Fear experienced by patients and their caregivers while performing tracheostomy suctioning: a comprehensive review

Authors

  • Christy Sharmila St John's College of Nursing, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India
  • Bindhu Mathew Department of Medical Surgical Nursing, St. John’s College of Nursing, Bangalore, Karnataka, India
  • Sreenivas Department of ENT, St. John’s Medical College, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20253651

Keywords:

Tracheostomy suctioning, Patient anxiety, Caregiver stress, Psychological impact, Airway management

Abstract

Tracheostomy suctioning is an essential procedure to prevent airway obstruction, yet it often triggers significant fear and anxiety in both patients and their caregivers. This comprehensive review analyzes the psychological and physical challenges associated with the procedure, drawing from peer-reviewed studies, case reports, and clinical guidelines. Patients frequently report profound fear linked to sensations of choking, breathlessness, pain, and a loss of control, which can contribute to long-term anxiety and depression. Concurrently, caregivers experience intense stress, fearing they might cause harm, complications like hypoxia or infection, or manage the procedure incorrectly due to inadequate training. This shared emotional burden can lead to burnout and negatively impact adherence to care. The findings confirm that fear associated with tracheostomy suctioning has significant psychological and clinical implications. Addressing these concerns through comprehensive caregiver training, patient reassurance, integrated psychological support, and adherence to standardized, gentle techniques is critical. Healthcare providers play a pivotal role in creating a supportive environment that empowers both patients and caregivers, ultimately reducing anxiety and improving the safety and efficacy of tracheostomy care.

Metrics

Metrics Loading ...

References

Nakarada-Kordic I, Patterson N, Wrapson J, Reay SD. A systematic review of patient and caregiver experiences with a tracheostomy. The Patient-Patient-Centered Outcomes Research. 2018;11:175-91. DOI: https://doi.org/10.1007/s40271-017-0277-1

Vargas M, Sutherasan Y, Antonelli M, Brunetti I, Corcione A, Laffey JG, et al. Tracheostomy procedures in the intensive care unit: an international survey. Crit Care. 2015;19:1-10. DOI: https://doi.org/10.1186/s13054-015-1013-7

Oermann MH, McHugh NG, Dietrich J, Boyll R. After a tracheostomy: Patients describe their sensations. Cancer Nurs. 1983;6(5):361-6. DOI: https://doi.org/10.1097/00002820-198310000-00003

Pryor LN, Baldwin CE, Ward EC, Cornwell PL, O'Connor SN, Chapman MJ, et al. Tracheostomy Tube Type and Inner Cannula Selection Impact Pressure and Resistance to Air Flow. Respir Care. 2016;61(5):607-14. DOI: https://doi.org/10.4187/respcare.04396

Howard TL, Korlipara H, Sharoha N. Prompt use of benzodiazepines for anxiety management in COVID-19-positive patients with tracheostomy. Prim Care Companion CNS Disord. 2020;22(6):26701. DOI: https://doi.org/10.4088/PCC.20l02785

Clini E, Vitacca M, Bianchi L, Porta R, Ambrosino N. Long-term tracheostomy in severe COPD patients weaned from mechanical ventilation. Respir Care. 1999;44:415-20.

Arroyo-Novoa CM, Figueroa-Ramos MI, Puntillo KA, Stanik-Hutt J, Thompson CL, White C, et al. Pain related to tracheal suctioning in awake acutely and critically ill adults: a descriptive study. Intensive Crit Care Nurs. 2008;24(1):20-7. DOI: https://doi.org/10.1016/j.iccn.2007.05.002

Parker LC. Tracheostomy care. Nurs Crit Care. 2014;9(6):38-41. DOI: https://doi.org/10.1097/01.CCN.0000453466.57833.dd

Amathieu R, Sauvat S, Reynaud P, Slavov V, Luis D, Dinca A, et al. Influence of the cuff pressure on the swallowing reflex in tracheostomized intensive care unit patients. Br J Anaesth. 2012;109(4):578-83. DOI: https://doi.org/10.1093/bja/aes210

Alakan YŞ, Akansel N, Özmen ÖA. Experiences of patients’ primary caregivers with tracheostomy suctioning before discharge. Eur J Oncol Nurs. 2023;67:102435. DOI: https://doi.org/10.1016/j.ejon.2023.102435

Breckenridge SJ, Chlan L, Savik K. Impact of tracheostomy placement on anxiety in mechanically ventilated adult ICU patients. Heart Lung. 2014;43(5):392-8. DOI: https://doi.org/10.1016/j.hrtlng.2014.01.005

Ferrario SR, Zotti AM, Zaccaria S, Donner CF. Caregiver strain associated with tracheostomy in chronic respiratory failure. Chest. 2001;119(5):1498-502. DOI: https://doi.org/10.1378/chest.119.5.1498

Karaca T, Altinbas Y, Aslan S. Caring for patients with a tracheostomy at home: a descriptive, cross-sectional study to evaluate health care practices and caregiver burden. Wound Manag Prev. 2019;65(3):22-9. DOI: https://doi.org/10.25270/wmp.2019.3.2229

