Tracheostomy Suctioning: Procedure, Benefits, Risks, Recovery and Alternatives

Tracheostomy suctioning is a critical procedure for many patients with a tracheostomy tube, helping to keep the airway clear of secretions and prevent complications. While it is a common practice in hospitals and home settings, it involves specific techniques, benefits, potential risks, and recovery considerations. This article provides a comprehensive, evidence-based overview of tracheostomy suctioning—explaining the procedure, its effectiveness, possible side effects, aftercare requirements, and alternatives.

Tracheostomy Suctioning: The Procedure

Tracheostomy suctioning is performed to remove mucus and secretions from the trachea in patients who are unable to clear them naturally. Proper technique is essential to minimize discomfort and complications while maintaining airway patency.

Step	Purpose	Key Considerations	Sources
Preparation	Ensure safety & comfort	Assess need, gather equipment	5 9
Catheter Insertion	Access secretions	Use correct catheter size	5 9 10
Suction Application	Remove secretions	Continuous/intermittent, <15s	8 9
Post-procedure Care	Restore stability	Hyperoxygenate, monitor	9 1

Table 1: Steps and Considerations in Tracheostomy Suctioning

Preparation and Assessment

Before suctioning, a thorough assessment is performed to determine if the procedure is necessary. Indications include audible or visible secretions, respiratory distress, or decreased oxygen saturation. Gather sterile equipment and ensure proper hand hygiene. The patient should be positioned comfortably, and explanations should be provided to reduce anxiety 5.

Catheter Selection and Insertion

A suction catheter that occludes less than half the tracheostomy tube diameter is recommended to minimize airway obstruction and trauma. The catheter should be inserted gently, without force, and not be advanced farther than necessary—ideally not beyond the tip of the tube or the carina 9 10.

Suctioning Technique

• Apply suction only while withdrawing the catheter, using continuous rather than intermittent suctioning for improved efficiency and reduced mucosal injury 8 9.
• Limit each suction pass to no more than 10–15 seconds to avoid hypoxemia 9.
• Avoid instilling normal saline before suctioning, as research indicates it may reduce oxygen saturation post-suctioning and does not improve secretion removal 11.

Post-procedure Care

After suctioning, provide supplemental oxygen and monitor vital signs. Patients may require reassurance, as suctioning can be uncomfortable. Hyperoxygenation before and after suctioning is recommended, particularly for patients at risk of hypoxemia 9 1.

Benefits and Effectiveness of Tracheostomy Suctioning

Tracheostomy suctioning plays a vital role in maintaining airway patency, preventing infection, and supporting respiratory function. Its benefits and effectiveness are well-documented in both acute and chronic care settings.

Benefit	Description	Patient Impact	Sources
Airway Patency	Clears secretions, prevents obstruction	Improved breathing	5 9 2
Infection Reduction	Removes potential pathogens	Lower pneumonia risk	4 5
Oxygenation	Maintains adequate oxygen levels	Reduces hypoxemia	2 7 4
Decannulation Aid	Helps assess readiness for tube removal	Shorter recovery	4

Table 2: Key Benefits and Effectiveness of Tracheostomy Suctioning

Maintaining Airway Patency

The main goal of suctioning is to clear mucus and secretions, which—if left unchecked—can block the airway, impair ventilation, and lead to serious complications like atelectasis or infection 5 9. Suctioning helps patients who cannot effectively cough to maintain open airways.

Reducing Infection Risk

By removing secretions that can harbor bacteria, suctioning reduces the risk of lower respiratory tract infections such as pneumonia and tracheobronchitis. Effective suctioning protocols have been linked to lower rates of infection and shorter hospital stays 4 5.

Supporting Oxygenation and Ventilation

Suctioning can immediately improve oxygenation by clearing obstructions that impede gas exchange. Both open and closed suctioning systems have been shown to be similarly effective in maintaining oxygen saturation and hemodynamic stability 7.

Facilitating Decannulation

The frequency of required suctioning is used as an indicator of readiness for tracheostomy tube removal. A lower need for suctioning, along with stable breathing, can help clinicians decide when to safely decannulate a patient, potentially reducing ICU and hospital stay durations 4.

Risks and Side Effects of Tracheostomy Suctioning

While essential, tracheostomy suctioning is not without risks. Potential complications can range from mild discomfort to serious, life-threatening events. Understanding these risks helps clinicians take preventive measures and respond promptly if issues arise.

Risk	Description	Likelihood/Severity	Sources
Mucosal Injury	Trauma to tracheal lining	Common, varies	9 10 12
Hypoxemia	Reduced blood oxygen	Moderate, transient	9 11
Pain/Discomfort	Procedure-associated pain	Mild to moderate	1
Infection	Introduction of pathogens	Possible, preventable	5 12
Bleeding	Due to mucosal trauma	Infrequent, mild	9 12

Table 3: Main Risks and Side Effects of Tracheostomy Suctioning

Mucosal Injury and Bleeding

Inserting a suction catheter can cause mechanical trauma to the tracheal mucosa, resulting in discomfort, bleeding, or damage to the cilia that help clear mucus naturally. Catheter design matters—those with atraumatic tips reduce injury and preserve mucociliary function better than traditional side-end hole designs 10.

