Clean Technique

Techniques for clean suctioning

Suctioning is an essential technique for clearing the airway of mucus, especially for individuals with spinal cord or brain injuries who may struggle with breathing and coughing. This process helps keep the airway open and ensures effective breathing.

Follow clean techniques and consult your doctor before performing suctioning. Here we walk you through the steps of suctioning, from gathering the necessary supplies to performing the procedure safely and effectively.

A person should be suctioned when any of the following happens:

Rattling breathing sounds are heard.
Mucous bubbles up in the throat or airway tube (trach tube).
When a hand placed on the chest can feel a vibration or rattling from congestion.
When the person tells you it is needed (when it is hard to breathe).

Try having the person cough first (or perform an assist cough). Sometimes the person may not need to be suctioned if he/she is able to remove the mucous with a good cough.

More About Dos and Don’ts of Suctioning

Step 1: Gather the supplies:

Portable suction machine
Clean suction catheter
Sterile normal saline (recipe below)
Resuscitator bag (also known as the Ambu Bag)
One helper

For a comprehensive list of supplies, visit our Suctioning Techniques page.

Step 2: Wash your hands.

Wash your hands with soap and water. Dry them with a clean towel.

Step 3: Check portable suction equipment.

Make sure all tubing connections and collection jar have a tight seal.

Step 4: Place portable suction unit on a flat, dry and safe surface.

Plug suction unit to an electrical outlet. Turn unit on.

Step 5: Set the suction pressure.

The portable suction pressure should not be set higher than 15 mm/Hg.
Check pressure by turning the machine on and covering the open end of the suction line with one hand. Look at the pressure dial.
It should rise but not go any higher than the 15 marker on the dial. I
f the pressure does not go up, re-check all tubing connections or adjust to the correct pressure.

Step 6: Pick up clean suction catheter.

Step 7: Put on gloves.

Step 8: Connect the tubing to the suction catheter.

Pick up the long connecting tubing that comes from the suction machine and attach it to the suction catheter.

Step 9: Turn on the suction machine.

Step 10: “Bag” the person.

The person must receive extra breaths during suctioning. This is done by using the Ambu Bag.
Attach the bag to the person’s airway (trach tube) and squeeze the bag to give extra breaths.
Each person will be different in respect to how many times he/she needs to be “bagged.”
Follow the directions you were given from your doctor or therapist. A person will need to be bagged before, during and after each suctioning.

Step 11: Place the catheter into the trach tube.

Place the catheter into the opening of the trach. Be careful not to let it touch anything before entering the opening. Please remember that the inner cannula must always be in place when a person is suctioned.
The inner cannula is the tube that fits into the trach at the neck plate. It can be reusable or disposable depending on your specific situation. The photo below shows the suction catheter entering through the inner cannula. Never suction without it in place.
Slowly move catheter down into the trach until resistance is felt. Do not force the catheter down.

Step 12: Cover the suction port.

Cover the suction port with your thumb. Slowly pull the suction catheter up and out. Do not leave the suction catheter in the trach tube for more than 10 seconds.
Suction Off (port open)
Suction On (port closed)

Step 13: Bag the person

Repeat steps 10, 11 and 12 until the mucous is gone. If you notice that the mucous is thick, you can use normal saline to make it thinner. Squirt a small amount into the trach tube and then bag the person with the Ambu Bag. This will help loosen up the mucous and make it easier to suction. Now you may insert the suction catheter and repeat Step 11.

Step 14: Disconnect the catheter from the suction tubing.

Set it aside for washing.

Step 15: Rinse the suction tubing.

Once suctioning is complete, the canister tubing must be rinsed. This can be done with tap water or normal saline.
With the suction machine still on, put the tubing in a container of water or squirt some normal saline into the tubing.
Allow it to rinse through the tubing until it is cleared of mucous.

Step 16: Shut off suction unit.

Step 17: Remove all gloves.

Step 18: Wash your hands.

Step 19: Wash suction catheter.

Sterile normal saline

Prepare a mixture of 1 quart of water with 2 teaspoons of table salt.
Heat until it comes to a boil.
Store normal saline in a clean, sterile jar. The jar and lid should be cleaned and sterilized as if for canning or preparing baby milk bottles.
Make normal saline fresh every day.

Sterile water

Boil 1 quart of tap water for 10 minutes.
Let it cool.
Store sterile water in a clean, sterile jar. Jar and lid should be cleaned and sterilized as if for canning or preparing baby milk bottles.
Make sterile water fresh every day.