The neonatal/pediatric specialist has difficulty suctioning thick secretions from a child with cystic fibrosis. The specialist should

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

Answer: (B)

Thick, sticky secretions in cystic fibrosis are made more liquid and easier to clear when a mucolytic is used before suctioning. Dornase alfa (Pulmozyme) is an inhaled mucolytic that breaks down extracellular DNA in the mucus, drastically reducing viscosity. By nebulizing Pulmozyme before suctioning, the secretions become less tenacious and easier to suction out, improving clearance while reducing the need for aggressive suctioning that can irritate or injure the airway.

Raising the suction vacuum too high risks airway mucosal injury, hypoxemia, and bronchospasm, which is especially risky in children. Instilling acetylcysteine can irritate the airways and provoke bronchospasm in some pediatric patients, and it’s not as consistently effective in CF as Pulmozyme. Switching to a larger suction catheter might help mechanically, but it doesn’t address the mucus’s viscosity and can increase trauma risk. Using a mucolytic like Pulmozyme beforehand provides the most targeted and effective improvement in secretion clearance.