A mechanically ventilated patient becomes severely hypoxemic every time the therapist disconnects her from the ventilator for purpose of performing suctioning. What can the therapist do to avoid this situation?

A. Attach a closed-circuit suction catheter system to the patient's breathing circuit.
B. Hyperoxygenate the patient with an Fio2 of 1.0 before the suctioning procedure.
C. Limit the suction procedure to less than 10 seconds.
D. Reduce the vacuum pressure used during the suctioning procedure.

ANS: A
A. Correct response: Many patients cannot tolerate being disconnected from the mechanical ventilator, especially when they are receiving PEEP. Open system suctioning requires the disruption mechanical ventilation and PEEP. To avoid the problem of inducing hypoxemia in this situation, the therapist can simply connect a closed-circuit suction system to the patient's ventilator breathing circuit. With the closed-circuit suction system in-line, the patient will remain ventilated and maintain PEEP. The Fio2 can also be increased if necessary for the suctioning procedure.
B. Incorrect response: For patients who become severely hypoxemic when disconnected from the ventilator, hyperoxygenation with an Fio2 of 1.0 before the suctioning procedure often fails.
C. Incorrect response: The problem is not the length of time the suction catheter is down the ETT. The problem is the total time of disconnection from the ventilator.
D. Incorrect response: Again, the issue is the length of time the patient is off the ventilator. The vacuum pressure does not affect this problem.