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Table 3 Adherence of intensive care nurses’ practice to 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 = 16) Variables Adherence
No. of nurses rate yes/no (%)
Preparation before Endotracheal suctioning Clinical indicators 1. I assessed the need for endotracheal suctioning as a routine part of the patient/ventilator system assessment Yesb 187 (66.5)
No 94 (33.5)
Patient communication 2. I encouraged patients to cough up their own secretions if they are able to Yes 192 (68.3)
No 89 (31.7)
Catheter size 3. I used the suction catheter occlude less than half of the internal diameter of the artificial airway Yes 167 (59.4)
No 114 (40.6)
The procedure of Endotracheal suctioning Suction Approach 4. I used a closed suction system suggested for adults with high FIO2, or PEEP, or at risk for acute lung injury Yes 156 (55.5)
No 125 (44.5)
Aseptic Technique 5. I washed my hands before and after suctioning and wore gloves during suctioning Yes 190 (67.6)
No 91 (32.4)
Humidification 6. I did not perform normal saline instillation routinely before endotracheal suction Yes 141 (50.2)
No 140 (49.8)
Insertion Depth 7. I inserted the suction catheter to the carina and then retracted 1–2 cm before suctioning or measured an identical endotracheal tube to estimate the length of the suction catheter. Yes 158 (56.2)
No 123 (43.8)
8. I performed deep suctioning for patients with large amounts of secretions in the lower airways Yes 180 (64.1)
No 101 (35.9)
Suction Pressure 9. I used 80-120mmHg suction pressure during endotracheal suctioning Yes 145 (51.6)
No 136 (48.4)
Time Length of Suction Procedure 10. I performed each suctioning procedure less than 15 s Yes 191 (68.0)
No 90 (32.0)
Frequency of Suction Procedure 11. I performed less than three consecutive suction procedures each time Yes 175 (62.3)
No 106 (37.7)
Suction Intervals 12. I performed suctioning for each patient at least every 8-hour Yes 146 (52.0)
No 135 (48.0)
Pre-oxygenation 13. I performed pre-oxygenation by delivering 100 % oxygen for at least 30 s prior to and after the suctioning procedure. Yes 184 (65.5)
No 97 (34.5)
Ventilation 14. I used a ventilator instead of a manual resuscitation bag to provide hyperventilation/hyperoxygenation prior to suctioning to reduce hemodynamic alterations Yes 143 (50.9)
No 138 (49.1)
15. I performed suctioning through an adaptor to preserve oxygenation in mechanically ventilated patients Yes 155 (55.2)
No 126 (44.8)
Evaluation after Endotracheal suctioning Monitoring 16. I monitored the following 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 171 (60.8)
No 110 (39.2)
  1. aAll items (n = 16) are recommended practices by the guideline [21]
  2. b‘Yes’ indicated participants’ practice adherence to the recommendations