Originally published on October 5, 2010

B.L. asks, “What should I do if the secretions become bloody? Am I suctioning too much?”

Answer: Secretions can become bloody because of tracheal irritation. And yes, this can be caused by frequent tracheal suctioning or strong coughing. However, the presence of bloody secretions should not cause you to suction less often. Rather, you should consider switching to red rubber catheters. These catheters are very soft and have a blunt tip (because they are actually urinary catheters). The use of these catheters has shown complete healing of tracheal lesions in as little as 24 hours.

The problem with these catheters is that one must use a separate adapter in order to connect it to the suction tubing. If you use a Y-shaped adapter, you can use your thumb over the open end to create intermittent suction. If you use a straight adapter, you will be unable to create intermittent suction.

Another solution is to ease off on the suction pressure. Too much negative pressure against the lumen of the trachea can also be an irritant. A few studies suggest that -200 cm H20 pressure should be the upper limit; however, this depends on the ratio of the size of the suction catheter to tube size.

Tracheal suctioning is one of the most important things that you can and must do for your tracheostomy patients. To suction less frequently is to do your patients a disservice, and may create harm by inspissation of secretions and obstruction of the tube.

Caution: Do not use red rubber catheters in a patient with a latex allergy.