Closed suctioning system: Critical analysis for its use

Abstract

Aim: To determine the efficacy and effectiveness of the closed suctioning system. Method: Literature review articles were accessed from the following databases: PubMed, EMBASE, CINAHL, and Cochrane Library. The literature review criteria included: all publication styles except meta-analysis, participants that were Ն18 years, written in English, and published between 1973 and 2008. Results: This literature review revealed that the efficacy and effectiveness of the closed suctioning system remains to be demonstrated. The device manufacturers' studies focused on cost reduction, crosscontamination, and preservation of the oxygen saturation of patients during endotracheal suctioning; however, the clinical studies focused on the use of closed suctioning systems to prevent ventilator-associated pneumonia. The reviewed studies had small sample sizes with heterogeneous demographics and nonrandomized controls. Recent studies suggest that closed suctioning systems are no better than open suctioning systems in terms of mortality, morbidity, or the cost-benefit ratio. A few studies did indicate that the closed suctioning system might reduce the loss of lung volume and oxygen desaturation. Conclusion:The studies reviewed in this article suggest that the evidence on the efficacy and effectiveness of closed suctioning systems is inconclusive. Only limited populations will benefit clinically from the use of this device. There is a need for further studies with randomized controlled trials to explore the use of closed suction systems and to update current clinical practise guidelines.

The practice of intensive care nurses using the closed suctioning system: An observational study

“…Based on clinical experience and the results of studies, there are recommendations for using minimally invasive catheter insertion, continuous rather than intermittent suctioning during withdrawal of the catheter, and maintaining a patent ETT by taking out the full length of catheter at the end of procedure using CSS. [ 6 15 23 ] Practices in relation with catheter irrigation and suctioning documentation are completely according to the practice recommendations. As shown in the results, most discrepancies were observed in nurses’ practice in relation to the practices prior to ETS.…”

“…Each item in the 23-item checklist was weighted with 0 and 1, or 0 and 2 depending on the strength of its effects on ETS, based on evidences. [ 6 23 ] Nurses’ practice in using CSS was observed, and the checklist was ticked in three time points: prior to suctioning, during the suctioning event, and post-suctioning practice. Recommended best practice was developed by calculating the highest score in each item, which was 44 representing perfect adherence to the best practice recommendations.…”

Ventilator-Associated Pneumonia in Patients Admitted to Intensive Care Units, Using Open or Closed Endotracheal Suctioning

“…Hanada in his review showed that there are no definite advantages of CTSS over OTSS; nevertheless, there are significant differences between the clinicians' and manufacturers' indications. In fact, CTSS could reduce the loss of lung volume in mechanically ventilated patients ( 33 ).…”

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

“…It is achieved by nurses to obtain effective oxygenation. (1)(2)(3)(4) Despite the necessity of ES plus some patients reported that the procedure eases their breathing, this approach can lead to complications such as damage to the trachea, bleeding, infection, cardiovascular and hemodynamic disturbances, impaired blood gas exchange and hypoxemia, bronchoconstriction, atelectasis and increased intracranial pressure. Moreover, ES is a source of pain and discomfort for MV patients.…”