For patients with a tracheostomy tube, regular suctioning is crucial for maintaining a patent airway. The frequency of suctioning depends on several factors, including the amount of secretions, type of tracheostomy tube, and patient’s condition. Establishing a routine suctioning schedule and suctioning as needed is important.
What is a tracheostomy?
A tracheostomy is a surgical procedure where an opening is created in the anterior neck that allows direct access to the trachea (windpipe). A tracheostomy tube is placed through this opening to help maintain an open airway. Reasons for needing a tracheostomy include:
- Long-term mechanical ventilation
- Upper airway obstruction
- Severe neurological conditions
- Severe facial trauma
The tracheostomy tube bypasses the upper airway and any obstructing lesions, allowing for direct suctioning of tracheal secretions. This helps prevent accumulation of mucus that could obstruct breathing.
Why is suctioning important for trach patients?
Suctioning removes mucus and other secretions from the airways that the patient cannot cough out on their own. Reasons why regular suctioning is important include:
- Prevents blockage of the tracheostomy tube
- Maintains a patent airway
- Decreases risk of respiratory infections
- Improves oxygenation
- Enhances comfort and ease of breathing
Without regular suctioning, tracheal secretions can accumulate and obstruct the tracheostomy tube. This can lead to life-threatening respiratory emergencies such as hypoxia, carbon dioxide retention, or respiratory arrest.
How often should suctioning be done?
There is no universal standard for how often trach patients require suctioning. Factors that influence suctioning frequency include:
- Amount of secretions – Patients with more copious secretions require more frequent suctioning.
- Consistency of secretions – Thicker secretions may require more frequent suctioning to prevent tracheal tube obstruction.
- Type of tracheostomy tube – A tube with a cuff requires less frequent suctioning compared to a tube without a cuff.
- Patient’s clinical status – Patients who are more critically ill or have impaired cough reflex require more frequent suctioning.
As a general guideline, trach patients are suctioned every 1-4 hours routinely. However, more frequent suctioning such as every 30 minutes may be required if the patient has thick, copious secretions.
Initial suctioning frequency
When a tracheostomy tube is first inserted, frequent suctioning is needed:
- Every 30 minutes for the first 24 hours after tracheostomy insertion
- Every 1-2 hours for the next 24 hours
- Then transition to a routine schedule based on assessment
Frequent initial suctioning helps remove blood, mucus and debris from the surgical procedure.
Routine suctioning frequency
| Clinical status | Recommended frequency |
|---|---|
| Minimal secretions and stable | Every 4 hours |
| Moderate secretions | Every 2-4 hours |
| Heavy secretions or impaired cough | Every 1-2 hours |
| Critically ill | Every 30 minutes to 1 hour |
The above reflects typical routine suctioning frequency. However, individual assessment is key.
Assessing the need for suctioning
While a routine suctioning schedule is helpful, patients also require suctioning as needed outside of the routine schedule. Frequent assessment allows clinicians to determine when a trach patient requires additional suctioning.
Signs that indicate the need for suctioning include:
- Audible secretions in the trachea
- Visible secretions in the tracheostomy tube or coming from the tracheal stoma
- Increase in respiratory rate or work of breathing
- Decrease in oxygen saturation levels
- Signs of respiratory distress – retractions, nasal flaring, use of accessory muscles
- restlessness
- Inability to generate an effective cough
- Change in mental status
If any of the above signs are present, immediate suctioning is warranted even if it is sooner than the scheduled time.
Suctioning techniques
Proper techniques are vital for suctioning trach patients effectively while avoiding complications:
- Use sterile gloves and catheter for each suction pass
- Explain procedure to patient
- Ensure patent suction setup with adequate negative pressure
- Use normal saline instillation if thick secretions
- Insert catheter only to the end of the tracheostomy tube
- Apply suction as catheter is withdrawn with a twisting motion
- Limit suctioning pass to 10-15 seconds
- Allow patient to rest and reoxygenate between passes
- Change catheter if becomes occluded with secretions
Avoiding excessive suction pressure and prolonged suction passes decreases the risk of hypoxia, tracheal trauma, and arrhythmias.
Special considerations
Certain types of tracheostomy tubes and patients require special suctioning considerations:
Fenestrated tubes
Fenestrated tracheostomy tubes have an opening along the length of the curved tube. This facilitates removal of subglottic secretions from above the tracheal cuff. Fenestrated tubes require more frequent suctioning to prevent accumulation of secretions above tracheal cuff.
Cuffless tubes
Tracheostomy tubes without a cuff require more frequent suctioning usually every 1-2 hours. Since there is no cuff to form a closed system, secretions can easily pool above and below the tube.
Thick or copious secretions
Patients with thick or excessive secretions often require 1-2 hourly suctioning and may benefit from saline instillation. Mucolytic agents can also help thin secretions.
Ineffective cough
Patients with weak cough effort require more aggressive routine suctioning such as every 1-2 hours to prevent mucus plugging. Airway clearance devices like a cough-assist machine may be helpful.
Unconscious or sedated patients
Heavily sedated or comatose patients are unable to protect their airway and rely entirely on suctioning by caregivers to keep airway clear. They typically require suctioning every 1-2 hours or more frequently.
Suctioning documentation
Proper documentation regarding trach suctioning includes:
- Date and time of suctioning
- Reason for suctioning – routine or symptomatic
- Appearance and amount of secretions
- Patient’s tolerance of procedure
- Patient’s respiratory response – improvement or worsening of oxygenation
- Any associated complications
Complete documentation helps the care team determine trends and appropriate suctioning frequency for a given patient.
Complications of suctioning
While suctioning is essential for trach patients, some potential complications include:
- Hypoxia
- Hypercarbia
- Cardiac dysrhythmias
- Mucosal injury or bleeding
- Infection
- Increased intracranial pressure
- Tracheal tube dislodgement
Careful attention to proper suctioning technique minimizes these risks. Appropriate suction pressures should be used – <80-120 mmHg for an adult and <100-120 mmHg for a child.
Conclusion
Establishing a structured routine suctioning schedule along with close assessment and suctioning as needed is key for trach patients. Typical frequency is 1-4 hours but should be individualized based on the patient’s underlying condition, amount of secretions, and clinical status. Proper techniques and complete documentation also optimize tracheal suctioning safety and effectiveness. Consistent airway suctioning is crucial for trach patients to prevent life-threatening respiratory complications.