A respiratory therapist is having difficulty effectively suctioning a patient's thick secretions. The patient is orally intubated with an 8.5-mm endotracheal tube and is being suctioned with a size 10 Fr catheter. Suction pressure at the wall is 100 mmHg when the catheter is completely occluded. To optimize suction efficiency, the respiratory therapist should first:

1) Obtain a size 8 Fr suction catheter
2) Switch to a size 12 Fr suction catheter
3) Switch to a coude-tipped catheter
4) Increase suction pressure to 120 mmHg

The respiratory therapist should switch to a size 12 Fr suction catheter to handle thicker secretions more effectively while ensuring suction pressure remains within safe limits.

Explanation:

To optimize suction efficiency for a patient with thick secretions who is orally intubated with an 8.5-mm endotracheal tube and currently being suctioned with a size 10 Fr catheter, the respiratory therapist should switch to a size 12 Fr suction catheter. Choosing a larger catheter size increases the catheter's ability to handle thicker secretions. However, the suction pressure should be closely monitored to remain within safe limits and avoid trauma to the patient's airway tissue.

In this scenario, using a smaller catheter (size 8 Fr) will not be effective, and increasing the suction pressure to 120 mmHg without changing the catheter size may also not yield the desired results and can be potentially harmful. A coude-tipped catheter is designed for specific situations, such as navigating around obstructions, and may not be necessary in this case.