Tracheostomy Care And Suctioning Safety - NCLEX-RN

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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.

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

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.

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

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

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