Development of standard practice guidelines for open and closed system suctioning

Knowledge levels and evidence-based approaches of undergraduate nursing students on suctioning practices: A cross-sectional study

BACKGROUND

Suctioning is one of the nursing interventions frequently applied in clinical and intensive care units. In order to perform suctioning correctly and effectively, it is important for nursing students to acquire and develop this skill during their undergraduate theoretical and practical education.

OBJECTIVES

The study aims to reveal the knowledge levels and evidence-based approaches of nursing students about suctioning practices.

DESIGN

The study is a descriptive and cross-sectional study.

SETTINGS

It was carried out in the Faculty of Nursing of two state universities in Konya between March and June 2022.

PARTICIPANTS

A total of 506 undergraduate students participated in the study.

METHODS

Data were collected using the Personal Information Form, the Knowledge of Suctioning Questionnaire, and the Attitude towards Evidence-Based Nursing Questionnaire. Data were analyzed by calculating number, percentage, mean, and standard deviation, and using the multiple linear regression analysis.

RESULTS

The mean Attitude towards Evidence-Based Nursing Questionnaire score of the students was found to be 63.04 ± 7.91, and their mean Knowledge of Suctioning Questionnaire score was 33.46 ± 14.63. 83.8 % of the students obtained a low score from the questionnaire. Senior students had high scores on the Attitude towards Evidence-Based Nursing Questionnaire, which are significant predictive variables affecting the level of knowledge about suctioning (p < 0.05).

CONCLUSIONS

It was found that the high scores of the students on the Attitude towards Evidence-Based Nursing Questionnaire had an effect on their level of suctioning knowledge. The study also revealed that being a fourth-year student and receiving training on suctioning affected the level of suctioning knowledge.

An in vitro study of the effects of respiratory circuit setup and parameters on aerosol delivery during mechanical ventilation

Introduction

Aerosol therapy is often prescribed concurrently during invasive mechanical ventilation (IMV). This study determines the effects of nebuliser position, circuit humidification source, and most importantly, lung health on the delivery of aerosol in simulated adult and paediatric IMV patients. Furthermore, the influence of closed suction catheters on aerosol delivery is also addressed.

Methods

A vibrating mesh nebuliser was used to deliver Albuterol to simulated adult and paediatric IMV patients with differing states of lung health. Four different nebuliser positions and two types of humidification were analysed. Closed suction catheter mounts, a mainstay in IMV therapy, were incorporated into the circuits. The mean ± SD dose of aerosol (%) was assayed from a filter at the distal end of the endotracheal tube.

Results

Nebuliser placement and circuit humidification source had no effect on the delivered dose (%) in adults, yet both significantly did in the simulated paediatric patients. The use of closed suction catheter mounts significantly reduced the delivered dose (%) in adults but not in paediatric patients. A simulated healthy lung state generated the largest delivered dose (%), irrespective of nebuliser position in the adult. However, different lung health and nebuliser positions yielded higher delivered doses (%) in paediatrics.

Conclusion

Lung health and respiratory circuit composition significantly affect aerosol delivery in both adult and paediatric IMV patients. Nebuliser placement and respiratory circuit humidification source do not affect the delivered dose in adult but do in paediatric IMV patients.

The effects of open and closed system endotracheal suctioning methods on suctioning frequency, amount of secretion, and haemodynamics: A single-blind, randomised, 2 × 2 crossover trial

BACKGROUND

Several studies have revealed that clinicians cannot suction all available secretion in the trachea and perform more frequent suctioning with a closed suctioning system (CSS) than with an open suctioning system (OSS). There are also studies claiming that the CSS is as effective as the OSS, based on either the amount of secretion, the frequency of suctioning, or haemodynamic parameters alone. However, there is no study examining all at once.

OBJECTIVES

This study aims to determine whether the CSS is as effective for secretion removal, suctioning frequency, tidal volume (VT), and peripheral oxygen saturation (SpO2) as the OSS.

METHODS

The study used a single-blind, randomised, 2 × 2 crossover (2-method, 2-arm, 2-period) design. One hundred intubated patients were randomly assigned to two study arms. Thirty-four were randomised to the CSS on the first day and the OSS on the second day (AB arm), and 35 were randomised to the OSS on the first day and the CSS on the second day (BA arm). A 12-h washout period was set between them. Haemodynamic parameters were measured just before suctioning and in the 5th minute after suctioning. The secretions obtained after suctioning were weighed, and the frequency of suctioning was recorded.

