Nurse Ramya is suctioning a tracheostomy tube of an adult patient. During the procedure, the catheter appears to attach to the tracheal wall and creates a pulling sensation. What is the best action for the nurse to take?

1. A

   Continue suctioning until the obstruction removed

2. B

   Increase the pressure of suction

3. C

   Insert the tube deeper and apply more pressure

4. D

   Release the suction by opening the vent

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2023

Explanation

• The pulling sensation described is a classic sign that the suction catheter is adhering directly to the tracheal mucosa.
• Releasing the thumb from the suction control vent is the immediate and correct action because it instantly breaks the negative pressure (vacuum).
• This action frees the catheter from the tracheal wall, preventing mucosal trauma, bleeding, edema, and potential ulceration.
• It is the fastest and safest way to resolve this common suctioning complication.

Why Other Options Were Wrong

• Option A: Continuing to apply suction while the catheter is attached to the mucosa will strip the delicate lining of the trachea, causing bleeding, inflammation, and increasing the risk of infection.
• Option B: Increasing the suction pressure will strengthen the vacuum's grip on the tracheal wall, leading to more severe and rapid tissue injury.
• Option C: Inserting the catheter deeper while it is stuck risks traumatizing the highly sensitive carina, which can trigger severe bronchospasm, laryngospasm, or dangerous cardiac arrhythmias due to vagal stimulation.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Management of complications during tracheostomy suctioning to guide bedside assessment, documentation, and the next nursing action.
• Proper suctioning technique is a critical nursing skill to maintain airway patency without causing iatrogenic harm like tracheal stenosis, ulceration, or infection.
• Patient safety is paramount. Recognizing complications like mucosal grabbing and acting immediately by releasing suction prevents significant injury and discomfort for the patient.
• Suction pressure for adults should be set between 100-120 mmHg, and never exceed 150 mmHg, to minimize the risk of mucosal damage.

How to Approach the Question

• Identify the clinical procedure being performed: Tracheostomy suctioning.
• Recognize the complication described: The catheter is stuck to the tracheal wall, causing a 'pulling sensation'.
• Analyze the underlying cause of the problem: The negative pressure from the suction is creating a vacuum and pulling the delicate tracheal tissue into the catheter.
• Apply the core principle of patient safety: The immediate priority is to stop the harmful action.
• Evaluate the options based on this principle. Continuing suction, increasing pressure, or advancing the catheter would all increase the injury.
• Select the only option that reverses the harmful action and resolves the immediate danger, which is releasing the vacuum by opening the vent.

Concept Tested & Keywords

• Concept Tested: Management of complications during tracheostomy suctioning
• Stem keywords: suctioning, tracheostomy tube, adult patient, catheter appears to attach, tracheal wall, pulling sensation
• Lead-in keywords: best action
• Clinical cues: The 'pulling sensation' is a key sign that the catheter is adhering to the tracheal mucosa, indicating an immediate need to stop the suction force.
• Negative lead-in flag: false

Question ID

QF7J-fPdcwgbuWmiR4orEa

Copy ID

Reference Book

E6 Nursing Fundamentals Potter Perry 12e Part 5 pp. 16-18, 19-21