Knowledge and Practices of Endotracheal Suctioning amongst Nursing Professionals: A Systematic Review

Abstract

Introduction: Ventilator-associated pneumonia, a common cause of mortality and morbidity, is commonly seen among patients with endotracheal intubation due to unsafe suctioning practices by health professionals. Objective: A systematic review was conducted to explore the gaps in the existing practices of nurses and thus proposing comprehensive guidelines for safe practice. Materials and methods: A two-phase strategy was adopted to identify the studies through a comprehensive electronic search in PubMed, Google Scholar, ProQuest, Ovid, and Helinet Summon by using predefined keywords within a year limit of 2002-2016. The quality of studies was reviewed using tools endorsed by Joanna Briggs Institute. This review was conducted according to the guidelines described in the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Qualitative data were described through the process of metasynthesis. Quantitative analysis was performed to combine the competent quantitative evidences to identify knowledge and practices of endotracheal suctioning (ETS). Results: Thirty studies had been subjected for metasynthesis, among which six provided relevant information for quantitative analysis. Quantitative analysis of the studies reported that only 36% of the nurses had assessed patients prior to suctioning and had knowledge about the size of the suction catheter while only 46% were aware of the appropriate suction pressure to be used for ETS. Handwashing compliance prior to suctioning was observed in only 62% of the nurses. It is reported that, despite the awareness on possible complications, nurses fail to adhere to the recommended practice guidelines. Conclusion:The current review would explore the best evidence-based practices (EBPs) among nurses related to ETS, which would ensure quality care to critically ill patients.

Adherence of critical care nurses to endotracheal suctioning guidelines: a cross-sectional study

“…A possible explanation is that CCNs might depend on their experience rather than clinical evidence to assess the need for suctioning [ 4 , 17 ]. Accordingly, such practices contradict the evidence that suctioning should be indicated and performed only when necessary [ 14 , 16 , 25 ].…”

“…The use of a small suction catheter with external diameters not exceeding one-half of the internal diameter of the ETT is recommended to allow air entry into the lungs during suctioning, consequently preventing the development of excessive negative pressure and potential atelectasis [ 16 , 25 , 30 ]. In the present study, the majority (57.5%) of the used catheter sizes were appropriate (less than half the internal diameter of ETT).…”

Investigation of the airway management practice of emergency department ward nurses: a nationwide survey in China

“…Nursing administrators and educators should provide nurses with regular training courses about airway management, and operation practice in clinical work should regularly be assessed by clinical supervisors. 27 Pinto et al 28 also stated that necessary training and continuing education on guidelines are warranted and should improve nursing quality. Noticeably, positive correlations were observed among the three scores, indicating that with adequate knowledge of airway management, nurses’ attitude will change as well as their behaviours in clinical airway management practice.…”

Nursing in Intensive Care Unit: Exploring Factors Related to Ventilator-Associated Pneumonia

“…Ventilator-associated pneumonia is a common cause of death and morbidity in patients with endotracheal intubation, partly due to unsafe suction. The correct selection of sputum aspiration tube is an important guarantee for effective sputum aspiration [25] . We observed that the diameter of the aspiration catheter should be less than half of the endotracheal intubation [26] .…”