RESULTS

There were no effects of method, period, or carryover on suctioning frequency and amount of secretion in the 2 × 2 crossover design t-test (p > 0.05). In the OSS, there was a weak, linear, and negative correlation between the amount of secretion and SpO2, and between VT and SpO2 measured before and after suctioning (p < 0.05 for all).

CONCLUSIONS

Open and closed suctioning systems were similar in terms of haemodynamic alterations, amounts of secretion, and frequency of suctioning. The CSS was as effective as the OSS.

REGISTRATION NUMBER

NCT04053751.

Evidence-based knowledge and emotional experiences of undergraduate nursing students regarding endotracheal suctioning: A cross-sectional, descriptive study

AIM

This study evaluated the evidence-based knowledge and emotional experiences of undergraduate nursing students regarding endotracheal suctioning.

RESEARCH METHODOLOGY/DESIGN

A cross-sectional, descriptive, survey design was used. Nursing students' knowledge level was measured using the Suctioning Knowledge Questionnaire, and emotions were assessed using the Clinical Stress Questionnaire.

SETTING

University undergraduate nursing programme.

RESULTS

The study included 445 undergraduate nurses. Students' mean knowledge score was 36.86 ± 14.45, and 85.8% of the total knowledge scores were 50 or less indicating a low level of knowledge. The mean score of the students who had experienced the suctioning procedure (44.5%, n = 198) was statistically higher than that of the students without experience (38.78 ± 12.62 and 35.32 ± 15.62, respectively) (p < 0.05). Students who performed the suctioning procedure expressed their emotions relating to suctioning as follows: I felt nervous (79.3%), worried (77.8%), frightened (70.2%), daunted (53.0%) and disgusted (51.0%).

CONCLUSION

The majority of nursing students' knowledge levels were insufficient. That they felt frightened or disgusted performing the procedure was noteworthy. Students should be given the opportunity to perform endotracheal suctioning and express their feelings about the procedure.

The Effects of Endotracheal Suctioning on Hemodynamic Parameters and Tissue Oxygenation in Pediatric Intensive Care Unit

Airway secretions may increase in intubated patients due to the impaired mucociliary clearance, impaired cough reflex, abnormal glottic function, insufficient moisturizing, and respiratory tract infections. As with any intervention, patients should be cautiously monitored for possible complications during the endotracheal suctioning. Procedure-related changes in the cerebral and somatic tissue oxygenation, hemodynamics, and oxygen saturation can be observed in these patients. It is important to ensure maintenance of tissue oxygenation during these and other interventions performed in critically ill children. The aim of this study was to investigate the effects of the endotracheal suctioning on tissue oxygenation in patients undergoing mechanical ventilation in the pediatric intensive care unit. Cerebral and somatic near-infrared spectroscopy (NIRS) monitoring were performed noninvasively using standardized NIRS equipment as a means of monitoring regional tissue oxygenation. Vital signs, level of sedation, pain scores, and somatic and cerebral tissue oxygenation values of mechanically ventilated patients were recorded prospectively 5 minutes before, during, and after endotracheal suctioning. Cerebral NIRS measurements did not exhibit any statistically significant changes during endotracheal suctioning. Somatic NIRS levels changed significantly before, during, and after endotracheal suctioning and remained low throughout the procedure. Endotracheal suctioning is an invasive intervention that facilitates clearance of tracheal secretions and maintenance of the oxygenation and ventilation. The maintenance of the tissue oxygenation should be documented during these and other interventions performed on critically ill children. Somatic NIRS is a useful tool for monitoring tissue oxygenation during such procedures.

Increasing suction pressure during endotracheal suctioning increases the volume of suctioned secretions, but not procedure-related complications: A comparative study in open system endotracheal suctioning

OBJECTIVES

To compare the effect of three different suction pressures (80 mmHg, 150 mmHg, 250 mmHg) with the open system suction method in terms of the volume of secretions and complications development in intubated intensive care patients.

RESEARCH METHODOLOGY/DESIGN

This study was planned as a prospective, experimental, self-controlled design. The study sample included 47 patients. Data were collected using a data collection and patient follow-up form from patient records.

SETTING

Single adult intensive care unit in a university hospital.

