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

Abstract

Aim and objectives. The purpose of this study was to investigate open system endotracheal suctioning (ETS) practices of critical care nurses. Specific objectives were to examine nurses' practices prior to, during and post-ETS and to compare nurses' ETS practices with current research recommendations.. Background. ETS is a potentially harmful procedure that, if performed inappropriately or incorrectly, might result in life-threatening complications for patients. The literature suggests that critical care nurses vary in their suctioning practices; however, the evidence is predominantly based on retrospective studies that fail to address how ETS is practiced on a daily basis.. Design and method. In March 2005, a structured observational study was conducted using a piloted 20-item observational schedule on two adult intensive-care units to determine how critical care nurses (n = 45) perform ETS in their daily practice and to establish whether the current best practice recommendations for ETS are being adhered to.. Results. The findings indicate that participants varied in their ETS practices; did not adhere to best practice suctioning recommendations; and consequently provided lower-quality ETS treatment than expected. Significant discrepancies were observed in the participants' respiratory assessment techniques, hyperoxygenation and infection control practices, patient reassurance and the level of negative pressure used to clear secretions.. Conclusion. The findings suggest that critical care nurses do not adhere to best practice recommendations when performing ETS. The results of this study offer an Irish/European perspective on critical care nurses' daily suctioning practices.. Relevance to clinical practice. As a matter of urgency, institutional policies and guidelines, which are based on current best practice recommendations, need to be developed and/or reviewed and teaching interventions developed to improve nurses' ETS practices, particularly in regard to auscultation skills, hyperoxygenation practices, suctioning pressures and infection control measures.

Effect of Application of Endotracheal Suction Guidelines on Cardiorespiratory Parameters of Mechanically Ventilated Patients

“…Zahran et al (50) found significant increase in PaCO 2 after ES with normal saline instillation. However Caramez et al (8) found PaCO 2 elevations after ES with open and closed method, the Özden et al (37) and U˘gras et al (51) didn't In addition, Kelher et al (52) showed that some nurses performed ES without consideration to recommended steps so excellence of this nursing intervention was less than predicted. Additionally, Jongerden et al (3) performed a practical study evaluating ES in which the suctioning procedure was done during standard way as needed based on advices.…”

“…It can be understood through that the standard ES technique comprised MV disconnection short time and hyperoxygenation which helps to avoid hypoxemia. Kelleher et al (41) and Day et al. (42) found that main deficiencies were related to failure to provide hyperoxygenation before as well as after ES procedure plus keeping suitable suction force.…”

Slaugytojų žinios ir įgūdžiai atliekant sekreto išsiurbimą iš tracheostomos vamzdelio

“…Slaugytojas turi turėti pakankamai kompetencijos nuspręsti apie sekreto išsiurbimo iš tracheostomos vamzdelio būtinumą. Užsienio šalyse atlikti tyrimai rodo, kad slaugytojai, atlikdami tracheostomos priežiūrą, ne visada remiasi įrodymais pagrįsta praktika [17][18][19][20][21]. Day T., Iles N., Griffiths P. (2009) teigimu, nepakanka įvertin-ti slaugytojų teorines žinias, nes jos gali prastai atspindėti praktiką [19].…”

“…Kelleher S., Andrews T. (2008) atliktų tyrimų praktinių veiksmų stebėjimo metu buvo nustatyta, kad slaugytojai prieš endotrachėjinį sekreto siurbimą neišklausė kvėpa-vimo garsų plaučiuose, o sekreto siurbimą atliko dažnai esant vienam požymiui, rodančiam siurbimo poreikį [20]. Lietuvoje nėra įprasta, kad slaugytojai auskultuotų pacientų plaučius ir pagal tai vertintų, ar reikalingas sekreto išsiurbimas iš tracheostomos vamzdelio, tai atlieka gydytojai.…”

“…stebėtų atvejų siurbimo slėgis buvo 80-150 mmHg [21]. Airijoje (2008) atlikto tyrimo metu sekreto siurbimo slėgiai viršijo rekomenduojamus slėgius ir svyravo 230 -450 mmHg [20]. Lietuvoje (2013) atlikto tyrimo metu, ITS skyriuose stebint praktinius veiksmus buvo registruotas sekreto išsiurbimo tracheostominio vamzdelio slėgis: mažiausias slėgis 100 mm/ Hg, didžiausias 525 mm/Hg.…”