Tracheostomy Suctioning: Purpose, Steps, Safety and Care
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is tracheostomy suctioning?
Tracheostomy suctioning is a procedure that removes mucus and secretions from a tracheostomy tube when coughing does not clear them, helping keep the airway open. The catheter should never be forced or inserted beyond the instructed depth, and each attempt should last no more than 10 seconds. If suctioning fails and breathing distress continues, call for emergency help immediately.
What the research says
Tracheostomy care standards rest largely on expert consensus, and caregiver education is a core element. A clinical consensus statement on tracheostomy care in children and adults used a modified Delphi process and reached consensus on 77 statements (another 39 were dropped for lack of consensus). The agreed statements address tube changes, management of emergencies and complications, prerequisites for decannulation, cuff and communication-device management, and patient and caregiver education needs. The panel also highlighted areas where more research is needed (Mitchell et al., Otolaryngol Head Neck Surg, 2013).
How often a person needs suctioning is itself clinically meaningful. In a randomized trial of 330 critically ill adults with a tracheostomy, using suctioning frequency (with continuous high-flow oxygen) as the sign of readiness for tube removal shortened the time to decannulation compared with a 24-hour capping trial (median 6 vs 13 days; absolute difference 7 days, 95% CI 5 to 9). Pneumonia and tracheobronchitis were less frequent and hospital stay was shorter, with no evidence of a difference in decannulation failure. This was an intensive care study in adults, so it does not set home-care schedules (Hernández Martínez et al., N Engl J Med, 2020).
What is tracheostomy suctioning?
A tracheostomy tube passes through a surgically created opening, called a stoma, in the windpipe. It provides an alternative route for breathing when a person cannot breathe naturally.
People with tracheostomies commonly have mucus or secretions. A strong cough is the best way to clear them, but thick mucus may remain even when someone tries to cough. Tracheostomy suctioning uses a connected catheter and suction machine to remove secretions from the tracheostomy tube, windpipe and lower airway when coughing is not enough.
This procedure is not a substitute for individualized training. A patient or caregiver should follow the instructions given for the specific tracheostomy tube, suction machine and care plan.
Definition: Tracheostomy suctioning is the trained use of a suction catheter and machine to clear mucus that cannot be removed effectively by coughing.
Why might a trach need suctioning?
A tracheostomy may need suctioning when mucus is affecting airflow or cannot be cleared. Possible signs include a moist cough, inability to clear secretions from the throat, visible mucus or bubbles at the trach opening, rattling or a whistling sound from the tube.
Breathing changes are especially important. Difficulty breathing, a feeling of not getting enough air, gasping, fast breathing, flaring nostrils or sinking in of the chest between the ribs can indicate that breathing is taking more effort. A bluish color around the mouth, clammy skin, irritability or restlessness can also be warning signs.
Possible sign | What it may mean in the care context |
Moist cough | Mucus may be present and difficult to clear. |
Visible mucus or bubbles | Secretions are near the trach opening. |
Rattling or whistling | Airflow may be affected by secretions or a blockage. |
Fast breathing or gasping | Breathing may be more difficult than usual. |
Chest retractions | The chest may be working harder to breathe. |
Bluish color around the mouth | Requires urgent attention to breathing. |
Restlessness or irritability | May occur when breathing is uncomfortable. |
Suspected blockage | The trach tube may not be open as expected. |
A single sign does not replace clinical judgment. Use the individualized plan provided by the healthcare team, especially when a person is short of breath or appears distressed.
What supplies are used?
The supplies commonly used are a tracheostomy suction machine, a clean suction catheter, connection tubing, a cup of clean distilled water, gloves and a bowl or basin.
Supply | Role in the procedure |
Suction machine | Creates the suction used to clear secretions. |
Clean suction catheter | Connects to the tubing and enters the trach tube as instructed. |
Connection tubing | Links the catheter to the suction machine. |
Clean distilled water | Used to help flush connection tubing after suctioning and may help clear a clogged catheter. |
Gloves | Clean, boxed gloves are typically used; sterile gloves are not necessary for home suctioning. |
Bowl or basin | Holds water and supports equipment cleaning. |
The exact equipment setup may vary. Confirm the correct supplies and instructions with a healthcare professional before performing suctioning at home.
How should someone prepare?
Wash your hands thoroughly with antibacterial soap and running water, then dry them with a clean towel. Sit or lie down comfortably, with the head and neck well supported.
Turn on the suction machine and confirm the prescribed or instructed pressure. A commonly cited range for tracheostomy suctioning is 80 to 120 mmHg. Pressure above 120 mmHg can damage the windpipe, so a healthcare professional should confirm the correct setting before use.
Put on clean, boxed gloves. Connect the clean suction catheter to the connection tubing, and connect the other end of the tubing firmly to the suction machine.
Take a couple of deep breaths before positioning the catheter. Breathing may feel more difficult while the catheter is in the trach, and coughing during suctioning can be normal.
