The nurse is preparing to perform suctioning on a client with a tracheostomy who is not on a mechanical ventilator. Which of the following actions by the nurse are appropriate?
The nurse instills normal saline into the airway before suctioning.
The nurse applies intermittent suction for 15 seconds while pulling the catheter straight out.
The nurse hyperoxygenates the client with the manual resuscitation bag before suctioning.
The nurse quickly inserts the catheter during inspiration until resistance is met or the client coughs.
The nurse quickly inserts the catheter during expiration until resistance is met or the client coughs.
The nurse applies intermittent suction for 10 seconds while rotating the catheter back and forth between the dominant thumb and forefinger.
Numbers 3 and 4 are correct.
Rationale: The client is hyperoxygenated before suctioning to decrease suction-induced hypoxemia. Inserting the catheter upon inspiration minimizes oxygen loss from suctioning while the client is exhaling. When resistance is met or the client coughs, the nurse should pull the catheter back 1 cm to avoid trauma to the tracheal mucosa. Pulling back prevents the catheter tip from resting against the mucosal wall and stimulates cough. Normal saline is no longer used routinely in tracheal suctioning unless ordered by the health care provider due to the risk of bronchospasm or introducing organisms to the respiratory tract. Intermittent suctioning should be performed for no more than 10 seconds to avoid hypoxemia. Rotating the catheter upon removal helps avoid injury to the mucosal lining.
