Table 2 Intensive care nurses’ awareness of the ETS guidelines
Practices prior to, during, and post ETS event | Itemsa (n = 26) | Variables | Awareness No. of nurses rate yes/no (%) | |
|---|---|---|---|---|
Preparation before Endotracheal suctioning | Clinical indicators | 1. Suctioning should only be done when a thorough assessment of the patient establishes the need for such a procedure and not be dictated by routine | Yesb | 191 (68.0) |
No | 90 (32.0) | |||
Patient communication | 2. If patients are able to cough up their own secretions, they should be encouraged to do so | Yes | 192 (68.3) | |
No | 89 (31.7) | |||
Catheter size | 3. Suction catheters should be as small as possible, yet large enough to facilitate secretion removal | Yes | 125 (44.5) | |
No | 156 (55.5) | |||
4. The size of the suction catheter should occlude no more than half of the internal diameter of the artificial airway to avoid greater negative pressures in the airway and to potentially minimize falls in PaO2 | Yes | 175 (62.3) | ||
No | 106 (37.7) | |||
Knowledge and Skills | 5. I possess required procedural skill and gentleness when suctioning because of the potential associated hazards | Yes | 193 (68.7) | |
No | 88 (31.3) | |||
The procedure of Endotracheal suctioning | Suction Approach | 6. The use of a closed suction system is suggested for adults with high FIO2 or PEEP, or at risk for acute lung injury | Yes | 170 (60.5) |
No | 111 (39.5) | |||
7. The closed or open suction system is not superior to the other in terms of oxygen saturation, cardiovascular instability, secretion removal, environmental contamination, and cost | Yes | 95 (33.8) | ||
No | 186 (66.2) | |||
Aseptic Technique | 8. Aseptic technique should be considered an essential component of the suctioning procedure for hospitalized patients with artificial airways, including handwashing and use of gloves because endotracheal suctioning is an invasive procedure that may lead to contamination of the lower airways | Yes | 192 (68.3) | |
No | 89 (31.7) | |||
Humidification | 9. Routine use of normal saline instillation prior to endotracheal suction should not be performed | Yes | 164 (58.4) | |
No | 117 (41.6) | |||
10. Ensuring patients are adequately hydrated is the way health care providers can facilitate the removal of respiratory secretions | Yes | 189 (67.3) | ||
No | 92 (32.7) | |||
Insertion Depth | 11. The suction catheter should be inserted to the carina and then retracted 1–2 cm before suctioning is performed, or the length of the suction catheter is estimated by measuring an identical endotracheal tube | Yes | 169 (60.1) | |
No | 112 (39.9) | |||
12. Deep suctioning is necessary for patients with large amounts of secretions in the lower airways | Yes | 186 (66.2) | ||
No | 95 (33.8) | |||
Suction Pressure | 13. Using the lowest possible suction pressure during endotracheal suctioning, usually 80–120 mmHg | Yes | 152 (54.1) | |
No | 129 (45.9) | |||
Time Length of Suction Procedure | 14. The suctioning procedure should last no longer than 15 s | Yes | 193 (68.7) | |
No | 88 (31.3) | |||
Frequency of Suction Procedure | 15. There should not be more than two consecutive suction procedures | Yes | 171 (60.9) | |
No | 110 (39.1) | |||
Suction Intervals | 16. Perform suctioning at least every 8-hour to reduce the risk of partial occlusion of the endotracheal tube and the accumulation of secretions | Yes | 139 (49.5) | |
No | 142 (50.5) | |||
Hyperinflation | 17. Using volumes of hyperinflation that is indexed to the size of the patient may assist in minimizing potential difficulties | Yes | 160 (56.9) | |
No | 121 (43.1) | |||
18. Tidal volumes should no more than 900 cc during hyperinflation because patients may feel dyspneic | Yes | 124 (44.1) | ||
No | 157 (55.9) | |||
19. If hyperinflation is used in the patients before suctioning, caution should be employed because it may be associated with increases in mean arterial blood pressure | Yes | 138 (49.1) | ||
No | 143 (50.9) | |||
Pre-oxygenation | 20. Pre-oxygenation by the delivery of 100 % oxygen for at least 30 s prior to and after the suctioning procedure is recommended to prevent a decrease in oxygen saturation, especially when the patient has a clinically important reduction in oxygen saturation with suctioning | Yes | 188 (66.9) | |
No | 93 (33.1) | |||
21. Combining hyperoxygenation and hyperinflation prior to suctioning can minimize suctioning-induced hypoxemia | Yes | 143 (50.9) | ||
No | 138 (49.1) | |||
Ventilation | 22. A ventilator should be used rather than a manual resuscitation bag to provide hyperventilation/hyperoxygenation prior to suctioning to reduce hemodynamic alterations | Yes | 151 (53.7) | |
No | 130 (46.3) | |||
23. Suctioning through an adaptor is preferred to preserve oxygenation in mechanically ventilated patients | Yes | 164 (58.4) | ||
No | 117 (41.6) | |||
24. A washout time of up to two minutes can be required when hyperoxygenation is being delivered via some ventilators to allow time for the increased oxygen percentage to come through the ventilator tubing and reach the patient | Yes | 183 (65.1) | ||
No | 98 (34.9) | |||
Evaluation after Endotracheal suctioning | Monitoring | 25. The following should be monitored prior to, during, and after the procedure, if indicated and available: breath sounds, oxygen saturation, respiratory rate and pattern, hemodynamic parameters, sputum characteristics, cough characteristics, intracranial pressure, and ventilator parameters | Yes | 187 (66.5) |
No | 94 (33.5) | |||
Adverse Effects | 26. Endotracheal suctioning, unless managed appropriately, can lead to various adverse events (tracheal trauma, hypoxemia, hypertension, cardiac arrhythmias, and raised intracranial pressure) and increase mortality and morbidity rates | Yes | 186 (66.2) | |
No | 95 (33.8) | |||