A nurse is caring for an infant who has an endotracheal tube in place for mechanical ventilation. Which of the following actions should the nurse take when suctioning the infant's airway?

Suctioning an infant with an endotracheal tube requires careful technique to maintain airway patency while minimizing complications such as hypoxia, trauma, and bradycardia. Infants are especially vulnerable to rapid oxygen desaturation because of their smaller airway size and limited oxygen reserves. Pre-oxygenation and post-oxygenation are essential to reduce the risk of hypoxemia during suctioning. Suctioning should be performed only when indicated and with the least invasive approach possible. Rationale: A. Administering supplemental oxygen before and after suctioning is correct because suctioning temporarily removes oxygen along with secretions and can rapidly cause hypoxemia. Pre-oxygenation helps increase oxygen reserves before the procedure, while oxygen after suctioning helps restore normal oxygen saturation. This is especially important in infants due to their high oxygen demand and limited respiratory reserve. B. Advancing the suction catheter until resistance is felt is not recommended because it can cause trauma to the airway mucosa and damage the delicate tracheal tissues. The catheter should be inserted only to the predetermined appropriate depth based on tube length and institutional guidelines. Forcing the catheter increases the risk of bleeding and irritation. C. Suctioning for intervals of 10 seconds is too long for an infant and increases the risk of hypoxia and bradycardia. Suction passes should generally be limited to about 5 seconds or less to minimize oxygen loss and physiologic stress. Short, efficient suctioning is safer and better tolerated. D. Routine suctioning is not appropriate because suctioning should only be performed when clinically indicated, such as visible secretions, decreased oxygen saturation, coarse breath sounds, or increased work of breathing. Unnecessary suctioning increases the risk of airway trauma, infection, and hypoxemia without providing benefit.