What are the main steps?
Tracheostomy suctioning should be performed only after a qualified healthcare professional has taught the patient or caregiver the technique for the specific tube. The following overview keeps the safety limits and sequence clear without replacing that training.
Gently place the catheter into the trach tube only as far as instructed. Different tubes have different lengths. Do not force it. If you feel resistance, stop.
Keep your finger off the suction-control vent while positioning the catheter. Suction should not be applied during insertion.
Pull the catheter back slightly before beginning suctioning so it has room to work.
Place your thumb over the suction-control vent to begin suctioning.
If suctioning causes discomfort, remove your thumb from the vent.
Suction for no more than 10 seconds at a time.
Remove the catheter gently, twisting as you pull it out.
The catheter should not be advanced farther than the individualized instructions allow. Do not use force to overcome resistance, and do not improvise a depth or pressure setting.
What if mucus is still present?
If you no longer see or hear mucus near the trach opening, suctioning may be complete. Some people may need more than one attempt.
Wait at least 30 seconds before suctioning again. If the suction catheter is clogged, water may help clear it, or the catheter can be replaced with a new one.
If you have tried three times without success, wait 10 minutes before trying again. This rule does not mean that breathing distress should be watched at home. If the person is in distress or feels short of breath, call for help or call your local emergency number (911 in the United States).
How often is suctioning needed?
A commonly cited routine schedule is twice each day: once when waking in the morning and again before bed in the evening. Suctioning is also commonly done before eating and after respiratory treatments.
The right timing can depend on the person's care plan, secretions and tracheostomy tube. Ask a healthcare professional if the routine schedule is unclear, if mucus is changing or if suctioning is becoming more difficult.
What happens after suctioning?
Clean the equipment after the procedure. Fill the bowl or basin with clean distilled water and use the suction catheter to flush water through the connection tubing. Turn off the suction machine.
Disconnect the catheter from the tubing. If it is disposable, place it in the wastebasket. If it is reusable, rinse it and set it aside for later disinfection. Hang the tubing on the suction machine with the tip pointing up.
Wash the bowl or basin with antibacterial soap and warm running water. Remove and discard the gloves, then wash and dry your hands thoroughly.
After-care step | Purpose |
Flush tubing with clean distilled water | Helps clear remaining secretions from the connection tubing. |
Turn off the machine | Ends the procedure safely. |
Dispose of or rinse the catheter | Follows the equipment type. |
Hang tubing with tip up | Keeps the tubing positioned for drying and storage. |
Wash the bowl or basin | Cleans the reusable container. |
Remove gloves and wash hands | Completes hand and equipment hygiene. |
Follow any additional cleaning or disinfection instructions provided for the specific equipment. Do not assume that a reusable component can be stored without the care team's instructions.
What are the benefits and possible complications?
Learning how to suction a trach at home may reduce office visits and give a patient or caregiver more flexibility to maintain the tube when necessary. Thick secretions can sometimes cause respiratory distress, and suctioning may improve breathing when secretions are the problem.
Complications are not common, but possible risks include bleeding, infection, pain or discomfort, and vagal nerve stimulation. Vagal nerve stimulation can lower heart rate and oxygen levels.
Potential issue | Safety response |
Pain or discomfort | Remove the thumb from the suction-control vent and stop suctioning. Ask a healthcare professional for guidance. |
Bleeding | Contact the healthcare team promptly, especially if bleeding is more than a minor spot or does not stop. |
Infection concern | Report foul-smelling or yellow, green, red or brown mucus. |
Persistent breathing difficulty | Seek immediate help or emergency services. |
Unsuccessful suctioning | Contact a healthcare professional immediately; the tube may occasionally need replacement if mucus is too thick to suction. |
When should someone call a healthcare professional?
Call a healthcare professional any time you have questions about tracheostomy suctioning, equipment, catheter depth or pressure settings.
Report foul-smelling mucus or mucus that is yellow, green, red or brown. These changes may indicate a possible infection.
Contact a healthcare professional immediately if suctioning is unsuccessful or if shortness of breath continues despite suctioning. If the person is in distress, call your local emergency number (911 in the United States) and follow the emergency instructions provided by the care team.
What questions should you ask before home tracheostomy suctioning?
Before home tracheostomy suctioning, ask whether you have been trained on the exact tube, how far to insert the catheter, what pressure to use and what the emergency plan is.
Has a qualified healthcare professional taught me or my caregiver the technique for this exact tracheostomy tube?
How far should the catheter be inserted, and what resistance should make us stop?
What suction pressure should we use on this machine?
How often should suctioning be done for this care plan?
What should we do if the catheter becomes clogged?
When should we wait 30 seconds, and when should we stop and call for help?
What is the emergency plan if suctioning does not clear the tube?
Which parts of the equipment are disposable, reusable or disinfected later?