Tolotti A, Cadorin L, Bonetti L, Valcarenghi D, Pagnucci N. Communication experiences of tracheostomy patients with nurses in the ICU: A scoping review. J Clin Nurs. 2023;32(11-12):2361-70. DOI: https://doi.org/10.1111/jocn.16296

Negi M, Cecilia MS, Sharma KK, Thakar A, Srivastava SP. Psychosocial, physical problems and coping strategies of patients having long term/permanent tracheostomy. Discov Psychol. 2024;4(1):171. DOI: https://doi.org/10.1007/s44202-024-00290-8

Pedersen ML, Handberg C, Dreyer P. Mental health reported in adult invasive home mechanical ventilation through a tracheostomy: a scoping review. Int J Nurs Stud Adv. 2022;4:100110. DOI: https://doi.org/10.1016/j.ijnsa.2022.100110

Arabi Y, Haddad S, Shirawi N, Al Shimemeri A. Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review. Crit Care. 2004;8(5):R347-52. DOI: https://doi.org/10.1186/cc2924

Ng FK, Healey MM, Goves J, Edwards ME, Lynch J, Wallace MS, et al. Give patients what they want: impact of tracheostomy quality improvement program on patients’ psychological wellbeing. Trends Anaesth Crit Care. 2020;30:e178-9. DOI: https://doi.org/10.1016/j.tacc.2019.12.438

Henningfeld J, Lang C, Erato G, Silverman AH, Goday PS. Feeding disorders in children with tracheostomy tubes. Nutr Clin Pract. 2021;36(3):689-95. DOI: https://doi.org/10.1002/ncp.10551

Acorda DE, Brown JN, Lambert EM, Gibbs KD. Psychosocial measures and outcomes among caregivers of children with tracheostomies: a systematic review. Otolaryngol Head Neck Surg. 2023;168(5):979-87. DOI: https://doi.org/10.1002/ohn.202

Tabootwong W, Vehviläinen-Julkunen K, Jullamate P, Rosenberg E, Turunen H. Family caregivers’ experiences of providing care for hospitalized older people with a tracheostomy: a phenomenological study. Working with Older People. 2022;26(4):355-67. DOI: https://doi.org/10.1108/WWOP-08-2021-0043

Sharmila KC, Mathew B. Perception of caregivers’ stress while caring for Tracheostomy Patients-Literature Review. Int J Med Surg Nurs. 2024;7(2):8–14.

Chew JY, Cantrell RW. Tracheostomy: complications and their management. Arch Otolaryngol. 1972;96(6):538-45. DOI: https://doi.org/10.1001/archotol.1972.00770090816008

Reising E. Developing the tracheostomy care anxiety relief through education and support (T-CARES) program. Clin J Oncol Nurs. 2014;18(5):522. DOI: https://doi.org/10.1188/14.CJON.522-527

Hernandez M, Torres A. Tracheostomy Complications. In: Emergency Anesthesia Procedures. New York, NY: Springer; 2023: 55. DOI: https://doi.org/10.1093/med/9780190902247.003.0007

Gursoy TR, Eyuboglu TS, Aslan AT, Pekcan S, Buyukkaya EZ, Hangul M, Kose M, Budakoglu II, Soysal S. The associations between the clinical course of children with tracheostomy and their mothers' depression, burnout, burden, and self‐esteem. J Clin Nurs. 2023;32(13-14):3412-20. DOI: https://doi.org/10.1111/jocn.16450

Aung WT, Ong NY, Yeo SQ, Juhari NS, Kong G, Lim NA, et al. Impact of pediatric tracheostomy on family caregivers’ burden and quality of life: a systematic review and meta- analysis. Frontiers in Public Health. 2025;12:1485544. DOI: https://doi.org/10.3389/fpubh.2024.1485544

Meyer‐Macaulay CB, Graham RJ, Williams D, Dorste A, Teele SA. “New Trach Mom Here…”: A qualitative study of internet‐based resources by caregivers of children with tracheostomy. Pediatr Pulmonol. 2021;56(7):2274-83. DOI: https://doi.org/10.1002/ppul.25355

Antoniou I, Wray J, Kenny M, Hewitt R, Hall A, Cooke J. Hospital training and preparedness of parents and carers in paediatric tracheostomy care: a mixed methods study. Int J Pediatr Otorhinolaryngol. 2022;154:111058. DOI: https://doi.org/10.1016/j.ijporl.2022.111058

Mai K, Davis RK, Hamilton S, Robertson-James C, Calaman S, Turchi RM. Identifying caregiver needs for children with a tracheostomy living at home. Clin Pediatr (Palo Alto). 2020 Nov;59(13):1169-81. DOI: https://doi.org/10.1177/0009922820941209

Day T, Farnell S, Haynes S, Wainwright S, Wilson‐Barnett J. Tracheal suctioning: an exploration of nurses' knowledge and competence in acute and high dependency ward areas. J Adv Nurs. 2002;39(1):35-45. DOI: https://doi.org/10.1046/j.1365-2648.2002.02240.x

