What causes sudden bradycardia during tracheostomy suctioning?

• A. Increased oxygen delivery
• B. Vagal stimulation from suction catheter insertion
• C. Hypercapnia
• D. Infection

Answer: (D)

During tracheostomy suctioning, the airway is irritated by the suction catheter. This can trigger a vagal response, especially when the catheter contacts the carina or tracheal walls, causing a rapid decrease in heart rate. The reflex slows conduction through the heart, leading to sudden bradycardia. Suctioning also briefly increases intrathoracic pressure and can cause transient hypoxemia, which can amplify the vagal response.

In practice, stop suctioning, remove the catheter, and provide 100% oxygen while monitoring the patient. If bradycardia persists, follow clinical protocol (e.g., atropine as indicated). The acute bradycardia during suctioning is not due to infection and is not typically caused by hypercapnia or increased oxygen delivery.