What are the steps for tracheostomy suctioning?

1. Suction ONLY for an indication: visible/audible secretions, desaturation, increased work of breathing — not on a schedule 2. Pre-oxygenate (100% or per policy) before each pass 3. Insert the catheter WITHOUT suction to the carina point, pull back 1 cm 4. Apply suction ONLY on withdrawal, rotating, ≤ 10–15 seconds per pass 5. Re-oxygenate between passes; limit total passes (usually ≤ 3) 6. Reassess: lung sounds, SpO₂, work of breathing, secretion character

What are common mistakes with tracheostomy suctioning?

Suctioning on insertion (mucosal damage, hypoxia) Routine scheduled suctioning of a patient who doesn't need it Normal saline lavage 'to loosen secretions' — not supported by evidence, causes desaturation

Tracheostomy Suctioning

Procedures

The steps

Suction ONLY for an indication: visible/audible secretions, desaturation, increased work of breathing — not on a schedule
Pre-oxygenate (100% or per policy) before each pass
Insert the catheter WITHOUT suction to the carina point, pull back 1 cm
Apply suction ONLY on withdrawal, rotating, ≤ 10–15 seconds per pass
Re-oxygenate between passes; limit total passes (usually ≤ 3)
Reassess: lung sounds, SpO₂, work of breathing, secretion character

🛡 Never skip

Keep at the bedside always: obturator, spare trach (same size + one smaller), suction working Fresh trach (< 7 days) that comes out = emergency, do not blindly reinsert — bag the face/stoma per situation, call for help Watch for vagal bradycardia during suctioning

Common mistakes

Suctioning on insertion (mucosal damage, hypoxia)
Routine scheduled suctioning of a patient who doesn't need it
Normal saline lavage 'to loosen secretions' — not supported by evidence, causes desaturation

Source: Lippincott Nursing Procedures, 9th ed.; AARC Clinical Practice GuidelineReference only — verify against your facility's policy.

Tracheostomy Suctioning

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