Wash hands and gather supplies
Explain the procedure to the patient if awake
Position the patient with the head of bed elevated
Check oxygen saturation and baseline vital signs
Put on gloves and other required protective equipment
Preoxygenate the patient if ordered or indicated
Open the suction catheter using sterile technique if required
Attach the suction catheter to the suction tubing
Set suction pressure to the prescribed level
Insert the catheter gently into the tracheostomy tube without applying suction
Advance the catheter until resistance is met, then withdraw slightly
Apply suction while withdrawing the catheter in a slow, rotating motion
Limit each suction pass to 10 to 15 seconds
Allow the patient to recover and reoxygenate between passes
Repeat suctioning only as needed
Monitor for coughing, distress, desaturation, or bleeding
Stop suctioning if the patient becomes unstable
Reassess breath sounds, oxygen saturation, and airway patency
Dispose of supplies and perform hand hygiene
Document the procedure, secretions, and patient response