Tracheostomy Care: Suctioning with a Closed Suction System (Ballard)

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Suctioning your child’s tracheostomy (trach) tube is done to remove mucus from his or her 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 placed. Later on, you will only suction your child when he needs it. You will know when he needs to be suctioned because you will see or hear signs your child needs suctioning.

The amount of suctioning needed is different for each child. You will need to suction more often when your child has 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 he eats helps prevent coughing episodes during a meal. Try to avoid suctioning your child’s trach right after he eats to prevent vomiting.

If your child is on a ventilator (vent), a catheter that is protected inside a sterile sleeve may be needed. This is called a closed suction system or Ballard suction. This catheter stays attached to your child’s trach and is changed weekly. This allows suctioning without taking your child off the vent.

How to suction your childMove catheter into trach, squeeze thumb valve to make vacuum, remove catheter until black tip shows

  1. Gather all needed equipment
    • Closed suction catheter (Ballard), Size ________Fr
    • Suction machine
    • Saline bullets
  2. Open the suction valve on the Ballard. (Picture 2,
    below the thumb)
  3. Gently insert the catheter into the trach by holding
    the clear elbow attached to your child’s trach tube.
  4. While holding the clear elbow with one hand, move the catheter into the trach with your thumb and index finger (Picture 1). Do not apply suction while inserting the catheter into the trach tube.
  5. Slide the catheter in the sleeve to the color or number as you were told. (See size and length chart page 3)
  6. To suction, squeeze the thumb valve. This will make a vacuum (Picture 2).
  7. Start pulling out the catheter. Remember to hold the clear elbow attached to your child’s trach while removing the catheter until you see the black tip in the dome (Picture 3).
  8. Do not leave the catheter in longer than 5 seconds. Your child may feel like he or she cannot breathe if the catheter is left in too long.
  9. Repeat suctioning until your child breathes easily or the lungs sound clear. Let your child have rest periods between suctioning. The length of the rest period depends on how comfortable your child feels.
  10.  Your child may cough during suctioning. This is normal and helps to bring up mucus.

Closed Catheter Suctioning Tube Size and Length

Trach Type

Ballard

View where Ballard attaches to tubing away from patient
(see arrow)

 

Trach Type

Ballard

View where Ballard attaches to tubing away from patient (see arrow)

NEO 3.0

< 10

 

PDC 4.0

Stop at red

NEO 3.5

10

 

PDC 4.5

Stop at red

NEO 4.0

11

 

PDC 5.0

Put red ½ in

NEO 4.5

11

 

PDC 5.5

Blue <14

 

 

 

 

 

PED 3.0

11

 

PLC 5.0

Blue <14

PED 3.5

Stop at red

 

PLC 5.5

Blue <14

PED 4.0

Stop at red

 

PLC 6.0

See yellow 14

PED 4.5

Stop at red

 

PLC 6.5

14

PED 5.0

Put red ½ in

 

 

 

PED 5.5

Blue <14

 

CFS 4.0

16 black

 

 

 

LPC 4.0

16 black

PDL 5.0

Blue <14

 

CFS 6.0

Green < 17

PDL 5.5

Blue <14

 

LPC 6.0

Green < 17

PDL 6.0

See yellow 14

 

 

 

PDL 6.5

14

 

 

 

where to measure for tube size and length

Tracheostomy Care: Suctioning with a Closed Suction System (Ballard) (PDF)

HH II-196 10/11, Reviewed 11/17 Copyright 2011, Nationwide Children's Hospital