While doing the tracheal suctioning of a patient, the suction should be applied

GMCH Chandigarh - 2019

Medical & Surgical Nursing

Easy

Appeared in: GMCH Chandigarh - 2019

Explanation

Suction should only be applied during the withdrawal of the suction catheter to prevent injury to the tracheal mucosa.
Applying suction while inserting the catheter is a dangerous practice that can cause severe hypoxemia (low blood oxygen) by removing air from the lungs and can lead to atelectasis (lung collapse).
The correct procedure involves inserting the catheter without suction, then applying intermittent suction while withdrawing the catheter with a rotating motion.
The entire suctioning event, from insertion to complete withdrawal, should be limited to 10-15 seconds to minimize the risk of complications.

Option B: Applying suction during insertion causes direct trauma to the delicate tracheal lining, leading to bleeding and swelling. It also removes a significant amount of air from the airway, causing rapid oxygen desaturation.
Option C: The timing of suction application (insertion vs. withdrawal) is a fundamental safety rule, not a variable action based on the patient's response. A cough may indicate the catheter has reached the carina, signaling the need to pull back slightly, but suction is still only applied on withdrawal.
Option D: The decision to perform suctioning is based on a comprehensive nursing assessment (e.g., audible secretions, desaturation, increased work of breathing, ventilator alarms), not solely on the presence of a cough. A patient may need suctioning even without a strong cough reflex.

Clinical Relevance

Nursing practice connection: Use the key finding related to Safe technique for tracheal suctioning to guide bedside assessment, documentation, and the next nursing action.
Tracheal suctioning is a high-risk procedure that can cause significant complications like hypoxemia, cardiac arrhythmias (from vagal nerve stimulation), bronchospasm, and atelectasis if performed incorrectly.
Nurses must always pre-oxygenate the patient before suctioning and strictly limit each suction pass to 10-15 seconds to minimize the risk of oxygen desaturation.
What if? If the patient's heart rate drops by more than 20 beats/min or increases by more than 40 beats/min, or if their SpO₂ drops below 90% or 5% from baseline, the procedure must be stopped immediately. The nurse should reapply the oxygen source and manually ventilate if necessary.

How to Approach the Question

First, identify the core of the question. It asks about the specific timing of applying suction during the procedure of tracheal suctioning.
Next, recall the fundamental principles of safe nursing procedures. The primary goal is always to achieve the therapeutic effect while minimizing harm to the patient.
Analyze the action of suctioning: it involves applying negative pressure to a delicate airway. Consider the potential consequences of applying this pressure as the catheter moves down into the lungs versus when it is being pulled out.
Evaluate the options based on this safety principle. Applying suction on insertion would drag the sensitive tracheal lining into the catheter, causing trauma and removing vital air. Applying it only on withdrawal allows for a controlled removal of secretions with less risk.
Eliminate options that introduce incorrect triggers (like coughing) for a fixed procedural step. Safety protocols in nursing are standardized and not typically altered by variable patient responses like a cough.

Concept Tested & Keywords

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