Clinical Practice Guideline for Suctioning the Airway of the Intubated and Non-Intubated Patient

Abstract

OBJECTIVE: To provide physicians, physiotherapists, nurses and respiratory therapists with guidelines for the application of airway suctioning. DESIGN: This clinical practice guideline was developed using the model by Browman and colleagues. A working group of representatives from four professional colleges (nurses, physicians and surgeons, physiotherapists and respiratory therapists) and research experts was formed to conduct a systematic review, develop evidence-based recommendations and generate clinical practice guidelines. MEDLINE (1966 to 1998), CINAHL (1982) and EMBASE (1974 as well as the reference lists of identified articles were searched. Inclusion of articles was determined by at least two group members, and studies were classified according to type. Randomized, controlled; randomized; and nonrandomized crossover and comparative cohort trials were grouped by type of intervention and population for use in the development of recommendations. Other observational and animal studies dealing with adverse effects of suctioning were included in the review but were not used in the development of recommendations. Input on the evidencebased recommendations was sought and incorporated from members of all four professions and from experts on content and methodology. SETTING: Any setting (hospital or home) where suctioning is performed. POPULATION: Intubated and nonintubated adults, infants and children. RESULTS AND CONCLUSIONS: An attempt was made to develop recommendations in each of the subcategories of suctioning techniques addressed by at least one study. In some subcategories, definite recommendations were made (13 in adults, and three in children and infants); in other subcategories, insufficient evidence precluded recommendations. The recommendations addressed the following aspects of suctioning: preoxygenation, hyperinflation, insufflation, hyperoxygenation, hyperventilation, saline instillation, adaptor use, medication use, open and closed systems, and various types of catheters.

Regional lung derecruitment after endotracheal suction during volume- or pressure-controlled ventilation: a study using electric impedance tomography

“…Desaturation caused by suctioning procedures is a sign of loss of FRC, decrease of compliance and increased pulmonary shunt. Preoxygenation is effective in preventing suctioning induced decrease of PaO 2 [50]. However, preoxygenation does not prevent lung collapse but simply conceals its´ consequences.…”

“…Within the same patient there is often a mix between closed and open suctioning procedures [69] and one possible explanation could be that closed suction is converted to open suctioning due to problems with secretion removal. Thus in patients with respiratory insufficiency and viscous secretions there may still be an indication for open suctioning, preferably with a subsequent recruitment manoeuvre, which positive effects on ventilation and gas exchange has been described by Dyhr et [22,50] but no consensus or algorithm describing exactly how to perform this recruitment. Preferably this would have to be an easy manoeuvre, performed with only a few adjustments of the ventilator settings and cautiously done, aimed at not worsen the cardiopulmonary side-effects of the suctioning procedure.…”

Physiotherapy Practice and Delegation Policies in Oxygen Administration: A Survey of Ontario Hospitals

“…Clinical practice guidelines for suctioning recommend that additional oxygen be given to patients on mechanical ventilation prior to suctioning. 7 Furthermore, hyperoxygenation with 100% oxygen should be used during suctioning for patients on mechanical ventilation as a result of trauma, cardiac problems, or COPD. 7 The physiotherapy entry-to-practice curriculum in all Ontario university programmes includes content related to the administration of oxygen.…”

“…7 Furthermore, hyperoxygenation with 100% oxygen should be used during suctioning for patients on mechanical ventilation as a result of trauma, cardiac problems, or COPD. 7 The physiotherapy entry-to-practice curriculum in all Ontario university programmes includes content related to the administration of oxygen. 8,9 This competency is evaluated in the national Physiotherapy Competency Exam and is considered to be an entry-level skill required for obtaining registration as a physiotherapist in Canada.…”

“…This represents a barrier to the provision of optimal patient care in accordance with best practice guidelines. 7 Hospital policy is influenced by many factors. The literature suggests that amalgamation-the merging of two or more hospitals into a single corporation 23 -increases the likelihood that existing hospital policies will be implemented or enforced.…”