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Schults JA, Charles KR, Harnischfeger J, Ware RS, Royle RH, Byrnes JM, Long DA, Ullman AJ, Raman S, Waak M, Lake A, Cooke M, Irwin A, Tume L, Hall L. Implementing paediatric appropriate use criteria for endotracheal suction to reduce complications in mechanically ventilated children with respiratory infections. Aust Crit Care 2024; 37:34-42. [PMID: 38142148 DOI: 10.1016/j.aucc.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Endotracheal suction is used to maintain endotracheal tube patency. There is limited guidance to inform clinical practice for children with respiratory infections. OBJECTIVE The objective of this study was to determine whether implementation of a paediatric endotracheal suction appropriate use guideline Paediatric AirWay Suction (PAWS) is associated with an increased use of appropriate and decreased use of inappropriate suction interventions. METHODS A mixed-method, pre-implementation-post-implementation study was conducted between September 2021 and April 2022. Suction episodes in mechanically ventilated children with a respiratory infection were eligible. Using a structured approach, we implemented the PAWS guideline in a single paediatric intensive care unit. Evaluation included clinical (e.g., suction intervention appropriateness), implementation (e.g., acceptability), and cost outcomes (implementation costs). Associations between implementation of the PAWS guideline and appropriateness of endotracheal suction intervention use were investigated using generalised linear models. RESULTS Data from 439 eligible suctions were included in the analysis. Following PAWS implementation, inappropriate endotracheal tube intervention use reduced from 99% to 58%, an absolute reduction (AR) of 41% (95% confidence interval [CI]: 25%, 56%). Reductions were most notable for open suction systems (AR: 48%; 95% CI: 30%, 65%), 0.9% sodium chloride use (AR: 23%; 95% CI: 8%, 38%) and presuction and postsuction manual bagging (38%; 95% CI: 16%, 60%, and 86%; 95% CI: 73%, 99%), respectively. Clinicians perceived PAWS as acceptable and suitable for use. CONCLUSIONS Implementation of endotracheal tube suction appropriate use guidelines in a mixed paediatric intensive care unit was associated with a large reduction in inappropriate suction intervention use in paediatric patients with respiratory infections.
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Affiliation(s)
- Jessica A Schults
- Metro North Health, Herston Infectious Disease Institute, Queensland, Australia; The University of Queensland, School of Nursing Midwifery and Social Work, Australia; The University of Queensland, Children's Health Research Centre, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
| | - Karina R Charles
- The University of Queensland, School of Nursing Midwifery and Social Work, Australia; The University of Queensland, Children's Health Research Centre, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia
| | - Jane Harnischfeger
- The University of Queensland, School of Nursing Midwifery and Social Work, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia; School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Ruth H Royle
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Joshua M Byrnes
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Australia
| | - Debbie A Long
- The University of Queensland, Children's Health Research Centre, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
| | - Amanda J Ullman
- The University of Queensland, School of Nursing Midwifery and Social Work, Australia; The University of Queensland, Children's Health Research Centre, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Sainath Raman
- The University of Queensland, Children's Health Research Centre, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia
| | - Michaela Waak
- The University of Queensland, Children's Health Research Centre, Australia; Queensland Children's Hospital, Paediatric Intensive Care Unit, Queensland, Australia
| | - Anna Lake
- The University of Queensland, Children's Health Research Centre, Australia
| | - Marie Cooke
- School of Nursing & Midwifery, Griffith University, Australia
| | - Adam Irwin
- The University of Queensland, Centre for Clinical Research, The University of Queensland, Queensland, Australia; Infection Management and Prevention Service, Queensland Children's Hospital, Queensland, Australia
| | - Lyvonne Tume
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK; Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Lisa Hall
- Metro North Health, Herston Infectious Disease Institute, Queensland, Australia; School of Public Health, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
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Arabpur A, Farsi Z, Butler S, Habibi H. Comparative effectiveness of demonstration using hybrid simulation versus task-trainer for training nursing students in using pulse-oximeter and suction: A randomized control trial. NURSE EDUCATION TODAY 2022; 110:105204. [PMID: 35101808 DOI: 10.1016/j.nedt.2021.105204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 10/06/2021] [Accepted: 11/03/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Educating medical professionals on the emergency protocol for cardiac arrest can improve survival. OBJECTIVES This study aimed to compare the effectiveness of demonstration using hybrid simulation versus task-trainer for training nursing students in using pulse-oximeter and suction following cardiac arrest. DESIGN This randomized clinical trial was conducted in 2019. SETTING The study was carried out in a nursing school in Tehran, Iran. PARTICIPANTS Nursing students. METHODS Nursing students were recruited and randomly assigned to one of three groups: a demonstration training group using hybrid simulation (standardized patient and task-trainer) in a transport ambulance (N = 15), a demonstration training group using task-trainer in skill lab (N = 15), and a control group (N = 15). No education was performed in the control group. Each student was evaluated pre and post-training on the use of a pulse-oximeter along with knowledge and skill of suction. Students were evaluated using a knowledge questionnaire and an appraisal checklist. RESULTS All three groups increased their abilities in using pulse-oximeter and suction two weeks post-training session. The trial groups demonstrated better scores on the knowledge questionnaire and skill checklist in comparison to the control group. However, hybrid simulation and task-trainer groups showed no significant difference in knowledge and skill on the use of two modes. CONCLUSION The use of demonstration using hybrid simulation in a transport ambulance and task-trainer in skill lab were equally effective in educating nursing students on the use of pulse-oximeter and suction following a cardiac arrest.
