Tracheostomy Care And Suctioning Safety - NCLEX Rn

1. Which assessment best indicates that tracheostomy suctioning is needed?

   Visible/auscultated secretions, increased WOB, or decreased SpO$_2$. These signs reflect secretion accumulation impairing airway patency and gas exchange, necessitating intervention.

2. What is the correct action if you cannot pass a suction catheter through the tracheostomy tube?

   Suspect obstruction; remove/replace inner cannula and reassess airway. Inability to pass suggests blockage, often from secretions in the inner cannula, requiring immediate clearance.

3. What is the recommended negative suction pressure range for an adult tracheostomy?

   $80$ to $120$ mm Hg (adult). This range provides effective secretion removal while minimizing risks of tracheal mucosa damage in adults.

4. What is the correct immediate action if a tracheostomy tube becomes dislodged in a new stoma?

   Call for help; maintain airway and ventilate; do not force reinsertion. New stomas can close rapidly, so forcing reinsertion risks false passage; prioritize support and expert help.

5. Which type of suctioning is preferred for routine tracheostomy care to lower infection risk?

   Sterile technique (especially for new tracheostomy or acute care). Sterile technique is essential to prevent introducing pathogens into the vulnerable respiratory tract.

6. What is the recommended negative suction pressure range for a child during tracheostomy suctioning?

   $80$ to $100$ mm Hg (child). Lower pressures are used in children to avoid barotrauma due to their smaller, more delicate airways.

7. What is the maximum recommended duration for each tracheostomy suction pass?

   No longer than $10$ to $15$ seconds per pass. Limiting duration prevents prolonged hypoxia and reduces mucosal trauma from extended negative pressure.

8. What is the correct cuff pressure range to reduce tracheal injury and aspiration risk?

   $20$ to $25$ cm H$_2$O cuff pressure. This range balances sealing for ventilation against excessive pressure that could cause tracheal damage.

9. Which method is preferred to monitor tracheostomy cuff pressure accurately?

   Use a cuff manometer (not minimal leak by estimation). Manometry provides precise measurement, avoiding overinflation risks associated with subjective methods.

10. What is the minimum time you should allow between suction passes to permit reoxygenation?

    Allow at least $30$ to $60$ seconds between passes. This interval allows adequate reoxygenation and recovery from potential vagal stimulation effects.

11. Which statement correctly describes why normal saline instillation before suctioning is avoided routinely?

    It can worsen hypoxemia and push bacteria deeper into airway. Routine saline use is discouraged based on evidence showing it displaces secretions distally without improving clearance.

12. What is the priority intervention if the patient develops bradycardia during suctioning?

    Stop suctioning and provide oxygen/ventilation. Bradycardia often results from vagal stimulation, and oxygenation helps stabilize heart rate and oxygen levels.

13. Which technique is correct for suctioning a tracheostomy regarding suction application on insertion?

    Do not apply suction during insertion; suction on withdrawal. Applying suction only on withdrawal prevents unnecessary trauma to the tracheal mucosa during insertion.

14. What is the correct practice for humidification in a patient with a tracheostomy?

    Provide heated humidification or HME to prevent thick secretions. Humidification maintains mucosal hydration, preventing secretion inspissation and promoting easier clearance.

15. Which finding during suctioning indicates the need to stop suctioning immediately?

    Bradycardia, severe desaturation, or new dysrhythmia. These signs indicate severe physiological stress, such as vagal response or profound hypoxia, requiring immediate cessation.

16. What is the correct immediate response to thick, tenacious tracheostomy secretions?

    Increase humidification and hydration; suction as needed. Enhancing moisture thins secretions for easier removal, addressing the root cause of tenacity.

17. Which bedside items are essential for tracheostomy safety in case of accidental decannulation?

    Obturator, spare same-size tube, and one size smaller tube. These items enable prompt, safe reinsertion if the tube dislodges, preventing airway compromise.

18. Identify the correct step when cleaning a reusable inner cannula during routine tracheostomy care.

    Remove inner cannula and clean per policy; rinse and reinsert when clear. Proper cleaning removes secretions and maintains patency without introducing contaminants.

19. What is the correct catheter handling method to minimize mucosal trauma during suctioning?

    Withdraw while rotating catheter; use intermittent suction. Rotation and intermittency ensure even secretion clearance while reducing the risk of tissue adherence and injury.

20. Which assessment finding most strongly suggests a cuff leak requiring intervention?

    New audible air leak with reduced delivered tidal volume/vent alarms. These indicate cuff failure, compromising ventilation and increasing aspiration risk, prompting urgent evaluation.

21. Which action is correct when changing tracheostomy ties to prevent accidental decannulation?

    Secure tube; have a second person stabilize tube during tie change. Stabilization by a second person ensures the tube remains in place, reducing dislodgement risk during the procedure.

22. Which action is the priority before suctioning a tracheostomy to reduce hypoxemia risk?

    Preoxygenate with $100\%$ oxygen per policy/protocol. Preoxygenation increases oxygen reserves to minimize desaturation risks during the apnea associated with suctioning.

23. What is the priority complication to monitor for when cuff pressure is too high?

    Tracheal mucosal ischemia and tracheal stenosis risk. Excessive pressure impairs tracheal blood flow, leading to necrosis and long-term narrowing.

24. What is the recommended negative suction pressure range for an infant during tracheostomy suctioning?

    $60$ to $80$ mm Hg (infant). Infants require even lower pressures to prevent airway injury given their vulnerable tracheal structures.

25. What is the maximum number of suction passes you should perform before reassessing the patient?

    No more than $2$ to $3$ passes, then reassess. Limiting passes prevents cumulative hypoxia and complications, with reassessment guiding further actions.

Study these flashcards