Can nurses safely assess the need for endotracheal suction in short-term ventilated patients, instead of using routine techniques?

doi:10.1016/S0964-3397(98)80486-2

Intensive and Critical Care Nursing

Volume 14, Issue 4, August 1998, Pages 170-178

https://doi.org/10.1016/S0964-3397(98)80486-2 Get rights and content

Most literature describes endotracheal suction as a hazardous procedure associated with numerous complications and proposes that it should only be performed as necessary to minimize these complications. Other authors suggest endotracheal suction only after assessment predisposes patients to a number of different complications.

This article describes a controlled study to compare and contrast the differences in endotracheal suction outcomes in patients who received ritualized 2 hourly suctioning and those who received it following assessment.

A group of qualified nurses in an Intensive Care Unit were taught auscultation skills to assess a patient's needs for suctioning and all the nurses received educational training regarding endotracheal suctioning. Short-term ventilated patients were allocated to receive endotracheal suctioning either when the need for it was determined by assessment only or routinely, using a standardized suctioning technique.

The results demonstrated a clear increase in nurses' knowledge regarding endotracheal suctioning. The assessed group of patients demonstrated significantly better outcomes and less complications than the controlled group in relation to changes in peak airway pressures, heart rate and mean arterial pressure pre- and post-endotracheal suctioning, and the amount of secretions obtained on suctioning.

Although only preliminary, these results do provide support for the view that endotracheal suction only in response to assessment is better practice for short-term ventilated patients.

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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.
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.
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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.
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Intubated patients may be unable to adequately cough up secretions. Endotracheal suctioning is therefore important in order to reduce the risk of consolidation and atelectasis that may lead to inadequate ventilation. The suction procedure is associated with complications and risks including bleeding, infection, atelectasis, hypoxemia, cardiovascular instability, elevated intracranial pressure, and may also cause lesions in the tracheal mucosa. The aim of this article was to review the available literature regarding endotracheal suctioning of adult intubated intensive care patients and to provide evidence-based recommendations The major recommendations are suctioning only when necessary, using a suction catheter occluding less than half the lumen of the endotracheal tube, using the lowest possible suction pressure, inserting the catheter no further than carina, suctioning no longer than 15 s, performing continuous rather than intermittent suctioning, avoiding saline lavage, providing hyperoxygenation before and after the suction procedure, providing hyperinflation combined with hyperoxygenation on a non-routine basis, always using aseptic technique, and using either closed or open suction systems.
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This literature review defines and describes the concept of competence in adult intensive care nursing, with special reference to clinical and professional competence. The aim was to see whether and how the studies reviewed defined or described the concept of competence, and which domains of competence have been investigated in intensive and critical care nursing research. The review focuses on empirical studies retrieved from the COCHRANE and MEDLINE (1994–2005) databases. The final analysis comprised 45 studies. The studies were analysed by inductive content analysis. Very few (n = 7) of the studies offered any definitions or descriptions of the concept of competence. Clinical and professional competence in intensive and critical care nursing can be defined as a specific knowledge base, skill base, attitude and value base and experience base of intensive and critical care nursing. Clinical competence can be divided into three and professional competence into four constituent domains. In clinical competence, these are the principles of nursing care; clinical guidelines; and nursing interventions. In professional competence, the domains are ethical activity; decision-making; development work; and collaboration. More empirical research is needed to examine competence in intensive and critical care nursing.
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Of the 18 eligible studies identified through the search strategy, only 5 studies were included in the review. The two endotracheal suction systems show no differences in the incidence of ventilator-associated pneumonia (5 trials: odds ratio [OR], 0.92; Mantel-Haenszel [M-H], fixed; 95% confidence interval [95%CI], 0.72-1.18) or mortality rates (3 trials: OR, 0.89; M-H, fixed; 95%CI, 0.62-1.28).
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Can nurses safely assess the need for endotracheal suction in short-term ventilated patients, instead of using routine techniques?

Intensive and Critical Care Nursing

Chest

Intensive and Critical Care Nursing

Chest

Intensive and Critical Care Nursing

Intensive and Critical Care Nursing

Endotracheal suctioning of mechanically ventilated adults and children with artificial airways

AARC Clinical Practice Guidelines

Making sense of suctioning

Nursing Times

Suctioning therapy in the critically ill patient

British Journal of Nursing

Physiological determinants of a clinically successful method of endotracheal suction

Western Journal of Nursing Research

Airway management

Artificial airway

Quantitative Data Analysis

Safe suctioning

Registered Nurse

The effect of pulmonary secretions on respiratory mechanics in intubated patients

Respiratory Care

Endotracheal suctioning: time worn ritual or timely intervention

American Journal of Critical Care

Differential effects of continuous versus intermittent suction on tracheal tissue

Heart and Lung

Evidence-based suction management in accident and emergency: a vital component of airway care

Accident and Emergency Nursing

The impact of technology on the risks associated with endotracheal suctioning and airway management: the changes a decade has wrought

Respiratory Care

Minimising the effects of mechanical aspiration

Aspects of Respiratory Care

Complications of endotracheal suctioning procedures

Respiratory Care

Potential hazards of tracheobronchial suctioning

Intensive and Critical Care Nursing

Basic questions: where are the answers

Respiratory Care

Ten tips for safer suctioning

American Journal of Nursing