When deciding whether to suction a tracheostomy tube, the nurse should base the decision on which of the following?

When deciding whether to suction a tracheostomy tube, the nurse should base the decision on which of the following?

• A. The doctor specifies how often to suction in the orders.
• B. The client tells the practical nurse when suctioning is necessary.
• C. The client is coughing up copious amounts of sputum from the tracheostomy.
• D. Assessment data heard on lung auscultation.

Answer: (D)

The key is to base suctioning decisions on the current airway and ventilation status, using objective assessment of the lungs. How the lungs sound tells you whether secretions are narrowing or blocking airways and whether the patient’s ventilation is being compromised. If auscultation reveals diminished or absent breath sounds, crackles or rhonchi, or there’s increased work of breathing, secretions are likely impeding airway clearance, and suctioning is indicated to restore patency and improve oxygenation. If lung sounds are clear and the patient is adequately perfused and ventilating, suctioning may not be needed now, even if there’s some sputum production. Relying solely on a doctor's orders or on the patient’s (often unreliable) sense of when suctioning is needed isn’t as reliable as using current lung sounds to guide the decision.

The key is to base suctioning decisions on the current airway and ventilation status, using objective assessment of the lungs. How the lungs sound tells you whether secretions are narrowing or blocking airways and whether the patient’s ventilation is being compromised. If auscultation reveals diminished or absent breath sounds, crackles or rhonchi, or there’s increased work of breathing, secretions are likely impeding airway clearance, and suctioning is indicated to restore patency and improve oxygenation. If lung sounds are clear and the patient is adequately perfused and ventilating, suctioning may not be needed now, even if there’s some sputum production. Relying solely on a doctor's orders or on the patient’s (often unreliable) sense of when suctioning is needed isn’t as reliable as using current lung sounds to guide the decision.