Coughing, suctioning, and humidification can help reduce secretions. Preventing the buildup of secretions is an important part of tracheostomy care.

People who have a tracheostomy typically experience a buildup of mucus secretions in the windpipe, also called the trachea.

Secretions are a natural reaction to the procedure, but they can increase the risk of complications, such as breathing difficulties, infection, and a blocked tracheostomy tube.

Managing and reducing the buildup of secretions is an important part of tracheostomy care. Effective methods include suctioning, humidification, coughing, and saline fluid.

In this article, we’ll explain why tracheostomy secretions occur, how to reduce secretions, and treatments for excessive coughing.

A tracheostomy secretion is a buildup of mucus in the trachea that occurs as a result of a tracheostomy procedure.

Secretions are normally thin in consistency. Thick secretions may indicate the need for humidification, more fluids, or other treatments to loosen or break up the mucus.

Secretions typically appear clear or white in color. Yellow, brown, or green secretions may be a sign of an infection. Traces of blood may indicate swelling or irritation.

The volume and thickness of secretions varies from patient to patient.

Excess mucus secretions can accumulate in the airway and tracheotomy tube. Without effective management, this buildup can increase the risk of complications such as:

  • inhaling the secretions (aspiration), which may also be contaminated
  • difficulty breathing
  • infection, such as pneumonia
  • blockage of the tracheostomy tube

Mucus secretions are a natural reaction to changes in the airway after a tracheostomy procedure.

Normally, the upper airway moistens, warms, and cleans the air you breathe as it passes through your nose and throat.

A tracheostomy tube bypasses this process, causing the air you breathe to become cooler, drier, and less clean. As a result, the body produces more mucus.

Several other factors can also contribute to the increase in mucus. This includes:

  • post-surgical inflammation in the airway
  • the presence of the tracheostomy tube in the trachea
  • the inability to cough normally due to bypassing the larynx

Because of this, many people experience a higher volume of secretions during the first few days after surgery.

In addition, dry indoor air can lead to thicker secretions. This can cause clogging in the tracheostomy tube.

You can reduce and clear tracheal secretions in a variety of ways, including self-care, suctioning, and humidification devices.

Self-care

The following steps may help you clear your airway on your own without the use of suctioning:

  • Bend forward and cough. Collect the mucus that comes out of the tube, not the nose or mouth.
  • Squirt sterile saline fluid into the tracheostomy tube. Then try to cough again.
  • Take a hot shower or bath, making sure to keep water out of the tube.
  • Place a warm piece of gauze over the tube.

If you have difficulty breathing, try suctioning. Call your local emergency number for immediate medical treatment if you continue to have trouble breathing after suctioning.

Suctioning

Suctioning is the use of a suction machine to clear mucus from the tracheostomy tube.

According to clinical practice guidelines, suctioning is recommended if you:

  • feel or hear mucus in the tube or airway
  • have trouble breathing
  • experience increased coughing
  • suspect a blockage in the airway
  • need to change the tube or deflate the cuff

You may need suctioning more often in the days following the procedure, but this may decrease over time.

While you’re recovering from a tracheostomy in the hospital, your healthcare team can perform suctioning when needed. Before you leave the hospital, a nurse or other healthcare professional can explain how to perform suctioning at home.

It’s important to note that suctioning too frequently can cause more secretions to build up. Suctioning is usually safe when performed as instructed, but complications such as pain or infection can occur.

Humidification

Humidification moisturizes the air you breathe, which can thin and loosen secretions. It can also help prevent the formation of thick, encrusted mucus.

Humidifiers for people living with tracheostomy can be active or passive. Active humidifiers use an external device to supply heat and humidification. Options include:

  • bubble humidifiers
  • passover humidifiers
  • counter-flow humidifiers

Passive humidifiers use a person’s own body temperature and hydration to provide humidification. They’re generally small devices that are easy to use. Options include:

  • heat moisture exchangers (HMEs), also known as artificial noses
  • stoma filters or bibs

Along with these devices, staying adequately hydrated is also important.

Inner cannula cleaning or replacement

If the tracheostomy tube becomes blocked with secretions, you may be able to remove and clean, or entirely replace, the inner tube within the main outer tube. The inner tube is called the inner cannula.

In a hospital setting, a medical professional may perform the cleaning or replacement. Follow your doctor’s instructions for proper replacement or cleaning of the inner cannula at home.

Respiratory muscle rehabilitation

Respiratory muscle rehabilitation aims to strengthen the respiratory muscles, which include the diaphragm, abdominal muscles, and rib cage muscles.

Training involves breathing exercises using a resistive or pressure threshold device. Research suggests this type of training can improve cough strength and swallowing, which can help reduce tracheostomy secretions.

Mucolytics are prescription medications that can help thin secretions. These meds can make it easier to clear secretions from the airway. It can also prevent mucus from plugging the tube.

Usually, mucolytics are provided as a liquid that you put into a nebulizer machine. The machine allows you to breathe in the medication as a mist.

Mucolytic medications include:

  • N-acetyl cysteine (NAC)
  • dornase alfa
  • carbocysteine
  • erdosteine
  • fudosteine
  • thymosin beta-4

Other medications that may help treat excessive airway secretions include:

  • expectorants
  • nasal decongestants
  • bronchodilators

A clinical case study from 2020 points out that “beyond small studies suggesting some benefit, there is limited high quality literature assessing the efficacy of mucolytic agents in critically ill patients.”

In this research analysis of studies ranging from 1970 to 2014, the researchers noted that only nine smaller studies totaling 379 people specifically addressed the topic. They collectively reported no benefit, and even adverse side effects weren’t consistently reported in those studies.

More research is needed to clearly examine how people respond to certain treatments and what possible benefits or side effects might come from using mucoactive agents.

Excessive coughing can occur with a tracheostomy as a result of breathing dry air through the tube.

Treatments that can help reduce coughing include humidification and hydration. Consider using a humidifier or taking a warm shower or bath.

Drink plenty of fluids to stay hydrated. Some people with a tracheostomy may have trouble swallowing and need to receive hydration intravenously or subcutaneously.

Talk with your doctor about other treatment options if your severe coughing persists.

You can use a variety of methods to effectively reduce tracheostomy secretions. This can include suctioning, humidification, saline solution, and medication.

Simple steps to help reduce secretions include staying hydrated, taking a warm shower, and coughing to remove secretions from the tube when needed.

Many people experience a higher volume of secretions in the days immediately following a tracheostomy procedure, with secretions gradually decreasing over time.

If secretions continue to be a problem, speak with your doctor about other treatment options.