A tracheostomy (trach) is an opening the doctor makes in your child’s neck. It gives your child a way to breathe without using the nose, mouth, and throat.The small tube that goes in your child’s trach helps the care team take care of this area for several weeks, months, or even longer.
Why do I need to suction the trach?
Everyone’s lungs make a substance called mucus. It cleans the air we breathe by trapping small particles, such as dust and bacteria. Mucus builds up in the trach tube and around it. Your child might be able to cough up the mucus, or he might not. If not, the mucus can dry out and block the trach tube. This makes it hard for your child to breathe. Suction helps remove mucus so your child can breathe better. You can also encourage your child to cough and breathe deeply. This can help keep mucus from building up.
Signs that your child might need suctioning
- Gurgling or coughing more often
- You hear mucus bubbling inside the tube, or a whistling noise from the tube
- Your child is anxious, crying, or looks like he is having trouble breathing
- Your child’s nostrils flare, he breathes faster than normal, or the skin pulls in around the ribs or collarbone
- Your child’s mouth, lips, and fingernails look pale or slightly blue
- Your child does not want to eat or drink
- Your child tells you he needs suctioning
How often should I suction my child’s trach?
- Whenever your child shows any signs from the list above
- When your child wakes up in the morning
- Before meals
- Before bed at night
- Before changing the trach tube – Your child might also need suctioning afterward
How long should my suction catheter be?
The suction catheter should be just long enough to go past the end of the trach tube, but not longer. This might be measured for you already, or it might not. No matter what, you need to know the right length before you suction your child’s trach. If the catheter is not measured already, compare it with the obturator. It should be the same length.
Once you know how long your suction catheter should be, write it on the trach sign in your child’s room, using a dry-erase marker.
How to suction the trach tube
Wash your hands with soap and water. Dry them well. See “Do you know…Clean hands.”
Gather your supplies in a clean work area. Open each package, but leave the items inside until you are ready to use them. This helps make sure the items stay sterile (free of germs).
You will need the items below.
- Suction machine with suction tubing attached
- Collection jar for mucus
- Sterile suction catheter size ______
- Sterile water packet (4 ounce cup)
- Ambu bag
- Sterile gloves __________ size
Turn the suction machine on and set it between 60–120mm Hg. Put your child in a position that is comfortable for him, and lets you suction easily.
Suctioning should take 5 to 10 seconds from start to finish. Doing it longer can seriously hurt your child. It can cause your child to lose oxygen he needs to breathe. It can also make the lung collapse.
Do not put any fluid in the trach tube while you suction. Make sure you have an ambu bag nearby.
Follow these steps to suction your child’s trach tube:
- Tell your child that you are ready to suction.
- Put on your gloves (See “Do you know… How to put on sterile gloves.”)
- Take hold of the suction catheter with the hand you usually write with. Only touch the catheter with this hand, nothing else. This keeps your hand sterile (germ free). The photo at the right shows you how this looks. Hold the catheter at the length you know is safe.
- With your other hand, attach the suction machine tubing to the end of the catheter. The photo at the left shows how this should look. Do not touch your sterile hand to anything except the catheter you are already holding.
- Suction some sterile water into the catheter to make sure it is working and to keep it from sticking. The photo shows how to do this.
- If your child is on a ventilator, disconnect the ventilator tubing.
- Optional step: Some children need to take extra breaths while you suction the trach.You can do this with the ambu bag. Most children do not need this, but if your child seems to have trouble breathing, follow the steps below.
- Use the suction catheter to remove any mucus you can see at the tip of the trach tube.
- Attach the ambu bag to the trach tube. Give your child a couple of breaths. The photo at left shows you how this looks. Doing this will loosen mucus and help your child breathe better.
- Then, do the rest of the steps to suction the trach.
- Gently put the catheter into the trach to safe suction length (The photo shows how this looks). Safe suction length for your child is _______ centimeters (cm). Do not use any suction yet. Your child might start coughing when you put the catheter into the trach.
- Apply suction by covering the thumb hole for 5 to 10 seconds. The photo shows how this looks. Do no tsuction longer than 5 or 10 seconds. Pause between each suction to allow your child to get oxygen.
- Slowly take the catheter out of the trach tube by twisting it between your thumb and index finger. Your child might keep coughing when you do this.
- You can suction the trach more than one (1) time. But after you suction 3 times in a row, you need to give your child oxygen using the ambu bag.
- If your child is on a ventilator, reattach the ventilator tubing to the trach tube. Let your child take a few breaths and rest at least 30 seconds. If your child needs more suctioning, follow the steps below.
- Put the catheter in the cup of sterile water. Apply suction to get some water into the catheter. This will rinse out any mucus.
- If your child needs more suctioning, repeat the steps above. Wait at least 30 seconds between each suctioning.
- After you finish suctioning the trach tube, you may suction your child’s mouth and nose with the catheter if needed. Do not put the catheter back in the trach tube after you use it in your child’s mouth or nose. When you are completely finished, wash your hands with soap and water, and dry them well.
When am I finished suctioning?
You are finished suctioning when your child:
- Looks comfortable;
- Is not coughing anymore;
- Is breathing easily; and
- Has skin and fingernails that look pink, not pale or blue.
What does the mucus look like?
- Normal: Clear or white with no smell.
- Infection: Yellow or green with a strong smell. Call your child’s clinic or doctor right away.
- Blood: Mucus with blood in it can be a color from pink to dark brown. Pink shows that there might be some irritation. Dark brown is a sign of bleeding that happened some time ago. Bright red mucus is a sign of fresh blood. This could mean there is a problem. If you see any signs of bleeding, call your child’s clinic or doctor right away.
What if suction does not help my child?
If your child keeps coughing after suctioning, and the mucus seems stuck, you might need to change the trach tube. See “Do You Know… Changing the trach tube.”
What do I do with my supplies afte rI suction?
Turn off the suction machine. Throw your gloves and suction catheter in the regular trash. Pour the remaining sterile water in a sink.
You may clean the suction canister and suction tubing with a mix of 1 cup of white vinegar and warm water. Use 1 cup of vinegar for every 1½ cups of warm water. Make as much of this mixture as you need to soak the tubing and canister for about 30 minutes. Then, rinse the canister and tubing with plain warm water. Put the items on a clean paper towel until they are completely dry.
Change the suction machine tubing and canister at least one (1) time each week, and more often if you need to.
Wash your hands with soap and water after you clean your supplies.
If you have questions or concerns about suctioning, talk to your child’s clinical nurse specialist. A nursing coordinator is always here to answer your questions and address your concerns. Call 901-595-3300 and ask for the nursing coordinator. If you are outside the Memphis area, dial toll-free 1-866-2STJUDE (1-866-278-5833), and press 0 when the call connects.
This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.
St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
ATTENTION: If you speak another language, assistance services, free of charge, are available to you. Call 1-866-278-5833 (TTY: 1-901-595-1040).
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