What should the respiratory therapist verify before applying a cap on a fenestrated tracheostomy tube?

• A. The inner cannula is in place and the cuff deflated
• B. The inner cannula is in place and the cuff inflated
• C. The inner cannula is removed and the cuff deflated
• D. The inner cannula is removed and the cuff inflated

Answer: (C)

Before applying a cap on a fenestrated tracheostomy tube, it is crucial for the respiratory therapist to ensure that the inner cannula is removed and the cuff is deflated. This is because the purpose of capping the tracheostomy tube is to allow for airway passage through the upper airway instead of the tube itself, facilitating the patient’s ability to breathe through their own airways.

When the inner cannula is removed, it prevents any obstruction from the artificial airway, promoting airflow through the fenestrations in the tracheostomy tube. Additionally, having the cuff deflated is critical because an inflated cuff would block airflow from the upper airway into the trachea, defeating the purpose of capping. This maneuver is often used as a step toward decannulation and helps assess the patient’s ability to manage their own airway.

The other scenarios would not be appropriate for cap application. For instance, having the inner cannula in place while the cuff is inflated would restrict airflow and could lead to inadequate ventilation. Therefore, the verified approach before capping is ensuring that the inner cannula is removed and the cuff is deflated, allowing for optimal airflow and a safe breathing trial for the patient.