For infants receiving exogenous surfactant, when should endotracheal suctioning be performed?

• A. Immediately following instillation of surfactant
• B. Twenty minutes following instillation of surfactant
• C. During instillation of surfactant
• D. Prior to instillation of surfactant

Answer: (D)

Timing matters because you want the surfactant to spread evenly through a clear, open airway. Suctioning before giving exogenous surfactant clears secretions and removes any mucus plugs, creating a patent path so the instilled surfactant can coat the alveoli effectively. If suctioning happens during the instillation, it can disrupt how the surfactant distributes and may cause fluctuations in airway pressures or oxygenation. Suctioning right after instillation can remove some of the delivered surfactant, reducing its therapeutic effect. So the best approach is to suction prior to instilling surfactant.