_Most tracheostomy patients are prescribed a
suction machine when returning home following surgery. Use of the suction will
be helpful in removing mucous and other secretions from the tube, ensuring a
Despite having a suction machine, it is
important to use a simultaneous strong
cough. Without strong and forceful coughs, mucous will not be cleared
adequately from lower portions of the airways.
Many patients find it helpful to use saline
bullets to assist with clearing/suctioning of their secretions. Use of saline
bullets can significantly help to thin the secretions while also moisturizing
the airways. In this sense, coughing/suctioning can be much easier. If you find
it is difficult to clear your mucous/secretions from your tracheostomy tube,
even with using suction, it may be helpful to use saline bullets to assist in
this regard. Your doctor or SLP staff can discuss this further with you.
_A saline bullet is a term used to describe
a small vial of sterile saline. These can range in size from 5-30ml, although
the physicians/SLP staff will typically advise the 30 ml size for use.
Indications: Saline bullets are used to provide quick,
temporary moisture to the pulmonary air passages and lungs and are most
commonly used to correct issues related to inadequate humidification for
tracheostomy patients not regularly using HMEs.
Saline bullet utilization can be helpful in
loosening dried mucous and mucous plugs as well as restoring moisture to dry
airways. These should only be used on the advice of your doctor or SLP staff.
Directions for Use (with 30ml vial):Position the tip of the vial into the
opening of the tracheostomy tube (speaking valve/HME removed). While
inhaling, squeeze firmly on the vial, releasing ~1/3 or 10ml at one time. This
will likely cause coughing. After secretions have been cleared, repeat this
until the vial is empty, usually 3-4 times in total. It may be helpful to use
suction during this procedure to better help clear mucous from the tube.
It is important to use saline bullets in the
morning. This will help to moisturize the air passages and clear any dry
secretions that may have formed during sleep, so you can be more comfortable
through your day. Your doctor or SLP staff will advise you on how often and
when to use saline bullets if you require more that once daily. These can be
used safely more than once daily, but you may be prescribed a specific
Keep it clean!
_Because the tracheostomy now provides a direct
pathway into the lungs, it is important to always keep your suction components
as clean as possible. Emptying the canister regularly as well as changing the
suction tubing/attachments according to the manufacturer’s recommendations is
extremely important in this regard.
Although various suction machines exist,
regardless of the model you are provided with, instructions for proper care and
operation will always be included. Once you read through these, the SLP staff
can assist you in a better understanding if needed.
Generally speaking, however, the tip of the
suction, can serve as a way of introducing bacteria into your tracheostomy
tube. Although your tube is not a sterile environment, keeping the tube and
suction as clean as possible will help to minimize the potential for
bacteria/viruses from entering the lungs this way. Whether you are using a
Yankauer tip or suction catheter, you should never allow the tip of your
suction (the part you touch the tracheostomy tube with), to come in contact
with soiled surfaces. Placing the tip in a clean sandwich bag or glass can help
ensure it is somewhat protected between uses. Never use the suction if the tip
(Yankauer/catheter) is visibly dirty or touches the floor/other similarly
soiled surfaces without first properly cleaning or even replacing if adequate
cleaning is not possible.
Updated Oct 18, 2013
Copyright 2011-2013 Katrina M. Jensen, M.A., CCC-SLP, PLLC