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Affiliation(s)
- Alireza Arabpur
- Student Research Committee Department, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran; Military Nursing Department, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran
| | - Zahra Farsi
- Community Health Department, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran; Research Department, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran.
| | - Samantha Butler
- Department of Psychiatry, Harvard Medical School, Children's Hospital Boston, MA, USA.
| | - Hengameh Habibi
- Emergency Department, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran
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Bohr NL, Ely E, Hanrahan KS, McCarthy AM, LaFond CM. Predicting Who Receives Nonpharmacologic Pain Interventions in the Pediatric Intensive Care Unit. Pain Manag Nurs 2022; 23:267-272. [DOI: 10.1016/j.pmn.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/04/2022] [Accepted: 01/16/2022] [Indexed: 10/19/2022]
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The Paediatric AirWay Suction (PAWS) appropriateness guide for endotracheal suction interventions. Aust Crit Care 2021; 35:651-660. [PMID: 34953635 DOI: 10.1016/j.aucc.2021.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 10/10/2021] [Accepted: 10/17/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND/OBJECTIVE Endotracheal suction is an invasive and potentially harmful technique used for airway clearance in mechanically ventilated children. Choice of suction intervention remains a complex and variable process. We sought to develop appropriate use criteria for endotracheal suction interventions used in paediatric populations. METHODS The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop the Paediatric AirWay Suction appropriateness guide. This included defining key terms, synthesising current evidence, engaging an expert multidisciplinary panel, case scenario development, and two rounds of appropriateness ratings (weighing harm with benefit). Indications (clinical scenarios) were developed from common applications or anticipated use, current practice guidelines, clinical trial results, and expert consultation. RESULTS Overall, 148 (19%) scenarios were rated as appropriate (benefit outweighs harm), 542 (67%) as uncertain, and 94 (11%) as inappropriate (harm outweighs benefit). Disagreement occurred in 24 (3%) clinical scenarios, namely presuction and postsuction bagging across populations and age groups. In general, the use of closed suction was rated as appropriate, particularly in the subspecialty population 'patients with highly infectious respiratory disease'. Routine application of 0.9% saline for nonrespiratory indications was more likely to be inappropriate/uncertain than appropriate. Panellists preferred clinically indicated suction versus routine suction in most circumstances. CONCLUSION Appropriate use criteria for endotracheal suction in the paediatric intensive care have the potential to impact clinical decision-making, reduce practice variability, and improve patient outcomes. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research.
