Possible cause(s)

• Mucous plug in the tracheal cannula: may be caused by insufficient humidity, excess secretions and/or insufficient frequency of suctioning
• Foreign body in the tracheal cannula
• Incorrect insertion of catheter for aspiration

What to do?

• Never force the insertion of the catheter in the tracheal cannula.
• Gently but rapidly, attempt to suction tracheobronchial secretions.
• Instill saline drops into the tracheal cannula, as you have been taught by your healthcare team.
• If you are unable to suction secretions (the tracheal cannula is obstructed), then:
  • change the cannula;
  • suction tracheal secretions if needed.
• If the problem is resolved:
  • observe your child’s breathing to detect any signs of respiratory distress;
  • inform your healthcare team.
• If you are still unable to suction secretions and your child IS in respiratory distress:
  • call 911 immediately;
  • if required, begin manual ventilation and CPR as instructed.
• If you able still unable to suction secretions and your child IS NOT in respiratory distress, immediately contact your child’s healthcare team.
• If you are able to aspirate secretions, then:
  • repeat the aspiration, using installation of saline drops, up to 2 more times, as needed;
  • review methods to prevent mucous plugs with your healthcare team.

Possible cause(s)

• Mucous plug or foreign body in the nostril
• Inflammation inside the nose, causing blockage of the nostril (eg, due to infection or allergy)
• Septum deviation of the nose
• Incorrect insertion of the catheter into the nose

What to do?

• Clean the nose, using saline drops, as taught to you by the healthcare team.
• Never force the insertion of the catheter into the nose.
• Review the method of nasal aspiration.
• Ensure that you are using the correct equipment and materials for nasopharyngeal suctioning.
• Rapidly contact your child’s healthcare team.

Possible cause(s)

• Equipment malfunction including any of the following:
  • suction device battery charge depleted
  • suction regulator pressure too low
  • suction device broken
  • canister containing secretion overfilled
  • canister cover incorrectly closed
  • suction tubing bent or pinched
  • suction device incorrectly assembled
  • suction catheter blocked
• Excess or very thick secretions are obstructing the airway

What to do?

• Quickly verify that the suction device is plugged into a working electrical outlet or that the battery is correctly charged.
• If no power is available, use the manual mucous trap device, as instructed by your healthcare team.
• If the power supply is adequate, quickly verify that the suction device is in working order:
  • verify that the pressure on the suction; regulator is set to the correct value
  • empty the canister if full;
  • verify that the canister cover is closed correctly;
  • verify that the suction tubing is correctly installed and not blocked, pinched, bent or damaged in any way;
  • verify that that all parts of the suction circuit are correctly installed;
  • verify that the suction valve or port is working correctly;
  • verify that the suction catheter is not blocked.
• After these steps, if you are unable to suction secretions (obstruction of the tracheal cannula):
  • change cannula;
  • suction tracheal secretions if needed.
• If the problem is resolved:
  • observe your child’s breathing to detect any signs of respiratory distress;
  • inform your healthcare team.
• If you are still unable to suction secretions and your child IS in respiratory distress:
  • call 911 immediately;
  • if required, begin manual ventilation and CPR as instructed.
• If you able still unable to suction secretions and your child IS NOT in respiratory distress, immediately contact your child’s healthcare team.
• If you are able to aspirate secretions, then:
  • repeat the aspiration, using installation of saline drops, up to 2 more times, as needed;
  • review methods to prevent mucous plugs with your healthcare team.

Possible cause(s)

• Irritation of the trachea by:
  • incorrect suctioning technique (too frequent, too deep or using a suction pressure that is too high)
  • excessive cough
• Respiratory tract infection
• Insufficient humidification
• Insufficient hydration

What to do?

If fresh blood in the secretions:

• Remain calm and reassure your child;
• If bleeding continues, immediately contact your child’s healthcare team;
• Observe your child’s breathing to detect any signs of respiratory distress (see next problem);
• If your child is in respiratory distress, remove the suction catheter and begin manual ventilation and CPR as instructed.

If blood streaks or pink secretions:

• Observe your child’s breathing to detect any signs of respiratory distress.
• Check the pressure of the suction device.
• Review suctioning technique; verify that you are inserting the catheter to the correct depth.
• Aspirate secretions gently.
• Avoid excessive aspiration which can damage the delicate lining of the airways.
• Increase the level of humidity.
• Contact your child’s healthcare team.

