The nurse is caring for a patient with a tracheostomy tube. Which nursing intervention is most effective in promoting effective airway clearance?

A) Suctioning respiratory secretions several times every hour
B) Administering humidified oxygen through a tracheostomy collar
C) Instilling normal saline into the tracheostomy to thin secretions before suctioning
D) Deflating the tracheostomy cuff before allowing the patient to cough up secretions

Humidification from air humidifiers or humidified oxygen tracheostomy collars can help prevent drying of secretions that cause occlusion. Suctioning should be done only as needed; too frequent suctioning can damage the mucosal lining, resulting in thicker secretions. Normal saline should not be instilled into a tracheostomy; research showed no benefit with this technique. The purpose of the tracheostomy cuff is to keep secretions from entering the lungs; the nurse should not deflate the tracheostomy cuff unless instructed to do so by the health care provider.