Tracheostomy Suctioning - Types, Procedure, Precautions, and Complications

Introduction

Tracheostomy is the insertion of a tracheostomy tube in the trachea or windpipe by creating an opening in the windpipe or trachea to resolve temporary or permanent breathing issues in a patient. Tracheostomy suctioning is a procedure that facilitates oxygen and air to reach the lungs by removing excess secretions and mucus from the tracheostomy tube.

It helps the person to breathe properly with the tracheostomy tube inserted during the tracheostomy procedure. The suctioning can be performed by the doctor on an urgent basis if there is a sudden airway block in a patient, or it can also be an elective procedure if any chronic health problem is causing breathing difficulty in a person.

Different types of tracheostomy tubes are available depending on the patient's need and situation. Tracheostomy can be permanent or temporary, and the suctioning removes the blockage caused by mucus and secretions in the tube to keep them clean.

When Is Tracheostomy Suctioning Needed?

Tracheostomy suctioning is needed in the following situations:

• Shortness of breath or dyspnea.

• Increased respiratory and heart rate.

• If a person has a rattling lung sound or coarse breathing sound present.

• Noisy breathing.

• A frequent non-productive cough is present.

• Visible secretions.

What Are the Various Types of Tracheostomy Suction Catheters Available?

There are mainly two types of tracheostomy suction catheters available:

• One-time Use Catheter With a Control Port: This type of suction catheter is available in a sterile kit, connecting tube, and sterile gloves. This catheter is sterile, reducing the risk of infections. Also, since it is a transparent catheter, the person can see secretions and fluids suctioning out of the trachea and airway passage. The thumb control port helps in controlling the suction. One-time-use catheters have a single-tip opening and are available in different sizes.

• In-line or Closed Suction Catheter: This type can be used for patients on mechanical ventilation, and it does not require disconnecting the ventilation machine. Closed or in-line catheters are used primarily in ICUs or intensive care units and are available wrapped in a sterile plastic sleeve. Therefore, they can be handled with normal sterile gloves. Sterile gloves are not available with these closed catheters.

What Supplies Are Needed Before Starting Tracheostomy Suctioning?

The following supplies are needed before starting suctioning of the trachea.

These include,

• Distilled water.

• Four to six-ounce paper cups.

• Hydrogen peroxide.

• Cotton swabs.

• White vinegar.

• Non-latex gloves.

• Face shield, google, or mask.

• Disposable paper drape, bath towel, or cloth.

• Charged suctioning machine with fresh catheter and tubing.

What Is the Procedure of Tracheostomy Suctioning?

Tracheostomy suctioning includes the following steps after the specialist arranges all the necessary supplies:

• Position the patient in a comfortable and stable posture with proper support to the head and neck.

• The doctor should wash arms and hands thoroughly with soap and water.

• Next, the paper cup should be filled with water.

• The doctor should then wear gloves and avoid touching equipment or the patient without sterilized gloves.

• Ensure that the tracheotomy tubes are inflated appropriately.

• After that, the doctor must open the suction catheter package to connect the tube and the hard plastic end. When the catheter is not in use, the operator should wrap the device around their sterilized gloved hand to avoid infection due to contamination.

• Then the tracheostomy opening is exposed after turning on the machine.

• The catheter is then inserted into the tracheotomy, opening up to six inches without the suction until some resistance is detected.

• The suctioning is then started by covering the vent of the suction.

• The catheter is then removed with rotation in even and slow motion while keeping the suction on. Suctioning should be done for at most ten seconds. The process is repeated a few times, and during each insertion and removal, the suction catheter should be dipped into the paper cup for cleaning. The suction vent should be used to pull up the distilled water for cleaning.

• The suction handler should give the patient rest for 20 to 30 seconds in between each suction pass. Also, they should monitor the patient for any signs of restlessness or distress during the entire procedure.

• Once the suctioning is done, distilled water should be filled in a basin and thoroughly flushed out through the tubing and catheter, and the machine should be turned off.

• After use, the catheter should be rinsed and disinfected with hydrogen peroxide and kept in its package.

• The operator should remove and dispose of the gloves, use a paper cup, and wash the hands thoroughly.

What Are the Precautions Needed While Suctioning?

The operator should take the following precautions while performing tracheostomy suctioning:

• Do not suction the patient for too long.

• Conduct a risk assessment of the patient before starting the procedure.

• Counsel and prepare the patient by explaining to them the procedure before starting.

• Monitor the patient carefully for any complications during the procedure.

• Do not force the catheter into the trachea after detecting the resistance.

• Equipment should be rightly selected depending on the patient’s need and situation.

What Are the Various Airway and Lung Problems that Need Tracheostomy?

• Congenital airway problems.

• Laryngeal spasms or injury.

• Severe neck and mouth injuries.

• Obstructive sleep apnea.

• Subglottic stenosis (narrowing of the airway between the trachea and vocal cords).

• Vocal cord paralysis.

• Tracheomalacia.

• Tumors of the neck.

• Foreign body obstruction.

• Pierre Robin Syndrome.

• Treacher Collin syndrome.

• Chest wall injury.

• Chronic pulmonary disease.

• Bronchopulmonary dysplasia.

• Diaphragm dysplasia.

What Are the Complications of Tracheostomy?

Initial Complications:

• Pneumothorax or air trapped around the lungs.

• Damage to the esophagus.

• Bleeding.

• Subcutaneous emphysema or air trapped around the tracheostomy.

• Blockage of the tube due to mucus, and blood clots, which can be prevented by suctioning and humidifying the tracheal air.

• Pneumomediastinum or air trapped in the deeper parts of the chest.

Later Complications:

• Damage to the windpipe due to friction, excess pressure, or bacterial infection forming tissue scars.

• Infection occurs around the tracheostomy tube and in the trachea itself.

• Accidental decannulation or removal of the tracheostomy tube.

Long-term Complications:

• Development of fistula in the tracheoesophageal area.

• Erosion or thinning of the trachea.

• Collapse or narrowing of the windpipe just above the tracheostomy site may require additional repair surgery.

• Failure of the tracheostomy opening to close independently for more than 16 weeks may require surgical closure.

Conclusion

The tracheostomy tube is inserted into the windpipe to give the patient an alternative breathing airway due to some trachea blockage. Suctioning of the tracheostomy tube is done to clear the mucus and secretion from the trachea in patients with an inserted tracheostomy tube. Therefore, an expert or trained healthcare professional should perform the tracheostomy suctioning procedure carefully to avoid injury or trauma to the bronchi or trachea and further complications such as infection or bleeding.