A Multisite Survey of Suctioning Techniques and Airway Management Practices

Abstract

• Background Ventilator-associated pneumonia, common in critically ill patients, is associated with microaspiration of oropharyngeal secretions and may be related to suctioning and airway management practices.• Objectives To describe institutional policies and procedures related to closed-system suctioning and airway management of intubated patients, and to compare practices of registered nurses and respiratory therapists.• Methods A descriptive, comparative, multisite study of facilities that use closed-system suctioning devices on most intubated adults was conducted. Nurses and respiratory therapists who worked at the sites completed surveys related to their practices.• Results A total of 1665 nurses and respiratory therapists at 27 sites throughout the United States responded. The typical respondent had at least 6 years’ experience with patients receiving mechanical ventilation (61%) and a baccalaureate degree or higher (54%). Most sites had policies for management of endotracheal tube cuffs (93%), hyperoxygenation (89%) and use of gloves (70%) with closed-system suctioning, and instillation of isotonic sodium chloride solution for thick secretions (74%). Only 48% of policies addressed oral care and 37% addressed oral suctioning. Nurses did more oral suctioning and oral care than respiratory therapists did, and respiratory therapists instilled sodium chloride solution more and rinsed the suctioning device more often than nurses did.• Conclusions Policies vary widely and do not always reflect current research. Consistent performance of practices such as wearing gloves for airway management and maintaining endotracheal cuff pressures must be evaluated. Collaborative, research-based policies and procedures must be developed and implemented to ensure best practices for intubated patients.

An observational study on the open‐system endotracheal suctioning practices of critical care nurses

“…While ETS is an important intervention when caring for critically ill patients, the practice surrounding ETS can vary widely between institutions and practitioners (Swartz et al 1996, Sole et al 2003 with much of that practice based on anecdote and routine rather than research (Paul Allen & Ostrow 2000, Thompson 2000, Day et al 2002b). This may partially have been influenced by a paucity of research evidence to guide practitioners in the care of a patient with an endotracheal tube (Thompson 2000).…”

“…The literature that does exist raises concerns about the standard of ETS practice among nurses (Paul Allen & Ostrow 2000, Day et al 2002b). This evidence is predominantly American and based on descriptive, retrospective studies that focus on closed suctioning systems (Swartz et al 1996, Paul Allen & Ostrow 2000, Sole et al 2003. While such studies are important for describing and documenting the aspects of ETS practice, they have one primary limitation.…”

“…While the literature has demonstrated that nurses are increasingly recognizing the role research has to play within modern health care (Hundley et al 2000), it seems that many established nursing practices are not underpinned by sound evidence (Glacken & Chaney 2004). One area of nursing practice that has caused concern is the endotracheal suctioning (ETS) of intubated patients (Swartz et al 1996, Thompson 2000, Sole et al 2003. ETS is an important intervention in caring for patients with an artificial airway (Thompson 2000) and an essential aspect of effective airway management in the critically ill (Wood 1998b).…”

Development of standard practice guidelines for open and closed system suctioning

“…Studies aiming to determine the knowledge and skills of nurses regarding endotracheal suctioning methods (Ç elik & Elbas¸2000, Day et al 2001, Kelleher & Andrews 2008 indicate that their training for and experience of suctioning is far from sufficient. Moreover, nurses are inclined to rely on personal experience and ward routine to inform practice over any other source (Sole et al 2003).…”

Relationship Between Feeding Tube Site and Respiratory Outcomes

“…Other authors have suggested that aspiration of oropharyngeal secretions is an important factor in bacterial contamination of the upper respiratory tree. [50][51][52][53][54] Unfortunately, we did not have a marker for the aspiration of oropharyngeal secretions.…”