A nurse is caring for a client who has a tracheostomy tube and is undergoing mechanical ventilation. The nurse can help prevent tracheal dilation, a complication of tracheostomy tube placement, by?

1. A

   Suctioning the tracheostomy tube frequently

2. B

   Using a cuffed tracheostomy tube

3. C

   Using the minimal leak technique and keeping cuff pressure <25 cm H2O

4. D

   Keeping the tracheostomy tube plugged

Appeared in: AIIMS Bhatinda NO - 2019

Explanation

• Excessive pressure from an overinflated tracheostomy cuff can exceed the capillary perfusion pressure of the tracheal wall (around 25-35 cm H₂O).
• This high pressure impairs blood flow, leading to tissue ischemia, necrosis, and softening of the tracheal cartilage, which results in tracheal dilation.
• The minimal leak technique (MLT) ensures the cuff is inflated with the lowest possible volume of air needed to create a seal, thus preventing over-inflation.
• Maintaining cuff pressure below 25 cm H₂O is the evidence-based standard to ensure adequate tracheal perfusion and prevent pressure-related injuries.

Why Other Options Were Wrong

• Option A: Suctioning is performed to clear secretions from the airway, not to manage cuff pressure or prevent tracheal wall injury. It addresses a different aspect of tracheostomy care.
• Option B: A cuffed tube is a piece of equipment, not an action. While necessary for positive pressure ventilation, its presence alone does not prevent complications. The complication arises from how the cuff is managed (i.e., if it's overinflated).
• Option D: Plugging (capping) a tracheostomy tube is only done when a patient is being weaned from the ventilator and can breathe independently around the tube. In a patient on mechanical ventilation, this would cause a complete airway obstruction and respiratory arrest.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Prevention of complications associated with tracheostomy and mechanical ventilation to guide bedside assessment, documentation, and the next nursing action.
• Nurses are directly responsible for monitoring and managing tracheostomy cuff pressure. This is a critical patient safety intervention.
• Cuff pressure should be checked with a handheld manometer at the start of every shift and any time the tube's position is adjusted.
• Failure to manage cuff pressure correctly can lead to long-term complications like tracheal stenosis (narrowing) or tracheomalacia (softening), which may require surgical repair.

How to Approach the Question

• First, identify the core of the question: it asks for an intervention to prevent a specific complication, 'tracheal dilation'.
• Next, recall the pathophysiology of tracheal dilation in this context. It's caused by excessive, prolonged pressure from the cuff on the tracheal wall.
• Analyze each option to see which one directly addresses the cause (excessive pressure).
• Option A (suctioning) relates to secretions, not pressure.
• Option B (using a cuffed tube) is a prerequisite but not the preventative action itself.
• Option D (plugging) is a dangerous contraindication.

Concept Tested & Keywords

• Concept Tested: Prevention of complications associated with tracheostomy and mechanical ventilation.
• Stem keywords: tracheostomy tube, mechanical ventilation, tracheal dilation, complication
• Lead-in keywords: prevent

Question ID

QYOPjp5Eg8IGxDUFpnYtAN

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor pp. 734-736, 736-738

E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 1