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Table 2 Intensive care nurses’ awareness of the ETS guidelines

From: Intensive care nurses’ knowledge and practice of evidence-based recommendations for endotracheal suctioning: a multisite cross-sectional study in Changsha, China

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)
  1. aAll items (n = 26) are guideline recommendations [21]
  2. b‘Yes’ indicated participants were aware of the recommendation