Trach Tomas — Tracheostomy & Suctioning Safety: Oxygenate First, Suction Out Only
His secretions are thick, his saturation is dropping, and the safest suction is the shortest one
Tomas's breathing turns gurgly and his oxygen saturation slips to 88%. The nurse reaches for suction — and follows every step in order.
Tomas breathes through a tracheostomy. Suctioning clears secretions but also removes oxygen, so the rules protect against hypoxia: hyperoxygenate first, use sterile technique, insert WITHOUT suction, apply intermittent suction only while withdrawing, limit each pass to about 10 seconds, and allow rest between passes. Suction only when indicated — noisy wet breathing, visible secretions, desaturation — not on a fixed schedule. Keep an obturator and a spare tracheostomy tube of the same size at the bedside. If the tube is dislodged, hold the stoma open and call for help immediately; if it is obstructed, suction, and if that fails, this is an emergency.
Read Trach Tomas's full story →The story arc
The setup
After prolonged ventilation, Tomas receives a tracheostomy and is learning to live with it.
The turn
His breathing becomes wet and rattly, and his saturation drifts down.
The crisis
Mid-suction his saturation falls further and his heart rate drops. The nurse withdraws the catheter and re-oxygenates.
The save
Tomas is hyperoxygenated, suctioned only on withdrawal, allowed to rest, and his stoma care is done with a spare tube ready at the bedside.
NCLEX study section — Tracheostomy & Suctioning Safety: Oxygenate First, Suction Out Only
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Respiratory
Take this chapter into practice questions on the same topic.