Possible cause(s)

• Mucous plug moved further down the airways towards the lungs
• Bronchospasm: narrowing or constriction of the airways (eg, due to irritation, inflammation and/or secretions in the airways)
• Pneumothorax (a puncture in the lining of the lungs)

What to do?

• Remain calm and reassure your child.
• Stop suctioning.
• Remove the suction catheter.
• Give prescribed medication, such as a bronchodilator (eg, Ventolin®) and/or oxygen if available and recommended by the healthcare team.
• If your child IS NO LONGER in respiratory distress, contact your child’s healthcare team.
• If your child REMAINS in respiratory distress:
  • call 911 immediately;
  • if required, begin manual ventilation and CPR as instructed.

Possible cause(s)

• Aspiration too soon after the last meal
• Incorrect aspiration technique (eg, insertion of the suction device such as Yankauer suction tip too far back in the throat)
• Stimulation of the gag reflex during oral or nasopharyngeal suctioning
• Incorrect insertion of the catheter

What to do?

• Turn your child’s head to the side to avoid choking or passage of vomit into the lungs.
• If the secretions were aspirated during a meal, pause your child’s feeding.
• Clean your child’s mouth.
• Closely observe your child’s breathing to detect any signs of respiratory distress (see previous problem).
• Rapidly contact your child’s healthcare team.

To avoid vomiting:

• Minimize aspiration of secretions immediately after meals.
• Review the correct technique for aspiration of secretions.
• Gently insert the suction catheter to avoid stimulating the gag reflex.

Possible cause(s)

• Agitated child, moving a lot during the aspiration procedure
• Incorrect insertion of the suction catheter
• Irritation of the nostril
• Excessive suctioning of the nose
• Suction pressure too high

What to do?

• Reassure your child.
• Apply direct pressure to the bridge of your child’s nose for a few minutes to stop bleeding; if possible put your child in the upright or sitting position.
• If the bleeding persists, rapidly contact your child’s healthcare team.

To avoid nosebleeds:

• Review the correct technique for nasopharyngeal aspiration of secretions.
• Verify that the suction pressure regulator is correctly set, as recommended by the healthcare team.
• Verify that the catheter is well lubricated prior to insertion.
• Gently insert the catheter into the nose.

Possible cause(s)

• Incorrect insertion of the suction catheter
• Bronchospasm: narrowing or constriction of the airways
• Respiratory tract infection

What to do?

• Stop suctioning.
• Remove the suction catheter.
• Reassure your child.
• Assess your child’s breathing and colour.
• If your child calms and stops coughing, gently re-insert the catheter to aspirate secretions.
• If the cough persists, consider administration of a bronchodilator such as Ventolin® and/or oxygen if available and recommended by the healthcare team.
• If your child shows signs of respiratory distress:
  • call 911 immediately;
  • if required, begin manual ventilation and CPR as instructed.
• If the cough persists, rapidly contact your child’s healthcare team.

To prevent this problem: Review the correct technique for aspiration of secretions.

Possible cause(s)

Low level of oxygen in the blood (desaturation or hypoxia)

What to do?

• Stop aspiration of secretions.
• Remove the suction catheter.
• Administer oxygen, if available.
• Closely observe your child.
• If your child is mechanically ventilated, reconnect your child to the ventilator.
• If your child remains in respiratory distress:
  • call 911 immediately;
  • if required, begin manual ventilation and CPR as instructed.
• If your child improves, immediately contact your child’s healthcare team.

Possible cause(s)

Vagal stimulation

What to do?

• Stop aspiration of secretions.
• Verify the general and respiratory status of your child, following the training provided by your healthcare team.
• If your child is in respiratory distress, call 911 immediately and begin manual ventilation and CPR as instructed.

Possible cause(s)

• Break or leak in the suction device system (eg, cover not secured, catheter or filter incorrectly connected)
• Defective suction device

What to do?

• Verify that the suction device is correctly installed and connections are secured.
• If necessary, use the manual mucous trap device to aspirate secretions from the tracheal cannula
• If the problem persists, rapidly contact your healthcare team.

Possible cause(s)

• Canister is overfilled
• Battery depleted
• Defective suction device

What to do?

• Verify that the suction device is plugged into a working electrical outlet or that the battery is correctly charged.
• Empty the canister if full.
• If the problem persists, rapidly contact your child’s healthcare team.