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Endotracheal suctioning practices of nurses and respiratory therapists: How well do they align with clinical practice guidelines?

Leddy R, Wilkinson JM - Can J Respir Ther (2015)

Bottom Line: Previous studies have shown a wide variation in suctioning practices, and although current evidence does not support the routine practice of normal saline instillation (NSI), anecdotally, this is believed to be a common practice.A significant number of participants from both the RN and RRT groups were unaware of the existence of suctioning and/or NSI protocols in the ICU.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Therapy, The Mississauga Hospital, Mississauga, Ontario.

ABSTRACT

Background: A common procedure within intensive care units (ICUs) is the suctioning of respiratory secretions in patients who have been intubated or who have undergone tracheostomy. Previous studies have shown a wide variation in suctioning practices, and although current evidence does not support the routine practice of normal saline instillation (NSI), anecdotally, this is believed to be a common practice.

Objective: To examine the suctioning practices of registered nurses (RNs) and registered respiratory therapists (RRTs) in six hospital ICUs in Ontario, with special attention devoted to the use of NSI.

Methods: A 24-question, self-administered survey was distributed to 180 participants (90 RNs and 90 RRTs) working in the ICU of six hospitals in Ontario. The survey addressed individual suctioning practices within the ICU.

Results: The survey response rate was 96%. There were many similarities between the RRT and RN groups, with both reporting high use of NSI. Both groups observed side effects following NSI with suctioning including decreased oxygen saturation, patient agitation and increased volume of secretions. A significant number of participants from both the RN and RRT groups were unaware of the existence of suctioning and/or NSI protocols in the ICU. Some respondents reported that they routinely suctioned mechanically ventilated patients rather than as required.

Conclusion: RNs and RRTs continue to practice NSI despite evidence-based practice guidelines suggesting that this therapy may be detrimental to patients. Increased awareness of best practices with respect to endotracheal tube suction generally, and NSI specifically, should be the focus of professional education in both groups of ICU staff.

No MeSH data available.


Related in: MedlinePlus

The frequency of registered respiratory therapists (RRTs [n=87]) and registered nurses (RNs [n=83]) response to the question “Have you observed any of the following effects following NSI?”. NSI Normal saline instillation
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f2-cjrt-51-60: The frequency of registered respiratory therapists (RRTs [n=87]) and registered nurses (RNs [n=83]) response to the question “Have you observed any of the following effects following NSI?”. NSI Normal saline instillation

Mentions: Those who responded that they use NSI were asked further questions about instillation practices (how the normal saline was prepared, why instillation was used, what effects they noted following instillation and what influenced suctioning practices). The majority (97.5% of RRTs, 96.4% of RNs) of respondents used sterile nebulae to prepare the normal saline. The remaining (3.6%) RNs used a pre-drawn syringe although the RRTs drew the syringe themselves (2.5%). The volume of saline used was similar between groups, with most using 1 mL to 2 mL (RRT 50.0%; RN 41%), or 3 mL to 5 mL (RRT 46.2%; RN 51.8%); the remaining respondents used >5 mL. Most respondents suctioned the airways immediately following the NSI (RRT 79.2%; RN 67.1%). The remainder waited up to 1 min (RRT 16.9%; RN 30.5%) or 1 min to 2 min (RRT 3.9%; RN 2.4%). Respondents were also asked why they used NSI before suctioning (Figure 1) and whether they had observed any effects following NSI (Figure 2). Most respondents had multiple reasons for using NSI and all had observed ≥1 adverse effect(s) on patient(s) following NSI. The only statistically significant differences between the two groups were in relation to the use of NSI to thin secretions (RRT 10.3% versus RN 1.2%; P=0.018) and that NSI increased the volume of secretions (RRT 29.6% versus RN 8.9%; P=0.001).


Endotracheal suctioning practices of nurses and respiratory therapists: How well do they align with clinical practice guidelines?

Leddy R, Wilkinson JM - Can J Respir Ther (2015)

The frequency of registered respiratory therapists (RRTs [n=87]) and registered nurses (RNs [n=83]) response to the question “Have you observed any of the following effects following NSI?”. NSI Normal saline instillation
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4530836&req=5

f2-cjrt-51-60: The frequency of registered respiratory therapists (RRTs [n=87]) and registered nurses (RNs [n=83]) response to the question “Have you observed any of the following effects following NSI?”. NSI Normal saline instillation
Mentions: Those who responded that they use NSI were asked further questions about instillation practices (how the normal saline was prepared, why instillation was used, what effects they noted following instillation and what influenced suctioning practices). The majority (97.5% of RRTs, 96.4% of RNs) of respondents used sterile nebulae to prepare the normal saline. The remaining (3.6%) RNs used a pre-drawn syringe although the RRTs drew the syringe themselves (2.5%). The volume of saline used was similar between groups, with most using 1 mL to 2 mL (RRT 50.0%; RN 41%), or 3 mL to 5 mL (RRT 46.2%; RN 51.8%); the remaining respondents used >5 mL. Most respondents suctioned the airways immediately following the NSI (RRT 79.2%; RN 67.1%). The remainder waited up to 1 min (RRT 16.9%; RN 30.5%) or 1 min to 2 min (RRT 3.9%; RN 2.4%). Respondents were also asked why they used NSI before suctioning (Figure 1) and whether they had observed any effects following NSI (Figure 2). Most respondents had multiple reasons for using NSI and all had observed ≥1 adverse effect(s) on patient(s) following NSI. The only statistically significant differences between the two groups were in relation to the use of NSI to thin secretions (RRT 10.3% versus RN 1.2%; P=0.018) and that NSI increased the volume of secretions (RRT 29.6% versus RN 8.9%; P=0.001).

Bottom Line: Previous studies have shown a wide variation in suctioning practices, and although current evidence does not support the routine practice of normal saline instillation (NSI), anecdotally, this is believed to be a common practice.A significant number of participants from both the RN and RRT groups were unaware of the existence of suctioning and/or NSI protocols in the ICU.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Therapy, The Mississauga Hospital, Mississauga, Ontario.

ABSTRACT

Background: A common procedure within intensive care units (ICUs) is the suctioning of respiratory secretions in patients who have been intubated or who have undergone tracheostomy. Previous studies have shown a wide variation in suctioning practices, and although current evidence does not support the routine practice of normal saline instillation (NSI), anecdotally, this is believed to be a common practice.

Objective: To examine the suctioning practices of registered nurses (RNs) and registered respiratory therapists (RRTs) in six hospital ICUs in Ontario, with special attention devoted to the use of NSI.

Methods: A 24-question, self-administered survey was distributed to 180 participants (90 RNs and 90 RRTs) working in the ICU of six hospitals in Ontario. The survey addressed individual suctioning practices within the ICU.

Results: The survey response rate was 96%. There were many similarities between the RRT and RN groups, with both reporting high use of NSI. Both groups observed side effects following NSI with suctioning including decreased oxygen saturation, patient agitation and increased volume of secretions. A significant number of participants from both the RN and RRT groups were unaware of the existence of suctioning and/or NSI protocols in the ICU. Some respondents reported that they routinely suctioned mechanically ventilated patients rather than as required.

Conclusion: RNs and RRTs continue to practice NSI despite evidence-based practice guidelines suggesting that this therapy may be detrimental to patients. Increased awareness of best practices with respect to endotracheal tube suction generally, and NSI specifically, should be the focus of professional education in both groups of ICU staff.

No MeSH data available.


Related in: MedlinePlus