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Difficulty: HardReduction of Risk Potential

A client with a tracheostomy requires suctioning to clear audible, coarse secretions. Arrange the following actions in the correct sequence that the practical nurse (PN) should perform to minimize the risk of hypoxia and mucosal trauma.

  1. 1Hyperoxygenate the client with 100% oxygen.
  2. 2Advance the sterile suction catheter without applying suction.
  3. 3Pull the catheter back slightly (1 to 2 cm) after meeting resistance.
  4. 4Apply intermittent suction while rotating the catheter upon withdrawal.
  5. 5Reassess the client's oxygen saturation and lung sounds.

Answer

The correct sequence is: hyperoxygenate the client, advance the catheter without suction, pull the catheter back slightly after meeting resistance, apply intermittent suction while rotating upon withdrawal, and finally reassess the client's status.
Performing tracheostomy suctioning requires a strict sequence to clear secretions safely. Preoxygenation protects against hypoxemia. Advancing without suction and pulling back at the carina prevents mucosal injury. Suctioning only on withdrawal with a twisting motion effectively clears mucus while avoiding tissue damage. Post-procedure assessment evaluates the success of the intervention.

Step-by-Step Solution

1
Hyperoxygenate the client with 100% oxygen.
The client's oxygen reserves are maximized.
Prevents severe hypoxemia when airflow is temporarily compromised by the suction catheter.
2
Advance the sterile suction catheter without applying suction.
The catheter is positioned deep into the trachea.
Applying suction during insertion damages the mucosal lining and unnecessarily depletes oxygen.
3
Pull the catheter back slightly (1 to 2 cm) after meeting resistance.
The catheter tip is positioned just above the carina.
Resting the suction tip directly on the sensitive carina causes severe coughing and tissue trauma.
4
Apply intermittent suction while rotating the catheter upon withdrawal.
Secretions are cleared from the airway.
Rotation prevents the catheter from adhering to one spot, and limiting suction minimizes airway collapse.
5
Reassess the client's oxygen saturation and lung sounds.
The effectiveness of the procedure is confirmed.
Ensures the airway is clear and oxygenation is stable before concluding care.

Key Concept

Airway Management and Complication Prevention
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Topics

Reduction of Risk Potential

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