Suctioning and Airway Clearance
Suctioning your tracheostomy requires inserting a small catheter into the trach tube that is attached to a suctioning device.
“Suctioning removes mucus that you are unable to clear adequately by coughing,” says Puram. “This can be especially important during the early postoperative period, when secretions may be increased until the patient’s body adjusts to the new tracheostomy.”
Suctioning should generally be done whenever needed, rather than simply as often as possible, he adds. “Unnecessary or overly frequent suctioning can irritate the airway and cause bleeding.”
Tracheostomy suctioning should be performed based on individual need, but frequency depends on several factors. “Suctioning is needed immediately after surgery because the body makes excessive mucus due to the procedure,” says Rosamilia. “As patients continue to heal, the amount of suctioning should not be needed as often. But anytime you’re unable to cough up mucus on your own, suctioning is needed.”
Individuals should try to give a strong cough to help bring the mucus up and then use the suction catheter to remove it, she says. “But if you’re coughing frequently and feel as if there is something stuck or not moving, it’s very important to suction because mucus that is not removed can cause what is known as a mucus plug,” says Rosamilia. A mucus plug is essentially a buildup of thick mucus that eventually can clog the trach.
“This can make it difficult to breathe normally,” she says. “Sometimes a mucus plug can even make it difficult for the suction catheter to pass into the tracheostomy appropriately.”
If the suction catheter can’t pass easily, contact your care team immediately, she says.
Other signs that you may need to suction your tracheostomy include hearing or feeling mucus rattling or gurgling in the trach, or your cough sounds wet or congested but does not clear the secretions, says Puram.
“You may also need suctioning if you’re breathing faster or working harder to breathe, or notice decreased airflow through the trach,” he says. “If you monitor oxygen at home and your oxygen level falls below the range your medical team told you is acceptable, you may need suctioning.”
It’s also important to follow the instructions your care team gives you — such as if you should suction at specific times, like right after waking up, or before certain treatments, Puram adds.
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