Tracheostomy and Endo-tracheal suctioning is one of the most common procedure performed in patients with artificial airways. It is a component of airway management and mechanical ventilation that involves the evacuation of the pulmonary secretions from the patient’s airway to prevent complications. Performance obstacle are those inhibiting factors perceived by critical care nurses in terms of knowledge and skill, tool and technology, and work setting which tend to affect their performance. Objectives: i) to assess the knowledge and performance obstacles perceived by critical care nurses while performing Endo- tracheal and Tracheostomy suctioning. ii) To find out the suggestions of critical care nurses on overcoming the performance obstacles identified in Endo-tracheal and Tracheostomy suctioning. Methodology: A cross sectional descriptive survey was designed among 80 and a questionnaire survey conducted among critical care nurses. Results: The performance obstacles during suction as perceived by nurses were 63% reported minimum obstacle, 27% reported medium obstacles, were as only 10% reported many obstacles while performing the suctioning. All of them suggested the need for training at the beginning of clinical posting in the unit, clear cut guidelines/protocol on ET suctioning and updating of guidelines/equipment. Conclusion: The performance obstacles were categorized into knowledge, skill, technology, tool and organization. The performance obstacles perceived by nurses were mostly related to the skill in doing the procedure. The major knowledge related performance obstacles perceived by nurses were inadequate training on ET suctioning in a real patient as s student (70%). Training on ET suctioning should be given during the induction program on the time of joining to the organization.
Introduction: Ventilator-associated pneumonia (VAP) is a nosocomial pneumonia that develops within 48 hours or more of mechanical ventilation. It is also associated with significant morbidity including increased ventilatory days, intensive care unit (ICU) stay and higher medical cost that leads to high mortality rate in ICU. Aim: To evaluate the clinical outcome of the patients diagnosed with VAP and also to identify the risk factors for VAP. Methodology: This retrospective study included 27 patients admitted in Medical and casualty ICU's from August 2013 to April 2014 who were diagnosed with various diseases and later developed VAP. The patient's demographic data and diagnosis based on Centres for Disease Control and prevention (CDC) criteria were collected. Results: Among 27 patients, 20 were male patients and 7 were female patients. The order of organism according to the frequency in the current study was found to be Acinectobacter, Klebsiella, Pseudomonas aeruginosa, methicillin resistant Staphylococcus aureus, Streptococcus pneumonia, Hemophilus influenza, Enterobacter sp. Twenty two patients had late onset VAP and five patients had early onset VAP. Overall the survival was 52%. Conclusion: The incidence and the mortality of VAP are high in the current ICU setup. The mortality rate in the current study was 48% and the patients who survived had a longer ICU stay due to ventilator dependence.
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