What is the first step when a patient’s endotracheal tube is suspected to be obstructed or misplaced?

• A. Suction
• B. Re-intubation
• C. Remove the tube
• D. Cough Assist

Answer: (A)

When an endotracheal tube is suspected to be obstructed or misplaced, the immediate priority is to restore airway patency and assess ventilation. Suctioning the tube is the fastest, least invasive way to clear secretions, mucus, or blood that may be blocking the tube, which can immediately improve airflow and allow you to evaluate whether the tube is functioning and in the proper position. If suctioning reveals that airflow cannot be established or continues to be compromised, then more definitive actions like repositioning or re-intubating are warranted. Removing the tube or using cough-assist intervention isn’t the first move because they either carry greater risk or don’t address the immediate blockage issue—the quickest way to determine patency and buy time for further assessment is suction.