In a child with cystic fibrosis who has thick secretions, which pre-suction therapy is recommended?

• A. Increase vacuum pressure to 120 mmHg
• B. Aerosolize Pulmozyme before suctioning
• C. Instill acetylcysteine before suctioning
• D. Change to a larger catheter

Answer: (B)

Thick, viscous secretions in cystic fibrosis hinder effective airway clearance, so pretreating with a mucolytic that actually reduces mucus thickness makes suctioning more effective. Pulmozyme (dornase alfa) is a mucolytic that digests extracellular DNA in mucus, dramatically lowering viscosity. Aerosolizing Pulmozyme before suctioning loosens secretions, allowing the suction catheter to remove more material with less effort and fewer passes, which improves airway clearance and reduces obstruction risk.

Increasing vacuum pressure doesn’t address mucus properties and can increase mucosal injury. Instilling acetylcysteine can irritate the airways and provoke bronchospasm in some children, with variable efficacy in this setting. Switching to a larger catheter changes the instrument size but not the mucus viscosity and can raise the risk of mucosal trauma.