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Khayer F, Ghafari S, Saghaei M, Yazdannik A, Atashi V. Effects of Open and Closed Tracheal Suctioning on Pain in Mechanically Ventilated Patients. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:426-430. [PMID: 33344215 PMCID: PMC7737833 DOI: 10.4103/ijnmr.ijnmr_135_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 05/11/2020] [Accepted: 06/08/2020] [Indexed: 11/19/2022]
Abstract
Background: Painful care procedures are the most common cause of stress in patients admitted to Intensive Care Units (ICUs). Tracheal suctioning is the most painful experience for ICU patients. The present study was conducted to compare open and closed endotracheal suctioning in terms of their effect in pain in mechanically ventilated patients. Materials and Methods: The present clinical trial recruited 70 mechanically ventilated patients with tracheostomy in 2019. The eligible patients were randomly divided into open and closed suctioning groups. The pain was measured in the patients using the Critical Pain Observational Tool (CPOT) before and during suctioning as well as 10 and 30 min later. The data were analyzed using the repeated measures Analysis Of Variance (ANOVA), paired t-test, and Chi-squared test. Results: The pain score was significantly higher in the open suctioning group during (t = 2.59, p = 0.01) and 10 min after suctioning (t = 3.02, p = 0.004). No significant differences were observed in the pain score between the two groups 30 min after suctioning (t = 0.32, p = 0.75). The post hoc Least Significant Difference (LSD) test showed that the CPOT scores 10 min after suctioning was significantly higher than that before suctioning and significantly lower than that during suctioning (p = 0.001). The CPOT score 30 min after suctioning was also significantly lower than that 10 min after suctioning (p < 0.001). Conclusions: The present findings suggested a lower pain in the patients with closed suctioning compared to those with open suctioning.
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Affiliation(s)
- Fatemeh Khayer
- MSc Student in Critical Care Nursing, department of nursing, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayeh Ghafari
- Assistant Professor, Nursing and Midwifery Care, Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahmoud Saghaei
- Professor of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadreza Yazdannik
- Assistant Professor, Department of Critical Care Nursing, Nursing and Midwifery School, Nursing and Midwifery Care Research Center, Isfahan University of Medical Science, Isfahan, Iran
| | - Vajihe Atashi
- PHD of Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Schults JA, Mitchell ML, Cooke M, Long DA, Ferguson A, Morrow B. Endotracheal suction interventions in mechanically ventilated children: An integrative review to inform evidence-based practice. Aust Crit Care 2020; 34:92-102. [PMID: 32763068 DOI: 10.1016/j.aucc.2020.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to review and critically appraise the evidence for paediatric endotracheal suction interventions. DATA SOURCES A systematic search for studies was undertaken in the electronic databases CENTRAL, Medline, EMBASE, and EBSCO CINAHL from 2003. STUDY SELECTION Included studies assessed suction interventions in children (≤18 ys old) receiving mechanical ventilation. The primary outcome was defined a priori as duration of mechanical ventilation. Secondary outcomes included adverse events and measures of gas exchange and lung mechanics. DATA EXTRACTION Data extraction were performed independently by two reviewers. Study methodological quality was assessed using Cochrane's risk of bias tool for randomised trials or the Newcastle-Ottawa Scale for observational studies. Overall assessment of the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations criteria. RESULTS Overall 17 studies involving 1618 children and more than 21,834 suction episodes were included in the review. The most common intervention theme was suction system (five studies; 29%). All included trials were at unclear or high risk of performance bias due to the inability to blind interventionists. Current evidence suggests that closed suction may maintain arterial saturations, normal saline leads to significant transient desaturation, and lung recruitment applied after suction offers short-term oxygenation benefit. LIMITATIONS Lack of randomised controlled trials, inconsistencies in populations and interventions across studies, and imprecision and risk of bias in included studies precluded data pooling to provide an estimate of interventions effect. CONCLUSIONS Based on the results of this integrative review, there is insufficient high-quality evidence to guide practice around suction interventions in mechanically ventilated children.
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Affiliation(s)
- Jessica A Schults
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Queensland, Australia; Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia.
