During suctioning of an endotracheal tube, the client’s heart rate drops from 78 to 44. What is the nurse's best action?

• A. Deflate the ET tube cuff
• B. Have the client cough several times in a row
• C. Oxygenate the client with 100% oxygen
• D. Notify the primary healthcare provider

Answer: (C)

During suctioning, brief interruptions in ventilation can cause hypoxemia, which can trigger a reflex drop in heart rate. Providing 100% oxygen quickly restores oxygen levels and helps prevent or reverse bradycardia. This immediate step addresses the underlying issue—insufficient oxygenation during suctioning—making it the best action in the moment. Deflating the ET tube cuff wouldn’t correct the hypoxemia and could risk losing the airway. Having the patient cough might increase intrathoracic pressure and vagal stimulation, potentially worsening the bradycardia rather than helping. If the bradycardia persists despite oxygenation, then escalate by pausing suction, continuing oxygenation, and notifying the provider.