What is the appropriate technique for suctioning a tracheostomy tube?

Insert the suction catheter forcefully to clear all secretions from the tracheostomy tube.

Hyper-oxygenate the patient before and after, and limit each pass to 10 seconds or less.

Insert the suction catheter until it reaches the carina, then apply suction while withdrawing the catheter.

Apply suction continuously while inserting the suction catheter into the tracheostomy tube.