| | - Marion L Mitchell
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia
| | - Marie Cooke
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Debbie A Long
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia; Paediatric Critical Care Research Group, The University of Queensland, Australia
| | - Alexandra Ferguson
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia
| | - Brenda Morrow
- Department of Paediatics and Child Health, University of Cape Town, South Africa
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Colley N, Mani H, Ninomiya S, Komizunai S, Murata E, Oshita H, Taneda K, Shima Y, Asaka T. Effective Catheter Manoeuvre for the Removal of Phlegm by Suctioning: A Biomechanical Analysis of Experts and Novices. J Med Biol Eng 2020; 40:340-347. [PMID: 32421097 PMCID: PMC7223703 DOI: 10.1007/s40846-020-00521-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 04/15/2020] [Indexed: 11/30/2022]
Abstract
Purpose The aim of this study was to determine the effective biomechanical technique for suctioning phlegm. Methods A novel tracheal suctioning simulator combined with a motion capture system was used to calculate the amount of simulated phlegm suctioned and the biomechanical parameters of the associated suctioning manoeuvre. A laboratory study, including 12 nurses with > 3 years of suctioning experience and 12 nursing students without any clinical suctioning experience, was conducted. The amount of phlegm suctioned, the maximum length of catheter insertion, and the biomechanical parameters of hand movement were calculated. Results The mean amount of phlegm suctioned per second was significantly larger in the experienced group than in the non-experienced group. The amount of phlegm suctioned correlated positively with the length of the vertical path of motion of the wrist and forearm, and with the angular velocity of thumb rotation in both the groups. Conclusion Greater vertical motion of the wrist and thumb rotation improved the effectiveness of phlegm suctioning and prevented the need for deep suctioning, which is unsafe.
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Affiliation(s)
- Noriyo Colley
- 1Department of Nursing, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Hiroki Mani
- 2Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, Hokkaido Japan
| | - Shinji Ninomiya
- 3Department of Clinical Engineering, Hiroshima International University, Hiroshima, Japan
| | - Shunsuke Komizunai
- 4Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Eri Murata
- 1Department of Nursing, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Hiroka Oshita
- 5Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Kenji Taneda
- 5Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Yusuke Shima
- 5Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Tadayoshi Asaka
- 2Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, Hokkaido Japan
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Schults JA, Long DA, Mitchell ML, Cooke M, Gibbons K, Pearson K, Schibler A. Adverse events and practice variability associated with paediatric endotracheal suction: An observational study. Aust Crit Care 2019; 33:350-357. [PMID: 31748181 DOI: 10.1016/j.aucc.2019.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/12/2019] [Accepted: 08/20/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine the incidence of endotracheal tube (ETT) suction-related adverse events (AEs) and to examine associations between AEs and patient and suction characteristics. Secondary objectives were to describe ETT suction practices in an Australian paediatric intensive care unit (PICU). METHODS A prospective, observational study was undertaken in a mixed cardiac and general PICU. Children were eligible for inclusion if they were intubated and mechanically ventilated. Data on patient and suction variables (indication for ETT suction, number of suction episodes per mechanical ventilation episode, indication for normal saline instillation [NSI] and NSI dose) including potential predictive variables (age, Paediatric Index of Mortality 3 [PIM3], NSI, positive end-expiratory pressure, and hyperoxygenation) were collected. The main outcome variable was a composite measure of any AE. MAIN RESULTS A total of 955 suction episodes were recorded in 100 children. AEs occurred in 211 (22%) ETT suctions. Suction-related AEs were not associated with age, diagnostic category, or index of mortality score. Desaturation was the most common AE (180 suctions; 19%), with 69% of desaturation events requiring clinician intervention. Univariate logistic regression showed the odds of desaturation decreased as the internal diameter of the ETT increased (odds ratio [OR]: 0.59; 95% confidence interval [CI]: 0.37-0.95; p = 0.028). Multivariable modelling revealed NSI was significantly associated with an increased risk of desaturation (adjusted OR [aOR]: 3.23; 95% CI: 1.99-5.40; p < 0.001) and the occurrence of an AE (aOR: 2.76; 95% CI: 1.74-4.37; p < 0.001). Presuction increases in fraction of inspired oxygen (FiO2) was significantly associated with an increased risk of experiencing an AE (aOR: 2.0; 95% CI: 1.27-3.15; p = 0.003). CONCLUSIONS ETT suction-related AEs are common and associated with NSI and the requirement for pre-suction increases in FiO2. Clinical trial data are needed to identify high-risk patient groups and to develop interventions which optimise practice and reduce the occurrence of ETT suction-related AEs.
