The nurse is preparing to suction secretions from the airway of an unconscious client whose lungs are mechanically ventilated with an endotracheal tube. Place the steps for suctioning the endotracheal tube in the correct order. All options must be used.

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11ecbb05_cb7c_ff95_b433_33b5ce7b97b1_MD0009_00 Clients with endotracheal tubes (ETTs) have impaired cough and gag reflexes and require suction to clear retained bronchial secretions and promote ventilatory efficacy. Ventilator circuits for ETTs typically have a reusable in-line endotracheal suction device, which remains sterile, in a flexible plastic sleeve. Oral secretions may pool near the base of the ETT and drip into the trachea; therefore, oropharyngeal suctioning and oral care are performed before ETT suctioning to prevent introduction of oral bacteria into the lungs. The steps for suctioning an ETT include: Perform hand hygiene and don clean gloves (Option E). Suction the oropharynx and perform oral care (Option F). Ensure that the system is connected to appropriate wall suction (<120 mm Hg). Hyperoxygenate the lungs (100% FiO₂) (Option D). Advance the catheter into the trachea just until resistance is met (level of the carina) (Option A). Do not suction while advancing the catheter. Gently remove the catheter while suctioning and rotating it. Do not suction for more than 10 seconds (Option C). Evaluate client tolerance; if further secretions remain, suctioning can be repeated 1 or 2 times. Document the procedure when complete (Option B). Resume oxygenation and ventilation settings as prescribed. Educational objective: Tracheal suctioning through an endotracheal tube helps clear retained bronchial secretions and increases ventilatory efficacy. The nurse must follow strict asepsis to prevent the introduction of bacteria into the lungs, hyperoxygenate the lungs to prevent hypoxia, and use appropriate technique to prevent airway trauma.

The Nurse Is Preparing to Suction Secretions from the Airway