When Your Child Needs a Tracheostomy: Suctioning

In a trach tube, mucus can build up and thicken. As a result, mucus can plug up the trach tube, making it hard for your child to breathe. Regular suctioning of mucus keeps the tube clear. You will be instructed on how to suction mucus to keep the tube clear. You will also be instructed about techniques for cleaning catheters and how deeply to insert them while suctioning. Below are the basic steps. Follow any other instructions you are given.

Child lying on back with pillow under neck. Gloved hand is inserting catheter into trach tube. Other hand is holding catheter near valve.


Child lying on back with pillow under neck. Gloved hand is twirling catheter and removing it from trach tube. Thumb of other hand is over valve.

Insert the catheter into the trach tube no further than instructed.

To remove mucus, cover the valve and twirl the catheter as you withdraw it.

When to suction

Usually, suctioning is done just before changing and cleaning the trach tube. But you may need to suction more often, depending on your child’s age and the reason for the trach tube. An older child may be able to tell you if he or she feels that suctioning is needed. Here are signs that you may need to suction:

  • Your child is breathing more quickly.

  • You hear a whistling or rattling sound when your child breathes.

  • There are bubbles of mucus at the trach opening or you hear gurgling or rattling sounds as though mucus is present.

  • Your child is having trouble breathing or eating.

Gathering your supplies

As with cleaning, you may find it easier to set up in the same area each time you do suctioning. Choose a clean, well-lighted space near a sink. It is a good idea to have access to a resuscitation bag, in case of an emergency with the trach. Suctioning supplies include:

  • Clean, disposable, powderless gloves

  • Suction machine, tubing, and catheters (you may also use an additional premarked catheter to help guide insertion depth)

  • Sterile water

  • Sterile saline solution

  • Syringe or eyedropper

  • Sterile or clean cup

  • Tissues

Setting up your equipment

First explain to your child what you are about to do. Then set up what you will need:

  • Wash your hands with liquid soap and water. Dry well. You may also use alcohol or disinfectant foam.

  • Put on gloves.

  • Attach the catheter to the suction machine. Don’t touch the end that will go into the trach tube.

  • Turn on the suction machine to 50mm Hg to 100mm Hg.

  • Pour sterile water into a cup.

  • Test whether the catheter is working. Dip the tip of the catheter into the sterile water.

Suctioning the trach tube

Below are basic instructions for suctioning. You may have been given additional specific instructions.

  • Do the following only if your healthcare provider tells you to: Use a syringe or eyedropper to put a small amount (about 1 mL) of sterile saline solution into the trach tube. This helps loosen mucus.

  • Have your child take a few deep breaths. This may cause your child to cough briefly. This is normal and helps to clear the mucus. 

  • Insert a catheter gently into the trach tube as far as you’ve been instructed to do. (Insertion depth depends on the size of your child and the length of the trach tube.)

  • Apply suction by covering and uncovering the suction valve on the catheter.

  • While twirling the catheter, withdraw it to remove mucus. Do not keep the catheter in place for more than 5 to 10 seconds at a time.

  • Draw saline from the cup into the catheter to clear it of mucus.

  • Let your child rest and breathe for 1 to 2 minutes.

  • Then repeat suctioning until the trach tube is clear and makes no more rattling sounds.

  • Check the secretions. Notify the healthcare provider if there are any changes in odor, thickness, color, or amount.

  • Do other steps as instructed. For example, you may also suction your child’s nose and mouth. Or you may need to give extra oxygen (do this only if instructed).

Cleaning up

When you have finished suctioning:

  • Turn off the machine.

  • Throw away the saline and gloves.

  • Follow equipment supplier directions for how to clean the suctioning machine and how often.

Making suctioning easier for your child

Suctioning can produce a gagging sensation, which can be scary to your child. Tell your child that this is normal. It may also help to do relaxing activities beforehand. Let your child rest in between suctioning. And don’t suction for any longer than your child can hold his or her breath. The whole session should last no more than 5 to 10 minutes.


Call the healthcare provider

Contact the healthcare provider right away if your child has any of the following: 

  • Red, painful, or bleeding stoma

  • Yellow or green, smelly, bloody, or thick mucus from the stoma

  • Fever of 100.4°F (38°C) or higher, or as advised by your healthcare provider

  • Swelling around the trach tube

  • Pain when you suction the trach tube

  • Shortness of breath or any trouble breathing

  • Vomiting

  • Trach tube or suction catheter that is difficult to insert