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Affiliation(s)
- Jessica A Schults
- Department of Anaesthesia and Pain Management, Lady Cilento Children's Hospital, Queensland, Australia; Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia.
| | - Debbie A Long
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Queensland, Australia
| | - Marion L Mitchell
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia
| | - Marie Cooke
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Kristen Gibbons
- Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia
| | - Kylie Pearson
- Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Queensland, Australia
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Queensland, Australia; School of Medicine, The University of Queensland, Queensland, Australia
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Mwakanyanga ET, Masika GM, Tarimo EAM. Intensive care nurses' knowledge and practice on endotracheal suctioning of the intubated patient: A quantitative cross-sectional observational study. PLoS One 2018; 13:e0201743. [PMID: 30114257 PMCID: PMC6095500 DOI: 10.1371/journal.pone.0201743] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 07/20/2018] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Endotracheal suction (ETS) is a common invasive procedure which is done to keep the airways patent by mechanically removing accumulated pulmonary secretions to all in patients with artificial airways. Many life-threatening complications can occur when the procedure is not performed correctly. Although the evidence-based recommendations regarding ETS are available, many of these have not been observed in nurse's clinical practice. We assessed the intensive care nurses' knowledge and practice of ETS to intubated patients in selected hospitals in Dar es Salaam, Tanzania. METHODOLOGY A descriptive cross-sectional study design involving 103 Intensive Care Unit (ICU) nurses in Dar es Salaam city was conducted in 2014. Data were analyzed using SPSS version 20 where descriptive statistics were employed to interpret data. RESULTS Majority of ICU nurses (69.9%) knew the indication for the procedure, (77.7%) knew the action to be taken in case of abrupt change in the ECG monitor; however, 80.6% demonstrated undesirable overall knowledge on ETS evidence-based recommendations. Nurses with ICU training (57.3%) significantly demonstrated higher knowledge of ETS than non-trained nurses (P<0.005), while all other factors had no influence. CONCLUSIONS AND RECOMMENDATIONS Majority of ICU nurses do not have desirable knowledge and skills of ETS, and are currently not following current ETS recommendations. This study has shown that training on ICU skills have positive influence to recommended ETS knowledge. We recommend ICU training, provision of clinical guidelines and adequate support to nurses employed in ICUs. Also, further studies using analytical approach to identify other factors beyond the scope of this study and testing the best approach in fostering adherence to ETS evidence-based recommendations are crucial.
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Affiliation(s)
| | - Golden M. Masika
- School of Nursing, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
| | - Edith A. M. Tarimo
- Department of Nursing Management, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
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Lema-Zuluaga GL, Fernandez-Laverde M, Correa-Varela AM, Zuleta-Tobón JJ. As-needed endotracheal suctioning protocol vs a routine endotracheal suctioning in Pediatric Intensive Care Unit: A randomized controlled trial. COLOMBIA MEDICA (CALI, COLOMBIA) 2018; 49:148-153. [PMID: 30104806 PMCID: PMC6084919 DOI: 10.25100/cm.v49i2.2273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective: To compare two endotracheal suctioning protocols according to morbidity, days of mechanical ventilation, length of stay in the Pediatric Intensive Care Unit (PICU), incidence of Ventilator-Associated Pneumonia (VAP) and mortality. Methods: A Pragmatic randomized controlled trial performed at University Hospital Pablo Tobón Uribe, Medellin-Colombia. Forty-five children underwent an as-needed endotracheal suctioning protocol and forty five underwent a routine endotracheal suctioning protocol. Composite primary end point was the presence of hypoxemia, arrhythmias, accidental extubation and heart arrest. A logistic function trough generalized estimating equations (GEE) were used to calculate the Relative Risk for the main outcome. Results: Characteristics of patients were similar between groups. The composite primary end point was found in 22 (47%) of intervention group and 25 (55%) children of control group (RR= 0.84; 95% CI: 0.56-1.25), as well in 35 (5.8%) of 606 endotracheal suctioning performed to intervention group and 48 (7.4%) of 649 performed to control group (OR= 0.80; 95% CI: 0.5-1.3). Conclusions: There were no differences between an as-needed and a routine endotracheal suctioning protocol. Trial registration: ClinicalTrials.gov identifier NCT01069185
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Affiliation(s)
- Gloria Lucía Lema-Zuluaga
- Epidemiology Academic Group (GRAEPIC), Universidad de Antioquia, Medellin, Colombia.,Research Unit, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | | | | | - John J Zuleta-Tobón
- Epidemiology Academic Group (GRAEPIC), Universidad de Antioquia, Medellin, Colombia.,Research Unit, Hospital Pablo Tobón Uribe, Medellín, Colombia
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