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Question

Difficulty: MediumPhysiological Adaptation

A client recovering from a radical neck dissection has a newly established tracheostomy. The client exhibits restlessness, and coarse rhonchi are heard upon auscultation. The practical nurse prepares to suction the artificial airway. Arrange the following steps of the procedure in the correct chronological order from first to last.

  1. 1Hyperoxygenate the client with 100% oxygen.
  2. 2Advance the sterile suction catheter into the airway without applying suction.
  3. 3Apply intermittent suction for no longer than 10 to 15 seconds during catheter withdrawal.
  4. 4Flush the suction catheter and connecting tubing with sterile saline.
  5. 5Auscultate bilateral lung sounds to evaluate the effectiveness of the intervention.

Answer

The correct sequence is to first hyperoxygenate the client, then advance the catheter without suction, apply intermittent suction only during withdrawal, flush the catheter with saline, and finally reassess the client's lung sounds.
Airway clearance via tracheostomy suctioning must follow strict chronological steps to ensure safety and prevent hypoxia. The client must first be pre-oxygenated to build a respiratory reserve. The catheter is then advanced without suction to protect the mucosal lining from trauma. Once resistance is met or the desired depth is reached, intermittent suction is applied only during withdrawal for a maximum of 10 to 15 seconds to remove secretions while limiting oxygen deprivation. Afterward, the catheter is flushed to maintain patency, and the client's respiratory status is reassessed to evaluate the procedure's success.

Step-by-Step Solution

1
Hyperoxygenate the client with 100% oxygen.
The client's oxygen reserves are maximized.
To prevent severe hypoxemia when oxygen is removed from the airway along with secretions.
2
Advance the sterile suction catheter into the airway without applying suction.
The catheter reaches the proper depth safely.
Applying negative pressure during insertion strips and traumatizes the tracheal mucosa, increasing the risk of bleeding.
3
Apply intermittent suction for no longer than 10 to 15 seconds during catheter withdrawal.
Secretions are cleared from the airway.
Intermittent suction clears the mucus, while the strict time limit minimizes oxygen deprivation and mucosal damage.
4
Flush the suction catheter and connecting tubing with sterile saline.
The catheter and tubing are cleared of thick secretions.
To maintain patency for subsequent passes or future use.
5
Auscultate bilateral lung sounds to evaluate the effectiveness of the intervention.
The client's respiratory status is documented.
To confirm whether the airway is clear or if the suctioning process needs to be repeated.

Key Concept

Airway Management: Tracheostomy Suctioning Sequence
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Topics

Physiological Adaptation

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