Enamandram SS, Peltz A, Arora A, Narula AA, Roberson DW, Hettige R. Global Tracheostomy Collaborative: the future of quality improvement strategies. Curr Otorhinolaryngol Rep. 2014;2(1):13-9. DOI: https://doi.org/10.1007/s40136-013-0034-5

Fiske E. Effective strategies to prepare infants and families for home tracheostomy care. Adv Neonatal Care. 2004 Feb 1;4(1):42-53. DOI: https://doi.org/10.1016/j.adnc.2003.11.011

McDonough K, Crimlisk J, Nicholas P, Cabral H, Quinn EK, Jalisi S. Standardizing nurse training strategies to improve knowledge and self-efficacy with tracheostomy and laryngectomy care. Appl Nurs Res. 2016;32:212-6. DOI: https://doi.org/10.1016/j.apnr.2016.08.003

Prickett K, Deshpande A, Paschal H, Simon D, Hebbar KB. Simulation-based education to improve emergency management skills in caregivers of tracheostomy patients. Int J Pediatr Otorhinolaryngol. 2019 May 1;120:157-61. DOI: https://doi.org/10.1016/j.ijporl.2019.01.020

Stone TS, Miller CL, Summey J, Bongiovanni R, Nemecek E, Merlin MA. Humidification and Tracheostomy Care in Transit: A Systematic Review of Current Evidence and Future Directions. Air Med J; 2024. DOI: https://doi.org/10.1016/j.amj.2024.10.006

Ireton J. Tracheostomy suction: a protocol for practice. Paediatr Nurs. 2007;19(10).

Swain SK, Acharya S, Das S. Social impact of tracheostomy: Our experiences at a tertiary care teaching hospital of Eastern India. J Sci Soc. 2020;47(3):148-52. DOI: https://doi.org/10.4103/jss.JSS_61_20

Zarzycka J, Kobos E, Czarnecka J, Imiela J. Social support and the acceptance of illness among patients with a tracheostomy tube. J Public Health Nurs Med Rescue. 2015;1(1):17-25.

Liu A, Hammack-Aviran C, Turnbull J. Tracheostomy Decision Making and Counseling: Comparing Providers’ and Caregivers’ Perspectives and Perceptions. J Palliat Med. 2024;27(9):1163-70. DOI: https://doi.org/10.1089/jpm.2023.0699

Nageswaran S, Gower WA, King NM, Golden SL. Tracheostomy decision-making for children with medical complexity: What supports and resources do caregivers need?. Palliat Support Care. 2024;22(4):776-82. DOI: https://doi.org/10.1017/S1478951522001122

Sherman J, Bower KL, Eskandanian K. “100 Things I Wish Someone Would Have Told Me”: Everyday Challenges Parents Face While Caring for Their Children With a Tracheostomy. Qual Health Res. 2024;34(11):1108-18. DOI: https://doi.org/10.1177/10497323231217387

Regan EN, Dallachiesa L. How to care for a patient with a tracheostomy. Nurs. 2009;39(8):34-9. DOI: https://doi.org/10.1097/01.NURSE.0000358572.79112.bd

Patton J. Tracheostomy care. Br J Nurs. 2019;28(16):1060-2. DOI: https://doi.org/10.12968/bjon.2019.28.16.1060

Cordeiro AL, Barroso AC, Donoso MT, Mata LR, Chianca TC. Tracheostomy care for adults and the elderly in the home environment: a scoping review. Rev Esc Enferm USP. 2024;58:e20240028. DOI: https://doi.org/10.1590/1980-220x-reeusp-2024-0028pt

Raimondi N, Vial MR, Calleja J, Quintero A, Cortés A, Celis E, Pacheco C, Ugarte S, Añón JM, Hernández G, Vidal E. Evidence-based guidelines for the use of tracheostomy in critically ill patients. J Crit Care. 2017;38:304-18. DOI: https://doi.org/10.1016/j.jcrc.2016.10.009

Siddiqui J, Sherren PB, Birchall MA. Evidence-based guidelines and protocols for the management of adult patients with a tracheostomy: a systematic review. Crit Care. 2013;17(2):P166. DOI: https://doi.org/10.1186/cc12104

Wooldridge AL, Carter KF. Pediatric and neonatal tracheostomy caregiver education with phased simulation to increase competency and enhance coping. J Pediatr Nurs. 2021;60:247-51. DOI: https://doi.org/10.1016/j.pedn.2021.07.011

Sandler ML, Ayele N, Ncogoza I, Blanchette S, Munhall DS, Marques B, Nuss RC. Improving tracheostomy care in resource-limited settings. Ann Otol Rhinol Laryngol. 2020;129(2):181-90. DOI: https://doi.org/10.1177/0003489419882972

Downloads

Published

2025-10-30

How to Cite

Sharmila, C., Mathew, B., & Sreenivas. (2025). Fear experienced by patients and their caregivers while performing tracheostomy suctioning: a comprehensive review. International Journal of Research in Medical Sciences, 13(11), 5073–5079. https://doi.org/10.18203/2320-6012.ijrms20253651

Issue

Section

Review Articles