Table 3 Adherence of intensive care nurses’ practice to the ETS guidelines

Preparation before Endotracheal suctioning

Clinical indicators

1. I assessed the need for endotracheal suctioning as a routine part of the patient/ventilator system assessment

Yes^b

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)