Tracheostomy Care: How to Suction Your Child's Trach Tube

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Suctioning your child’s trach tube removes mucus from the trachea through the trach tube. When the trach is new, your child will need to be suctioned more often. This is because there is usually more mucus when a trach is first put in. Later on, you will only suction when your child needs it. You will know when he or she needs to be suctioned because you will see or hear signs that your child needs suctioning.

The amount of suctioning needed is different for each child. You will need to suction more often when there is a respiratory infection. Normal mucus is clear to white in color and thin or slightly thick. It should not have an odor. Mucus builds up during sleep, so it is good to suction the trach when your child wakes up in the morning or after naps. Suctioning before eating helps prevent coughing episodes during a meal. Try to avoid suctioning your child’s trach right after he eats to prevent vomiting.

When to Suction Your Child

If you see any of the following signs in your child, you will need to suction the trach:
  • Restlessness; unable to be soothed by cuddling or rocking
  • Trouble breathing
  • Clammy skin
  • Rattling in chest
  • Frightened look on his face
  • Difficulty sucking
  • Bubbles of mucus at the trach opening
  • Pale, blue or dusky color around the mouth
  • Flared nostrils
  • Increased coughing

How to Suction Your Child (Sterile Suctioning)

1. Gather all needed equipment:
  • Suction catheter kit
  • Suction catheters for the trach (_____ Fr)
  • Suction machine
  • Suction connection tubing
  • Gloves
  • Saline
  • Cup

Steps of removing the trach

2. Wash your hands with soap and water for 15 seconds. Rinse and dry.
3. Pour saline into the container or into a cup from your kit.
4. Turn on the suction machine. Check the pressure gauge on it by covering the opening at the end of the machine tubing with your thumb. The pressure gauge needle should stay between 80 to 120 mmHg. If the gauge needle does not stay between those numbers, adjust the pressure according to the instructions from your homecare company.
5. Put on glove(s) (optional).
6. Remove the catheter from the package without touching the end that will go into your child’s trach (Picture 1).
7. Connect the catheter to the suction tubing.
8. Place your fingers at the number located on the catheter. (Refer to the size chart on page 4)
9. Put the free end of the catheter into the saline. Apply suction by holding your thumb over the opening on the catheter (Picture 2). After you are sure the equipment and tubing are working properly, lift your thumb from the opening, and remove the catheter from the saline.
10. Place your fingers on the suction catheter at the number
found on the chart. Gently insert the catheter into the trach tube until your fingers are at the rim of the tube (Picture 3). Do not apply suction while inserting the catheter into the trach tube. Place your thumb over the opening on the catheter to make a vacuum.
11. Start pulling out the catheter. Twirl it between your thumb and finger to keep it from sticking to the trach (Picture 4). As you slowly pull out the catheter, move your thumb on and off the opening to cause the vacuum to go on and off.
12. Do not leave the catheter in longer than 5 seconds. Your child will feel like he cannot breathe if the catheter is left in too long.
13. Repeat suctioning until your child breathes easily or the lungs sound clear. Rest between periods of suctioning. The length of the rest period depends on how comfortable he or she feels.
14. After suctioning is done, throw away the suction catheter and other supplies you used.
15. Your child may cough during suctioning. This is normal and helps to bring up mucus.
16. If necessary, using a different suction catheter, suction your child’s nose and mouth. See Helping Hand HH II-25, Suctioning at Home.
17. Draw water through the tube to clean out secretions in the tube. Suction air through the tubing to dry the tube.

Suction Catheter Size and Length

Trach Type
Suction catheterlength (cm)
Hold at this number
Size of suction catheter in kit
# French
NEO 3.0 6 6
NEO 3.5 6 8
NEO 4.0 6 8
NEO 4.5 6 8
PED 3.0 6+ 6
PED 3.5 6 1/2+ 8
PED 4.0 7 8
PED 4.5 7 8 or 10
PED 5.0 7 10
PED 5.5 8 10 or 12
PDL 5.0 8 10 or 12
PDL 5.5 8 12
PDL 6.0 8+ 12
PDL 6.5 9 12
PDC 4.0 7 8
PDC 4.5 7 8 or 10
PDC 5.0 7 10
PDC 5.5 8 10 or 12
PLC 5.0 8 10
PLC 5.5 8 10 or 12
PLC 6.0 8+ 12
PLC 6.5 9 12
CFS 4.0 10 10
LPC 4.0 10 10
CFS 6.0 11 12
LPC 6.0 11 12
HH-II-193 8/11 Reviewed 4/15 Copyright 2011, Nationwide Children's Hospital