The risks of suction are well documented. Nurses caring for children with tracheostomies must use their clinical judgement as well as a safe suction procedure based on evidence. Preperation, correct equipment and suction pressures, a safe suction procedure and post-procedure assessment are included in a proposed protocol for a self-ventilating child with a tracheostomy. Suction presures are recommented at the lower limits suggested by research, i. e. presures of 80-120 mmHg (10-16 Kpa) for adolescents, 80-100 mmHg (10-13 Kpa) for children and 60-80 mmHg (8-10 Kpa) for neonates. Three holed catheters are advocated of a size no larger than half the internal diameter of the patient's tracheostomy. It is recommended that the suction catheter not be inserted further than the end of the tracheostomy tube. Routine instillation of saline is not recommended. A combination of education, staff involvement and mechanisms for adult, evaluation and modification of the protocol are required to support implementation of the protocol and improvements in practice.