Trach Care for Children
When your pediatric patients go home with a tracheostomy or trach tube, their parents must learn to suction it properly during home care. Suctioning a child’s trach with a closed system can be intimidating and even scary for parents who are new to the experience, so educating them properly is key to not only their comfortability with the task but your patient’s comfort and continued good care at home.
A closed system consists of a protected catheter inside a sterile sleeve when a child is on a ventilator. This catheter stays attached to a child’s trach and suctioning is possible while the child remains on a ventilator.
Parents must understand that suctioning a child’s tracheostomy tube with a closed system removes the mucus that builds up in the trachea, especially when the trach is first placed, since there is typically more mucus then, and helps the child breathe more easily and prevents infections. 
How will parents know when to suction?
Parents may wonder how they’ll know when their child needs suctioning. Based on clincial practice guidelines, this is easily explained by teaching them to listen and view their child’s trach tube for signs like visible mucus in the tube or gurgling or rattling noises when the child breathes. The guidelines note that other telltale signs include: 
- Retractions in the skin around the bones in the chest during each breath
- Flaring nostrils
- Rapid breathing
- Fussy, distressed, clammy skin
- Pale or blue color
While every child is different and some need more suctioning than others, there are specific times when parents should suction including during a cold or respiratory infection because it can produce more mucus, after waking up or napping since mucus tends to build during sleep, and before meals to help prevent coughing. Parents should also be instructed when not to suction, such as immediately after meals to reduce vomiting. [1,2]
Besides these regular times, prescribing a timetable for parents such as every six hours as needed for mucus buildup is helpful along with any time parents change the tracheotomy ties or the tube itself. 
Steps for Suctioning
- Wash hands.
- Assemble all equipment.
- Open the suction valve. 
- Suction some saline to test the suction and to wet the inside of the suction catheter so secretions will go through smoothly. 
- Gently insert catheter into trach by holding the clear elbow attached to the tube. 
- Holding the elbow with one hand, insert the catheter into trach with thumb and index finger. Do not apply suction while inserting.
- Slide catheter into the sleeve to the color code or number instructed by the child’s physician. 
- Squeeze thumb valve to create a vacuum and begin to suction. 
- When finished, pull out the catheter until you see the tip in the dome by holding the elbow attached to the trach.
- Do not leave the catheter in longer than five seconds. The child could have difficulty breathing when the catheter is inserted too long.
- Repeat suctioning until the child breathes easily, lungs are cleared and mucus seems removed. Let the child rest between each suctioning session. 
- Coughing during suctioning is normal and helps to bring up mucus. 
- Discard catheter 
- Wash hands. 
Secretions should be clear or white and odorless, and parents should be taught to pay attention to any odor or color which could indicate an infection or bleeding and require a call to their child’s physician immediately. Older children can be encouraged to cough to help clear mucus and minimize the need for suctioning. 
At first the suctioning process may seem difficult for both parents and children but with practice it gets easier for everyone.
- Tracheostomy Care: Suctioning with a Closed System. Nationwide Children’s Hospital. [cited 2011]. Accessed July 2018. https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/helping-hands/tracheostomy-care-suctioning-with-a-closed-suction-system-ballard
- Suctioning your Child’s Trach: Simple Suction Catheter. Seattle Children’s Hospital. [cited 2016] Accessed July 2018. https://s3.amazonaws.com/external_clips/attachments/1933760/original/PE1870.pdf?1529335101
- Suctioning, the Importance of Suctioning. U Chicago Medicine. [cited 2018]. Accessed July 2018. https://www.uchicagokidshospital.org/specialties/pulmonary/patient-guides/breathing/suction/