Originally published on October 31, 2010

B.W. asks, “What does it mean if I start to have trouble passing the suction catheter?”

Answer: Meeting resistance upon passage of a suction catheter usually means one of two things: either the inner lining of the tracheostomy tube is becoming coated with secretions, or the tracheostomy tube has entered a false passage.

The suction catheter is your most valuable tool because it can provide you with much useful information. Not only is it used for removing secretions, but it can be used to predict future problems. If a suction catheter meets some resistance, but can be passed several centimeters, then it usually means that secretions are beginning to coat the inside of the tracheostomy tube. In this case, the inner cannula should be changed. If the tube does not have an inner cannula, the entire tube should be changed.

If the suction catheter can be passed only a few centimeters and no more (i.e., the length of the tracheostomy tube), it usually means that the tube has entered a false passage. In other words, the tube is lodged within the tissues anterior to the trachea. In that case, the obturator should be used to maneuver the tube into the correct position. Alternatively, the entire tube should be changed. After any of these maneuvers, the proper position of the tube should be confirmed by easy passage of a suction catheter and return of tracheal secretions.

One should be aware of the proper sizes of suction catheters to be used for tracheostomy tubes. A size 14 French should easily pass through a size 6 and 8 tracheostomy tube. However, a size 4 tube often requires a size 10 or 12 French suction catheter. The response to difficult passage of a suction catheter should not be a switch to a smaller catheter. Rather, it should be a warning sign to consider the reason for the difficulty.

Another use for the suction catheter is as a “guidewire” to determine the tracheal tract. A tracheostomy tube can then be slid into position over it.