According to the nursing book I studied, I am suppose to insert the suction tube with no suction and then twirl the tube between my thumb and index finger and suction on the way out of the trach and to only do this one time and throw away the suction catheter. I have been doing this and it seems that hardly anything actually comes out. Mom does the suctioning the way you would do a regular suctioning on someone without a trach. She goes in twice with the same suction catheter and she gets rid of a lot of mucus. Since Mom is actually getting good results with her way of doing it perhaps I should do what Mom is doing? Mom says each suction catheter costs $10 a piece.