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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 percentage of registered respiratory therapists (RRTs [n=87]) and registered nurses (RNs [n=83]) response to the question “What do you feel influences your practice the most?”
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f3-cjrt-51-60: The percentage of registered respiratory therapists (RRTs [n=87]) and registered nurses (RNs [n=83]) response to the question “What do you feel influences your practice the most?”

Mentions: The greatest influence on both RNs’ and RRTs’ practice was reported to be EBP guidelines followed by initial training and continuing education (Figure 3). There was no statistically significant difference between the two groups in this area (P=0.220). When asked whether they had attended any training or workshops that discussed suctioning of mechanically ventilated patients, most reported ‘no’ (45.3% overall; RRT 34.5% versus RN 56.6%; P=0.005) followed by ‘yes, but it was more than a year ago’ (RRT 32.25 versus RN 16.9%; P=0.022). Approximately 16% overall (RRT 19.5% versus RN 13.3%; P=0.306) reported they had attended training in the past 12 months, where suction was discussed and the remainder could not recall whether it was discussed (RN 13% versus RRT 14%).


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 percentage of registered respiratory therapists (RRTs [n=87]) and registered nurses (RNs [n=83]) response to the question “What do you feel influences your practice the most?”
© Copyright Policy
Related In: Results  -  Collection

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

f3-cjrt-51-60: The percentage of registered respiratory therapists (RRTs [n=87]) and registered nurses (RNs [n=83]) response to the question “What do you feel influences your practice the most?”
Mentions: The greatest influence on both RNs’ and RRTs’ practice was reported to be EBP guidelines followed by initial training and continuing education (Figure 3). There was no statistically significant difference between the two groups in this area (P=0.220). When asked whether they had attended any training or workshops that discussed suctioning of mechanically ventilated patients, most reported ‘no’ (45.3% overall; RRT 34.5% versus RN 56.6%; P=0.005) followed by ‘yes, but it was more than a year ago’ (RRT 32.25 versus RN 16.9%; P=0.022). Approximately 16% overall (RRT 19.5% versus RN 13.3%; P=0.306) reported they had attended training in the past 12 months, where suction was discussed and the remainder could not recall whether it was discussed (RN 13% versus RRT 14%).

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