A female adult client has a tracheostomy but doesn’t require continuous mechanical ventilation. When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for:
A. 15 to 60 seconds.
B. 5 to 20 minutes.
C. 30 to 40 minutes.
D. 45 to 60 minutes.
Correct Answer: B. B. 5 to 20 minutes.
Initially, the nurse should plug the opening in the tracheostomy tube for 5 to 20 minutes, then gradually lengthen this interval according to the client’s respiratory status. Tracheal plugging is ordered by the doctor to help the client wean off an artificial airway. Plugging covers the opening of the trach tube in the throat, and allowing her to breathe through her nose mouth. Plugging will also help make the sound of her voice stronger.
Option A: A client who doesn’t require continuous mechanical ventilation already is breathing without assistance, at least for short periods; therefore, plugging the opening of the tube for only 15 to 60 seconds wouldn’t be long enough to reveal the client’s true tolerance to the procedure.
Option C: Plugging the opening for more than 20 minutes would increase the risk of acute respiratory distress because the client requires an adjustment period to start breathing normally. Weaning from a tracheostomy tube by either decannulation cap or speaking valve increases the workload of breathing.
Option D: During the weaning process, one of the benefits that can be achieved for the patient is the ability to vocalize for short periods of time. Adjuncts that allow patients to vocalize increase the workload of breathing and therefore should only be considered for use in patients in whom it has been agreed within the multidisciplinary team to commence weaning from the tracheostomy tube.
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