How To Suction A Pediatric Trach Safely: A Mom’s Step-by-Step Walkthrough

A long hospital stay and then heading home with a trach can feel like stepping into a new world. When I first heard the word “suction,” I had no idea what it meant, and I had a thousand questions:

“Is it going to hurt my baby? What if I forget to do it? Is it going to be a scary thing to do?”

That fear is normal. I was terrified the first time I suctioned my daughter Paige. I went one centimeter too deep with an inline catheter, panicked, and thought I had injured her. It wasn’t until a respiratory therapist showed me exactly where the catheter sits in the trach that things clicked. 

Table of Contents

• Why suctioning matters (and why it becomes normal)
• Common questions answered
• Types of suction catheters — what they are and when to use them
• Sizing and suction depth — the one thing you must memorize
• Step-by-step: Suctioning via the ventilator using an inline catheter
• Practical tips from experience
• Final reassurance

Why suctioning matters (and why it becomes normal)

Suctioning clears mucus from around the trach tube so your child can breathe comfortably. At first it can feel like a medical procedure you’re terrified to perform multiple times a day — I remember reading the instructions that said “minimum three times a day” and thinking, how will I do this at home?

But like many parts of life with medical equipment, suctioning becomes routine. Now, suctioning for Paige is as ordinary as changing a diaper. Yes, it’s messy. No, it doesn’t hurt her. You learn how and when to go a little deeper, when to stop, and how many passes are needed.

Common questions answered

• Does suction hurt? No — when done correctly it should not hurt. You may see or hear mucus but not blood if you follow recommended depths and technique.
• How often? The booklet might say “minimum three times a day,” but frequency depends on your child’s needs. Some days you may do more, some days less.
• Gloves and hand hygiene? Wash hands or use gloves — whatever you’re comfortable with. Clean hands are important every time you suction.

Types of suction catheters — what they are and when to use them

There are several kinds of suction catheters. Their purpose is the same — remove mucus from the trache — but they differ in form and intended use. Here’s how to tell them apart and choose the right one.

Closed (inline) suction vs. sterile (open) suction

• Inline (closed) suction catheter: Designed for use while a child is connected to a ventilator. It usually has a sleeve and connects directly in-line with the ventilator tubing. Because of its design it can be reused for a period (often a day) and helps reduce contamination.
• Sterile (open) suction catheter: Used when a child is off the ventilator and breathing on their own. These are typically single-use (sterile) and come without the inline connector.

Sleeved vs. no sleeve

A sleeved catheter has a protective sleeve around it so you can use the catheter multiple times without exposing the suction channel directly to the environment. If the package says “sleeved” or “closed,” it generally means you can use it repeatedly for the intended time period. If it doesn’t say sleeved, it’s likely the single-use style.

Brand names, trays, and extras

Packages vary. Some say “tray” even though there’s not a tray in the box. Some kits include stickers to mark suction depth, caps, blue markers, or small sample gloves. Those extras are often geared toward hospital use where multiple caregivers might need reminders. At home, it’s ideal for caregivers to memorize the correct suction depth rather than rely on stickers.

 

Sizing and suction depth — the one thing you must memorize

Two important sizing concepts:

• French size (8, 10, 12 French): This measures the thickness (diameter) of the catheter. For example, 10 French is thicker than 8 French. Thicker catheters sometimes remove more mucus but need to be appropriate for the trach size.
• Suction depth (in centimeters): Each child has an assigned suction depth (for Paige it’s 9 cm). That number tells you how far to insert the catheter before applying suction.

Important: If you use an inline suction catheter with a connector that adds length (many have a white hub or extra chamber), you must add that extra length to your suction depth. In my case the inline adds about 3 cm, so Paige’s suction depth of 9 cm becomes 12 cm with the inline in place. Make sure the correct number appears in the little view window on the inline catheter before suctioning.

Step-by-step: Suctioning via the ventilator using an inline catheter

Below is the process I use when suctioning Paige while she’s on the ventilator. This is intended as a clear demonstration, not a replacement for your respiratory therapist’s training and your individual care plan.

1. Set up the suction unit and select the sleeved inline catheter. Make sure the unit is ready and the tubing is attached. (Example device shown in video.)
2. Confirm the suction depth. If the prescribed depth is 9 cm and you have an inline with an extra connector, add 3 cm, so set it to 12 cm and make sure the marker is visible in the window.
3. Turn on the suction unit.
4. Remove the HME (heat-moisture exchanger) or cap from the trach site carefully. Keep a thumb handy to hold position if needed.
5. Insert the catheter to the set depth (watch the marker) and then apply suction while withdrawing the catheter with a twisting motion as instructed by your respiratory therapist.
6. Check the inline window or suction canister for mucus (“gunk”). Because inline suction routes through tubing, you may not hear as much suctioned material — rely on the visual cues in the inline assembly.
7. If needed, repeat suctioning one or two more times until clear. Use clinical judgment and your training to avoid over-suctioning.
8. Replace the HME and confirm secure connection and ventilator settings.

In the video I show doing this with Paige: powering on the unit, setting to 12, attaching the suction to the inline port, inserting to the green 12 marker and pulling the catheter back while suctioning. You’ll see a little mucus appear in the inline window — that’s your visual confirmation that suction worked.

Practical tips from experience

• Memorize the suction depth for your child and teach caregivers the same number. Stickers are helpful in hospitals, but at home it’s better if caregivers know the depth without having to check labels.
• Know which catheter to use: inline for on-vent, sterile open for off-vent.
• Remember the inline connector adds length (commonly about 3 cm). Double-check the marker before suctioning.
• Change sleeved/closed catheters according to instructions — often daily or per your team’s guidelines.
• If you hear little or no gunk through an inline system, rely on the visual collection point rather than sound alone.
• At home, suction noises can sound loud — in the hospital it may be quieter. Don’t be alarmed by the sound if everything else looks normal.
• When in doubt, ask your respiratory therapist. A quick demonstration or clarification saved me a lot of worry early on.

Final reassurance

Suctioning is scary at first. I thought I’d harm my child. But with practice, instruction, and time, it becomes a normal part of daily care. You’ll learn the feel of it, when to go deeper, when to stop, and how to tell that your child is clear. Don’t be ashamed to be “Dr. Mom” — you’re doing an important, loving job.