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VOLUME 28 , ISSUE 1 ( January, 2024 ) > List of Articles

Original Article

Audit on Practices of Endotracheal Suctioning in Intensive Care Unit Patients among Health Care Workers (HCWs)

Rahil Singh, Anju Romina Bhalotra, Shubhangi Sharma

Keywords : Critical care, Endotracheal suctioning, Intensive care unit

Citation Information : Singh R, Bhalotra AR, Sharma S. Audit on Practices of Endotracheal Suctioning in Intensive Care Unit Patients among Health Care Workers (HCWs). Indian J Crit Care Med 2024; 28 (1):58-65.

DOI: 10.5005/jp-journals-10071-24615

License: CC BY-NC 4.0

Published Online: 30-12-2023

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: Endotracheal suctioning (ETS) is one of the most frequently performed invasive procedures in intensive care units (ICUs). This audit was aimed at studying current practices and knowledge regarding ETS in the Indian critical care setup, with the background aim of raising awareness regarding correct practices as per current recommendations in critically ill patients. Materials and methods: After registering the trial with the clinical trial registry, India, a structured audit questionnaire containing 20 questions pertaining to ETS was distributed through electronic media among resident doctors working in the ICUs across India. Responses received were statistically analyzed. Results: The questionnaire was sent to 530 clinicians, of which only 200 (37.73%) responded. The audit revealed that only 22% respondents set the maximum negative pressure every time before suctioning, on the suction apparatus and only 32% said they would choose a catheter size of less than half the internal diameter of the endotracheal tube (ETT). About 90% of the respondents did not routinely do any form of documentation of the ETS. Almost 72% of the responders opined that closed suction systems reduce the chances of developing ventilator-associated pneumonia (VAP). Only 46% of respondents thought that no solution should be routinely instilled in ETT during ETS. Conclusion: There is lack of awareness regarding frequency and technique of ETS, infection control and monitoring required during ETS. Institutional protocols should be in place to follow correct guidelines for performing ETS.


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  1. American Association for Respiratory Care. AARC Clinical Practice Guidelines: Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respir Care 2010;55(6):758–764. PMID: 20507660.
  2. Guglichninotti J, Desmonts JM, Dureuil B. Effects of tracheal suctioning on respiratory resistances in mechanically ventilated patients. Chest 1998;113(5):1335–1338. DOI: 10.1378/chest.113.5.1335.
  3. Zeb A, Ul Haq S, Ali F, Hussain N, Haidar S, Shah A, et al. Knowledge and practice of ICU nurses regarding endotracheal suctioning in tertiary care hospitals. Peshawar J Nurs Care 2017;06:2–5. DOI: 10.4172/2167–1168.1000400.
  4. Negro A, Ranzani R, Villa M, Manara D. Survey of Italian intensive care nit nurses’ knowledge about endotracheal suctioning guidelines. Intensive Crit Care Nurs 2014;30(6):339–345. DOI: 10.1016/j.iccn.2014.06.003.
  5. Favretto DO, Silveira RC, Canini SR, Garbin LM, Martins FT, Dalri MC. Endotracheal suction in intubated critically ill adult patients undergoing mechanical ventilation: A systematic review. Rev Lat Am Enfermagem 2012;20:997–1007. DOI: 10.1590/s0104-11692012000500023.
  6. Sole ML, Bennett M, Ashworth S. Clinical indicators for endotracheal suctioning in adult patients receiving mechanical ventilation. Am J Crit Care 2015;24(4):318–324.
  7. Pedersen CM, Rosendahl-Nielsen M, Hjermind J, Egerod I. Endotracheal suctioning of the adult intubated patient-What is the evidence? Intensive Crit Care Nurs 2009;25:21–30. DOI: 10.1016/j.iccn.2008.05.004.
  8. Leddy R, Wilkinson JM. Endotracheal suctioning practices of nurses and respiratory therapists: How well do they align with clinical practice guidelines? Can J Respir Ther 2015;51(3):60–64. PMID: 26283870.
  9. Patak L, Gawlinski A, Fung NI, Doering L, Berg J. Patients’ reports of health care practitioner interventions that are related to communication during mechanical ventilation. Heart Lung 2004;33(5):308–320. DOI: 10.1016/j.hrtlng.2004.02.002.
  10. Ansari A, Alavi NM, Adib-Hajbagheri M, Afazel M. The gap between knowledge and practice in standard endo-tracheal suctioning of ICU nurses. Shahid Beheshti Hospital. J Crit Care Nurs 2012;5:71–76.
  11. Ntoumenopoulos G, Hammond N, Watts NR, Thompson K, Hanlon G, Paratz JD, et al. Secretion clearance strategies in Australian and New Zealand Intensive Care Units. Aust Crit Care 2018;31:191–196. DOI: 10.1016/j.aucc.2017.06.002.
  12. Heidari M, Shahbazi S. Nurses’ awareness about principles of airway suctioning. J Clin Diagnostic Res 2017;11:LC17–LC19. DOI: 10.7860/JCDR/2017/25550.10452.
  13. Chaseling W, Bayliss SL, Rose K, Armstrong L, Boyle MS, Caldwell J et al. Suctioning an adult ICU patient with an artificial airway: A clinical practice guideline 2014. Available from: http://handle.westernsydney.edu.au:8081/1959.7/uws:50103. Accessed on: 30 November 2023.
  14. Wilińska M, Zielińska M, Szreter T, Lesiuk W, Wilkowski J, Ziółkowski J, et al. Endotracheal suctioning in neonates and children. Med Wieku Rozwoj 2008;12(4 Pt 1):878–884. PMID: 19471061.
  15. Plevak D, Ward J. Airway Management. In: Burton G, Hodgkin J, editors. Respiratory Care: A Guideline to Clinical Practice. New York: Lippincott Williams & Wilkins; 1997. pp. 555–609.
  16. Pittet D, Allegranzi B, Boyce J, World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts. The World Health Organization guidelines on hand hygiene in health care and their consensus recommendations. Infect Control Hosp Epidemiol 2009;30(7):611–622. DOI: 10.1086/600379.
  17. 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(8): e0201743. DOI: 10.1371/journal.pone.0201743.
  18. Sanaie S, Rahnemayan S, Javan S, Shadvar K, Saghaleini S, Mahmoodpoor A. Comparison of closed vs open suction in prevention of ventilator-associated pneumonia: a systematic review and meta-analysis. Indian J Crit Care Med 2022;26(7):839–845. DOI: 10.5005/jp-journals-10071-24252.
  19. 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. DOI: 10.5005/jp-journals-10071-23326.
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