This may come across as mean to some of the previous responders, but I have to voice this. I used to be a pediatric pulmonary nurse. I served on a committee to review/drastically change our trach policy in the pediatric hospital where I work. Many of the things mentioned above are not correct. We did lots of research, including consulting hospitals and lit reviews before deciding on what to change in our policy.
First, the suction length should ALWAYS correspond to the trach length. ALWAYS. If you are unsure, or just want to double check, take the CORRECT size catheter (which should be half the size of the diameter of the trach), insert it into the extra trach you should always have at the patient’s bedside, even in homecare (which I also do). The first (or only) hole in the catheter should just appear at the bottom of the trach. This is your suction length. Suction length is in centimeter, not inches. The hole needs to be just through the bottom to provide the correct suction to adequately remove secretions. DO NOT go past this, ever! You will cause abrasions in the trachea, which can provide a place for bacteria to grow. This is especially important in kids/adults who do not have a gag reflex-they will not respond or cough, but you are still scraping the trachea.
As far as suctioning only on the way out, at my hospital, we suction in and out. There is no research that supports either way. We also just went to sterile suctioning at my hospital. A pain, yes, but with all of the healthcare changes going on, our goal is to prevent nosocomial infections that are no longer covered by medicare/medicaid.
And as to the rrequency question above, we try to suction as infrequently as possible. In fresh trachs, we have to suction every two hours (they are sutured in, and in case of a plug off it is a code situation, so we do it to prevent that situation). Otherwise, only as needed. You are not preventing secretions from developing by more frequent suctioning, and could be making them cough, thus increasing secretions. In other words, if they are not goopy, don’t suction them.
Also, saline drops have not been proven to break up secretions, and have been shown to lead to pneumonia(flowing down to lungs). We are not permittted in my hospital to use saline, ever.