Does anyone in your family have a tracheostomy tube to help them breathe? Or do you use one yourself? Then you probably know that it's normal for mucus and other debris to build up inside this tube. Most of the time, it clears up with a good cough. But sometimes, no matter how hard you try, you can't get rid of this mucus. That's when you need to "suction" the tube, which is to say, clean it with a machine. Today, we'll talk about how to do this properly and safely.
What is tracheostomy suctioning?
Simply put, a tracheostomy is a small surgical procedure in the front of the neck that inserts a tube directly into the windpipe (trachea) of a person who is having difficulty breathing. This tube allows the person who is unable to breathe naturally to breathe more easily.
It is normal for mucus to build up in the trachea of someone with a tube in this way. The best way to clear this mucus is to cough vigorously. But sometimes the mucus can become too thick to be cleared by coughing. In those cases, we use a suction machine to suck out the mucus and remove it, which is called tracheostomy suction.
This can be done by medical staff in a hospital, or they can teach you how to suction your tube (or your child's tube) yourself at home. It is very important to learn this correctly to prevent the tube from getting stuck and to make breathing easier.
How do you know if the tube needs suction?
When caring for someone with a tracheostomy tube, you should be aware of several signs that indicate it's time to suction the tube. These signs mean that the tube is clogged with mucus and needs to be cleaned.
| Visible/tangible sign | What does this mean? |
|---|---|
| A wet, phlegmy cough | The mucus comes out with the cough, but it doesn't go away completely. |
| Feeling short of breath | I feel like I'm not getting enough breath. |
| The appearance of mucus bubbles near the mouth of the tube | The mucus is trying to come out of the tube. |
| Hearing a snoring sound | This sound is made because air moves through the mucus when you breathe. |
| Increased breathing rate, wheezing | An attempt to get the oxygen the body needs. |
| Blue discoloration around the mouth (cyanosis) | This is an emergency. It's a sign that the blood isn't getting enough oxygen. |
| A whistle-like sound coming from the pipe | The tube has become narrower, and there is less room for air to pass through. |
| Restlessness, agitation | Stress caused by difficulty breathing. |
Simply put, the best thing to do is to suction the tracheostomy tube any time you think it's blocked.
Things to prepare before suctioning
It is very important to have everything you need ready before starting this task. Then you can do the job without any hassle.
- Tracheostomy suction machine
- A clean, new suction catheter
- Connection tubing that connects the catheter to the machine
- A cup of clean, boiled water
- Gloves
- A small basin or bowl
How does this process happen? Let's find out step by step!
If you are suctioning yourself or someone else, you can do so safely by following these steps.
1. Wash your hands thoroughly: Apply soap and rinse your hands under running water and dry with a clean towel.
2. Find a comfortable position: Sit in a chair or lie down in bed. Position yourself in a way that provides good support for your head and neck.
3. Turn on the machine and set the pressure: Turn on the suction machine and set the pressure to low or medium. This pressure is usually kept between 80-120 mmHg (millimeters of mercury). Never increase the pressure above 120 mmHg. Doing so may damage the airway. If you are not sure about this, ask your doctor first to find out for sure.
4. Put on gloves: Put on a pair of clean gloves. You don't need sterile gloves for this.
5. Set up the catheter: Attach the clean suction catheter to one end of the tubing. Make sure the other end of the tubing is securely attached to the machine.
6. Take a deep breath: You won't be able to breathe properly while the catheter is in the tube. So take a few deep breaths beforehand. It's normal to cough during suctioning.
7. Insert the catheter: Now carefully insert the catheter into the tracheostomy tube. Only insert it as far as you have been instructed. Do not force it . If you feel something getting stuck, stop right there. Do not cover the suction hole with your finger at this time. This means that it is not a good idea to use suction while inserting the catheter.
8. Pull the catheter back slightly: Before you start suctioning, pull the inserted catheter back slightly. This will allow it to work properly.
9. Start suctioning: Now place your thumb over the suction control vent and close it. The mucus will start to be sucked out. Do not continue to suck for more than 10 seconds. If you feel any discomfort while doing so, remove your finger immediately.
10. Remove the catheter: Gently twist the catheter as you remove it from the tracheostomy tube.
If you don't hear or see any mucus near the tube, you're done. But you may need to apply more suction. If so, wait at least 30 seconds before doing it again. If the catheter gets clogged with mucus, suck out some water to clean it, or use a new one.
If you have tried three times and still can't get the mucus out, wait about 10 minutes and try again. However, if you experience severe difficulty breathing, seek help immediately or go to the nearest hospital's Emergency Department (ETU).
How do you clean the equipment when you're done?
It is very important to clean the equipment properly after suctioning.
- Put some clean, boiled water in the sink.
- Suck that water through the suction catheter and rinse the inside of the tubing thoroughly.
- Turn off the suction machine.
- Remove the catheter. If it is disposable, throw it in the trash. If it is reusable, wash it and set it aside for later sterilization.
- Hang the connecting tube from the machine with its tip facing up.
- Wash the sink thoroughly with soap.
- Remove gloves and discard.
- Finally, wash your hands thoroughly with soap again.
What are the benefits and possible complications of this?
Learning to suction at home can reduce the number of hospital visits. It also gives you the freedom to clean the tube whenever needed. This is the best way to get quick relief from breathing difficulties caused by thick mucus.
Complications are rare, but they can sometimes occur.
- A little bleeding
- Infections
- Pain or discomfort
- Sometimes, vagal nerve stimulation can reduce heart rate and oxygen levels.
When do you need to talk to the doctor?
Talk to your doctor anytime you have any concerns about your tracheostomy suctioning. Especially if you notice any of the following :
- If the mucus smells bad.
- If the mucus changes color (yellow, green, red, or brown), these may be signs of an infection.
If you are unable to remove the mucus after suctioning, or if you continue to have difficulty breathing despite suctioning, call your doctor immediately or go to the nearest hospital emergency department (ETU). Sometimes, if the mucus is very thick, the tracheostomy tube may need to be replaced.
Living with a tracheostomy tube has its challenges. But when you learn these things properly, you too can overcome those challenges and live a life of freedom doing the things you love.
Take-Home Message
- Suction the tracheostomy tube as soon as you notice signs of needing suction (groaning, difficulty breathing). Do not wait until the scheduled time.
- When suctioning, do not do it for more than 10 seconds at a time. This can make it difficult to breathe.
- Always use clean equipment. Wash your hands thoroughly before and after work.
- If the color of the mucus changes, if it smells bad, or if the difficulty breathing does not improve even after suctioning, call your doctor immediately or go to the ETU.
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