Hi Kelly, I work in ON, in a group home type setting for medically fragile children. We have quite a few trachs. We suction to a prescribed distance which is measured out on the suction catheter for each client with a trach. We have a large age range infant and up so size of the client determines the distance. We also suction the oral and nasal cavities. I can't remember if we had extra orientation on this upon hire. Hope this helps, Heather