Respiratory: Tracheostomy suctioning (for nursing assistant training)

Tracheostomy suctioning is a procedure used to remove secretions from the trachea in individuals with tracheostomy tubes. A tracheostomy tube is an alternative airway for breathing that is inserted through a hole made on the neck and trachea into the tracheal lumen. Tracheostomy tubes are used to bypass an upper airway obstruction; to prevent aspiration; and enable easier suction of tracheal secretions, which can block the normal airflow and lead to an insufficient oxygen supply.

Generally, nursing assistants should alert the nurse if they think a client requires suctioning. They can assist with tracheostomy suctioning by gathering the required supplies. Now, common signs and symptoms that suggest that a client may require suctioning include a non-productive cough, increased heart and respiratory rate, noisy breathing, shortness of breath, visible secretions, and the presence of coarse breathing sounds or rattling lung sounds.

Now, there are two types of suction catheters used for tracheostomy suctioning. The first one is a one-time use catheter with a control port, which comes in a sterile kit along with sterile gloves and connecting tubing. This catheter is sterile, which minimizes the risk of infection; it’s transparent, which lets the nurse see the secretions and fluids being suctioned out; and it has the thumb control port, which enables suction control. One-time use suction catheters typically have a tip with a single opening and come in various sizes.

For clients who require mechanical ventilation, a closed, or in-line, suction catheter can be used without disconnecting the mechanical ventilator; they are typically used in intensive care units. These catheters are wrapped by a sterile plastic sleeve, so sterile gloves are not necessary. Instead, the nurse can use the regular, or clean, gloves.

Switching gears and moving on to the supplies. If this procedure is within your authorized duties and facility policy and you’re assigned to gather supplies, confirm with the nurse what supplies are needed and the proper sizes. Supplies for this procedure include mask and goggles or face shield; bath towels, cloth, or disposable paper drape; sterile cup; sterile water or saline; and sterile or regular gloves depending on the type of the catheter. Most importantly, you need a suction device, connecting tubing, and suitable-size catheter. If needed, you should also get a nasal or oral airway. Additionally, make sure there is an extra sterile tracheostomy of the same size and an obturator in the client’s room in case of complications, such as blockage or accidentally dislodging the tube.