Who should we contact about foul-smelling or discolored mucus?
What should we do if suctioning causes pain, bleeding or a change in breathing?
When should you seek urgent help with tracheostomy suctioning?
Call local emergency services immediately for severe breathing difficulty, visible distress, a bluish color around the mouth, gasping, chest retractions or suspected airway blockage that does not improve with the trained care plan.
Do not keep repeating unsuccessful suction attempts while a person remains short of breath. Emergency responders and the treating healthcare team can guide the next step, including whether the trach tube needs professional assessment or replacement.
Conclusion
Tracheostomy suctioning can clear mucus that a person cannot remove by coughing and may help keep a trach tube open. The procedure depends on individualized training, correct equipment, controlled pressure, careful catheter positioning and short suction intervals.
The key safety limits are simple but important: never force the catheter, do not apply suction while positioning it, do not suction for more than 10 seconds at a time and wait at least 30 seconds before another attempt. After three unsuccessful attempts, wait 10 minutes before trying again, but seek immediate help sooner if distress or shortness of breath continues.
Frequently Asked Questions
What is tracheostomy suctioning?
Tracheostomy suctioning is a procedure that uses a suction catheter and machine to clear mucus and secretions from a tracheostomy tube, windpipe and lower airway when coughing does not work well enough.
Can tracheostomy suctioning be done at home?
Tracheostomy suctioning can be done at home after a healthcare professional teaches the patient or caregiver the technique for the specific tracheostomy tube and equipment.
What pressure is used for tracheostomy suctioning?
A commonly cited range is 80 to 120 mmHg, and pressure above 120 mmHg can damage the windpipe. Settings can differ by age and care plan, so confirm the correct setting with a healthcare professional before use.
How long should suctioning last?
Do not suction for more than 10 seconds at a time. If another attempt is needed, wait at least 30 seconds first.
How many times can someone try suctioning?
After three unsuccessful attempts, wait 10 minutes before trying again. If the person is in distress or remains short of breath, call for immediate help or local emergency services instead of continuing unsupervised attempts.
How often should a trach be suctioned?
A commonly cited routine schedule is twice daily, on waking and before bed, plus before eating and after respiratory treatments. Follow the individualized care plan if it differs.
Is coughing during suctioning normal?
A person may cough during suctioning. Deep breaths before positioning the catheter can help prepare, but the patient or caregiver should follow the technique taught by the healthcare professional.
What should happen if the catheter meets resistance?
Stop and do not force it. Tracheostomy tubes have different lengths, so catheter depth must follow the instructions for the individual tube.
How do I prepare for tracheostomy suctioning?
Gather a suction machine, a clean suction catheter, connection tubing, a cup of distilled water, gloves and a bowl. [3] Wash your hands with antibacterial soap and running water (clean boxed gloves are fine; sterile gloves aren't necessary), set the suction to low or medium pressure of 80 to 120 mmHg, and sit or lie with the head and neck supported. [3]
Does tracheostomy suctioning hurt?
Pain or discomfort is a possible complication, and coughing during suctioning is normal. [3] If it feels uncomfortable, take your thumb off the suction-control vent to stop suctioning; suction for no more than 10 seconds at a time and wait at least 30 seconds before trying again. [3]
What mucus changes should be reported?
Report foul-smelling mucus or mucus that is yellow, green, red or brown because these may indicate a possible infection.
What if suctioning does not clear the mucus?
After three unsuccessful attempts, wait 10 minutes before trying again. If shortness of breath or distress continues, contact a healthcare professional immediately or call your local emergency number (911 in the United States).
Related Reading
Tracheostomy: Purpose, Procedure, Recovery and Living With a Trach explains what a tracheostomy is, why it is done, the types of procedure and how recovery works.
References
Mitchell RB, Hussey HM, Setzen G, et al. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg. 2013;148(1):6-20. PMID 22990518. https://doi.org/10.1177/0194599812460376
Hernández Martínez G, Rodriguez ML, Vaquero MC, et al. High-flow oxygen with capping or suctioning for tracheostomy decannulation. N Engl J Med. 2020;383(11):1009-1017. PMID 32905673. https://doi.org/10.1056/NEJMoa2010834
Cleveland Clinic. Tracheostomy Suctioning. Cleveland Clinic. Last updated October 12, 2023. https://my.clevelandclinic.org/health/procedures/tracheostomy-suctioning
NHS. Shortness of breath. NHS. Last reviewed January 30, 2024. https://www.nhs.uk/symptoms/shortness-of-breath/
Disclaimer
This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition.
It is educational content and does not authorize an untrained person to perform tracheostomy suctioning, choose a pressure setting or determine catheter depth. Patients and caregivers should follow individualized instructions from a qualified healthcare professional for their specific tracheostomy tube and equipment. Do not force the catheter, continue repeated unsuccessful attempts during breathing distress or change prescribed care without professional guidance.
Comments