Tracheostomy Suctioning: Purpose, Procedure & Care Guide

Every year, around 15,000 people in England and Wales require a tracheostomy – and for many of them, going home means taking this clinical need with them. Suctioning is at the heart of that daily care. Do it well, and life stays manageable. Miss the signs, or rush the technique, and things can deteriorate faster than most people expect.

Whether you’re a community nurse visiting a patient for the first time post-discharge, a family carer who’s just been handed a portable suction machine and a care plan, or an HCA freshening up your knowledge – this guide walks you through the tracheostomy suctioning procedure from start to finish: what it is, why it matters, and how to do it safely.

What Is Tracheostomy Suctioning – and Why Is Tracheostomy Airway Management So Critical?

Tracheostomy suctioning is the clinical procedure of passing a sterile catheter through a tracheostomy tube to remove secretions and maintain a patent airway. It is one of the most fundamental aspects of tracheostomy airway management.

When someone has a tracheostomy, their airway bypasses the nose and mouth entirely. The nose normally warms, filters, and moistens incoming air – without it, secretions thicken, pool in the trachea, and many patients simply cannot cough them clear. The tracheostomy stoma and tube itself can also increase mucus production, adding to the burden.

Left unmanaged, those secretions block the tube, drop oxygen levels, and quickly become a breeding ground for infection. In our experience at Secure Healthcare Solutions, carers who understand why they’re suctioning – not just how – respond far more calmly when a patient becomes distressed.

Signs That Tell You Suctioning Is Needed

The key signs that a tracheostomy needs suctioning include:

• Audible bubbling or gurgling from the tracheostomy site
• A drop in oxygen saturation (SpO₂) from the patient’s normal baseline
• Visible secretions at the opening of the tube
• Increased breathing effort — use of accessory muscles, restlessness
• The patient pointing to their throat or appearing to struggle
• Coughing that isn’t shifting anything

There is no fixed suctioning schedule. Frequency is based entirely on clinical assessment – some patients need it several times a day, others far less. Always encourage the patient to cough first; an effective cough is preferable to suction.

Open vs. Closed Tracheostomy Suctioning: Which Applies to Your Patient?

In community and home care settings, open suctioning is the standard method. If your patient is on a home ventilator, their care plan will specify closed suctioning – and you will have been trained on this before discharge.

Open suctioning disconnects the patient from any humidification or ventilator circuit. It works well but carries a slightly higher risk of deoxygenation and infection if technique is poor.

Closed (in-line) suctioning keeps the catheter within a sealed system – no disconnection, less contamination risk, less oxygen loss. Used primarily for ventilated patients.

Whichever method applies, maintaining adequate humidification via an HME (heat and moisture exchanger) is essential – it reduces secretion thickness and makes suctioning less frequent and less traumatic.

Choosing the Right Tracheostomy Suction Catheter Size

The correct tracheostomy suction catheter size should not exceed half the internal diameter of the tracheostomy tube – this is the standard rule across NHS trust guidelines. As a practical guide, most adult patients in the UK will use sizes 10, 12, or 14 FG, but the exact size must always be confirmed from the patient’s tracheostomy passport, where it is documented by the discharging hospital team.

The Tracheostomy Suctioning Procedure: How to Suction a Tracheostomy Safely

Before you begin, explain what you’re about to do. Even patients who can’t respond verbally are aware, and a calm explanation reduces distress for everyone in the room.

1. Wash hands and put on gloves, apron, and eye protection
2. Check equipment — suction pressure set to 80-120 mmHg for adults, correct catheter size
3. Assess first — check SpO₂, listen, observe. Is suctioning actually needed right now?
4. Pre-oxygenate if indicated — as per the care plan
5. Attach catheter to suction tubing without activating suction
6. Insert gently using a shallow technique — to the tip of the tube or 1-2 cm beyond. Deep suctioning risks carina trauma and is not recommended in community settings
7. Apply suction on withdrawal only — rotating motion, no more than 10-15 seconds per pass
8. Rest between passes — 20-30 seconds minimum, watch SpO₂ recover
9. Repeat if needed — maximum 3 passes; beyond that, stop and reassess
10. Flush and dispose — sterile water flush, single-use catheters discarded after the episode
11. Document — colour, consistency, volume, patient tolerance, SpO₂ before and after

A note on saline instillation: routine use of saline before suctioning is no longer recommended by current UK guidance unless specifically directed by the patient’s care team.

Complications of Tracheostomy Suctioning – and How to Stay Ahead of Them

The main complications of tracheostomy suctioning – hypoxia, mucosal trauma, infection, cardiac arrhythmia, and patient distress – are mostly preventable with correct technique.

• Hypoxia — limit suction duration, pre-oxygenate where indicated
• Mucosal trauma or bleeding — correct catheter size, never force the catheter
• Infection — strict Aseptic Non-Touch Technique (ANTT) every time; never reuse single-use catheters
• Vagal response / cardiac changes — deterioration mid-procedure: stop immediately
• Anxiety and distress — talk throughout; never work in silence

Escalate immediately if:

• SpO₂ remains low after suctioning
• Frank blood in secretions
• Catheter cannot be passed
• Tube appears blocked and won’t clear

→ Call 999. The emergency tracheostomy box lives at the bedside for a reason.

Tracheostomy Care at Home: What Families and Carers Need to Know

Family members and home carers can perform tracheostomy suctioning safely – and in the UK, they are trained by specialist nurses before discharge. You should not go home without that training and the right equipment in place.

A few things experienced home-care teams know well:

• The Tracheostomy Passport — a formal NHS document developed in line with National Tracheostomy Safety Project (NTSP) guidance — records tube type, catheter size, humidification needs, and emergency instructions. It goes everywhere with the patient.
• Secretions that change colour, thicken significantly, or develop an odour suggest possible infection — contact the GP or community team promptly.
• Home suction machines need regular checks. Know who to call if equipment fails out of hours.
• If secretions suddenly thicken, check the HME filter is in place and functioning.
• In the longer term, some patients are assessed for decannulation — removal of the tracheostomy tube. This is a specialist multidisciplinary decision, not a community one.

Tracheostomy Care in Wolverhampton: How Secure Healthcare Solutions Can Help

Tracheostomy suctioning looks straightforward on paper – but the judgment around when to act, how to read the patient, and when to escalate takes experience. That’s something no checklist fully replaces.

At Secure Healthcare Solutions, we provide specialist tracheostomy care in Wolverhampton and across the surrounding community – from suctioning and airway management to tube changes and dedicated home care plans. Our trained team supports patients and families through every stage of tracheostomy care at home, so hospital discharge feels like a transition, not a cliff edge. Get in touch with our team today to discuss your needs.

References: 

• https://tracheostomy.org.uk/
• https://www.nhs.uk/tests-and-treatments/tracheostomy/