Hypoxemia and Cardiovascular Effects

Suctioning, especially if prolonged or done without adequate pre-oxygenation, can cause transient drops in oxygen saturation and even cardiovascular instability. Hyperoxygenation before and after the procedure is recommended to minimize these effects 9 11.

Pain and Discomfort

Although suctioning is often considered a routine procedure, up to half of patients report moderate to severe pain during the process. Younger, surgical, and non-white patients may be at higher risk for experiencing pain. Analgesia is infrequently used, suggesting a need for more individualized pain management 1.

Infection Risk

Inadequate aseptic technique or use of contaminated equipment can introduce pathogens, leading to tracheal or lung infections. Strict adherence to infection prevention protocols is critical 5 12.

Immediate, Intermediate, and Late Complications

Complications can occur at any time, from immediate events like hypoxemia and arrhythmias to intermediate issues such as infection, and late problems like tracheal stenosis or granulation tissue formation 12 13.

Recovery and Aftercare of Tracheostomy Suctioning

Proper aftercare ensures the patient’s comfort, promotes healing, and minimizes complications. Recovery from suctioning is generally rapid, but ongoing care is vital for optimal outcomes.

Aspect	Description	Key Actions	Sources
Monitoring	Watch for complications	Check oxygen, bleeding	5 9 1
Humidification	Prevents secretion thickening	Use humidifiers	5
Hygiene	Reduces infection risk	Sterile technique	5 12
Patient Comfort	Addresses pain/discomfort	Reassure, manage pain	1 5

Table 4: Aftercare and Recovery Strategies

Monitoring and Immediate Support

After suctioning, monitor the patient’s respiratory rate, oxygen saturation, heart rate, and for signs of bleeding or respiratory distress. Most adverse effects, such as hypoxemia or mild bleeding, resolve quickly with supportive care 5 9.

Humidification and Airway Care

Tracheostomy bypasses the upper airway’s natural humidification, making secretions thicker and harder to clear. Ongoing humidification—via heated humidifiers or nebulizers—is recommended to maintain secretion mobility and prevent mucus plugs 5.

Hygiene and Infection Prevention

Strict aseptic technique must be maintained during and after suctioning to prevent infection. Regular cleaning or changing of suction catheters, and routine tracheostomy site care, are essential 5 12.

Managing Pain and Discomfort

Patients may feel anxious or uncomfortable after suctioning. Providing reassurance, adjusting pain management as needed, and explaining future procedures can improve the experience and outcomes 1 5.

Alternatives of Tracheostomy Suctioning

While manual suctioning remains standard, alternatives and adjuncts can reduce risks, improve effectiveness, or eliminate the need for frequent invasive suctioning.

Alternative	Description	Advantages	Sources
Mechanical Insufflation-Exsufflation	Device-assisted secretion removal	More effective in some patients	2
Closed Suction Systems	Suctioning without disconnecting ventilator	Reduces infection risk	3 7
Automated Suctioning	Mechatronic/robotic systems	Saves staff time	6
Humidification & Airway Clearance	Mobilizes secretions	Non-invasive	5 4

Table 5: Alternatives and Adjuncts to Tracheostomy Suctioning

Mechanical Insufflation-Exsufflation

This technique uses a device to deliver positive pressure followed by negative pressure, simulating a cough. Studies in patients with neuromuscular diseases (e.g., ALS) have shown it can be more effective than standard suctioning for secretion removal, improving oxygenation and reducing work of breathing 2.

Closed Suction Systems

Closed systems allow suctioning without disconnecting the patient from the ventilator, thus maintaining oxygenation and reducing the risk of infection and aerosol generation—especially important in infectious disease outbreaks like COVID-19 3 7.

Automated and Mechatronic Systems

Emerging technologies include automated suction devices that can be programmed or remotely controlled, reducing the burden on caregivers and standardizing suctioning frequency and technique 6.

Humidification and Airway Clearance Techniques

Optimizing humidification and using airway clearance physiotherapy can reduce the need for frequent suctioning by making secretions easier to mobilize and cough out naturally 5 4.

Conclusion

Tracheostomy suctioning is a life-saving, essential procedure for many patients, but requires careful technique, awareness of risks, and attention to patient comfort. Advances in technology and alternative airway clearance methods are improving outcomes and patient experience.

Key Points:

• Tracheostomy suctioning clears secretions, prevents airway obstruction, and supports respiratory function.
• The procedure must be performed with sterile technique, proper equipment, and careful monitoring to minimize risks.
• Benefits include improved breathing, reduced infection, and better oxygenation, but complications like mucosal injury, hypoxemia, pain, and infection can occur.
• Recovery involves vigilant monitoring, pain management, humidification, and infection prevention.
• Alternatives such as mechanical insufflation-exsufflation, closed suction systems, and automated devices offer additional options for airway management.

By understanding the procedure, benefits, risks, recovery, and alternatives, healthcare professionals can provide safer, more effective care for patients with tracheostomies.