Questions: A patient complains of shortness of breath while receiving oxygen via transtracheal catheter. Her pulse oximeter reading has decreased from 92% to 85%. The respiratory therapist should first A. increase the flow to the catheter. B. remove the catheter and flush it with saline. C. administer metaproterenol via small volume nebulizer. D. replace the transtracheal catheter with a nasal cannula.

The answer is the second one (B): remove the catheter and flush it with saline.

Explanation for each option:

A. Increase the flow to the catheter.

• This option might seem logical at first, but if the catheter is obstructed, increasing the flow will not resolve the issue. The underlying problem needs to be addressed first.

B. Remove the catheter and flush it with saline.

• This is the correct answer. A decrease in oxygen saturation from 92% to 85% suggests that there might be an obstruction in the transtracheal catheter. Removing and flushing the catheter with saline can help clear any blockage and restore proper oxygen flow.

C. Administer metaproterenol via small volume nebulizer.

• Metaproterenol is a bronchodilator used to treat bronchospasm. While it might help if the patient has bronchospasm, it does not address the immediate issue of a potential catheter obstruction.

D. Replace the transtracheal catheter with a nasal cannula.

• This could be a temporary solution, but it does not address the potential obstruction in the transtracheal catheter. The catheter should be checked and cleared first before considering alternative oxygen delivery methods.

Summary: The most appropriate initial action for the respiratory therapist is to remove the transtracheal catheter and flush it with saline to clear any potential obstruction, thereby addressing the immediate cause of the decreased oxygen saturation.