubing with your other hand. Do not touch any unsterile surfaces.
10. Attach the catheter to the connecting tubing.
11. Suction a small amount of 0.9% saline solution from the container to make sure the equipment is working right.
12. Suction the trach. To do this:
    1. Give your baby extra oxygen if:
       1. Your baby’s mouth, fingers, or toes start to turn blue.
       1. Your baby starts breathing faster or slower than normal.
       1. The saturation number on the pulse oximetry machine drops below 90%.
    1. If your baby is receiving mechanical ventilation, open the suction access (swivel adapter). If necessary, remove the oxygen or humidity delivery device.
    1. Without applying suction, gently and quickly insert the catheter into the trach using your thumb and forefinger of your dominant hand.
    1. Place your non-dominant thumb over the catheter vent to apply suction.
    1. Using continuous suction, withdraw the catheter while twirling or rotating it between your dominant thumb and forefinger. Do not suction for more than 5 seconds at a time.
    1. If your baby is receiving mechanical ventilation, close the swivel adapter or replace the oxygen delivery device.
13. Using continuous suction, rinse the catheter and connecting tubing with 0.9% saline solution, sterile water, or tap water in the container until cleared.
14. Repeat these steps one or two more times until your baby no longer has noisy breathing. Allow your baby to rest for at least 1 minute between each suction pass. Provide oxygen or support with a self-inflating bag as necessary.
15. End by suctioning the secretions out of the nose and mouth. Do not reinsert the catheter into the trach after oral or nasal suction.

What to do after suctioning the tracheostomy

• Throw out the soiled catheter in this way:
  • Coil the suction catheter into the palm of your hand.
  • Pull the glove off inside out, starting from the wrist and down over the hand and fingers. This will keep the soiled catheter inside the glove.
  • Throw away the glove.
• Turn off the suction machine.
• Remove the towel or paper drape.
• Allow your baby to rest briefly.
• Provide a short period of ventilation (with a self-inflating bag) with or without oxygen, as ordered by the health care provider.
• If oxygen was stopped before the procedure, reapply the oxygen delivery device,
• Throw away used supplies.
• Remove your gloves.
• Wash your hands well with soap and warm water.

Contact a health care provider if:

• Your baby is vomiting.
• Your baby has swelling, redness, warmth, drainage, or tenderness around the stoma.

Get help right away if:

• Your baby has:
  • Trouble breathing even after suctioning and cleaning.
  • Trouble swallowing.
  • Unusual sounds coming from the airway or continues to cough after suctioning.
  • Bright red blood in his or her mucus.
• Your baby’s trach tube becomes plugged and you cannot clear it.
• Your baby’s trach tube falls out and cannot be put back in.
• Your baby’s breathing is fast, difficult, or noisy.

If you think your baby’s breathing or heart function is in danger because of a blocked or dislodged trach tube, follow directions of the health care provider. If you are not able to do this, call your local emergency services (911 in U.S.) for help.

Summary

• It is important to suction your baby’s trach tube two or more times a day. You may need to suction your baby’s trach tube more than two times a day if your baby is breathing noisily or your baby’s health care provider tells you to.
• Do not let the catheter touch any unsterile surfaces.
• Do not suction for more than 5 seconds at a time.
• If oxygen was stopped before the procedure, reapply the oxygen delivery device.
• If you think your baby’s breathing or heart function is in danger because of a blocked or dislodged trach tube, follow directions of the health care provider.