RESULTS

Fifty five percent of the patients were male, 61.7% were older than 65 years and 38.32% had lung infection. The amount of suctioned secretions tended to increase significantly with increasing negative pressure and there was a significant difference between the pressures in terms of the median volume of suctioned secretions (p < 0.001). There was no significant difference between the suction pressures in terms of oxygen desaturation, hypertension rates (p > 0.05). Tachycardia, bradycardia, hypoxaemia, tracheal mucosal damage or mucosal bleeding were not observed during suctioning with three different suction pressures.

CONCLUSION

It may be assumed that 250 mmHg suction pressure, via compliance with open system suction method related procedures, is being more effective and equally safe for secretion cleaning in comparison to the 80 and 150 mmHg suction pressures.

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

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.

How to cite this article

Pinto HJ, D'silva F, Sanil TS. Knowledge and Practices of Endotracheal Suctioning amongst Nursing Professionals: A Systematic Review. Indian J Crit Care Med 2020;24(1):23–32.

Intensive care nurses' knowledge and practice on endotracheal suctioning of the intubated patient: A quantitative cross-sectional observational study

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.

Longitudinal effects of single-dose simulation education with structured debriefing and verbal feedback on endotracheal suctioning knowledge and skills: A randomized controlled trial

We evaluated the longitudinal effects of single-dose simulation education with structured debriefing and verbal feedback on critical care nurses' endotracheal suctioning knowledge and skills. To do this we used an experimental design without other competing intervention. Twenty-four months after simulation education, no significant time and group differences or time × group interactions were identified between the study groups. The need for regularly repeated educational interventions with audiovisual or individualized performance feedback and repeated bedside demonstrations is evident.

Knowledge and practice of intensive care nurses for endotracheal suctioning in a teaching hospital in western Turkey

OBJECTIVES

This study was conducted to determine intensive care nurses' knowledge and practice levels regarding open system endotracheal suctioning and to investigate if there is a relationship between nurses' demographic characteristics and their knowledge and practice.

RESEARCH METHODOLOGY/DESIGN

The study was conducted as a cross-sectional and non-participant structured observational design. Data were collected using a 45-item structured and self-administered questionnaire and a 31-item observational checklist. The study sample included 72 nurses.

SETTING

Three adult intensive care units in a teaching hospital.

RESULTS

The nurses' mean scores of knowledge and practice were 23.79±3.83 and 12.88±2.53. Their level of knowledge was very good in 59.7%, good in 34.7%, and the level of practice was fair in 79.2% and good in 18.1%. The relationship between the type of unit and the nurses' knowledge scores was statistically significant (p=0.013). The correlation between the nurses' scores of knowledge and practice was not statistically significant (r=0.220; p=0.063).

CONCLUSION

This study suggests that the knowledge level of most of the nurses was good and their practice level was fair. Intensive care nurses must perform suctioning procedures safely and effectively to ensure delivery of quality of care and eliminate complications.

Effects of open and closed suction systems on the haemodynamic parameters in cardiac surgery patients

AIMS

This study was carried out to determine the effects of open and closed suction systems on haemodynamic parameters of the patients who underwent open heart surgery.

BACKGROUND

Nurses should work meticulously and carefully as many complications may develop if the method used to perform suctioning is not appropriate.

DESIGN

The quasi-experimental study design was used.

METHOD

The study sample comprised 120 patients who underwent open heart surgery in the cardiovascular surgery intensive care unit of a state hospital in Turkey. Haemodynamic parameters were determined just before, right after, at the 5th and 15th minute after suctioning. The data were evaluated with the One-Way Analysis of Variance (ANOVA) for Repeated Measures, independent t-test and Bonferroni's test for further analysis (post hoc).

RESULTS

The difference between heart rate (HR) and mean blood pressure, mean PaO2 and PaCO2 , SaO2 and pH values measured before, right after and at the 5th and 15th minute after suctioning was found to be significant in patients who underwent the open suctioning procedure. It was determined that the difference between mean PaO2 values was not significant and that SaO2 versus SpO2 values increased in patients who underwent the closed suctioning procedure. When the open and closed suction systems were compared, statistically significant difference was determined in terms of MAP, SpO2 .

CONCLUSION

It was determined that HR, arterial blood pressure and arterial blood gases of the patients who underwent open heart surgery were negatively affected by the open suction system but did not increase significantly as soon as suctioning was over during the closed suctioning procedure. The data obtained indicate that closed system suctioning, compared with open system suctioning, can be used safely on this patient group.

RELEVANCE TO CLINICAL PRACTICE

The closed suction system is recommended since it contributes to the enhancement of patient safety and the quality of nursing care.