ABSTRACT
Objective To describe the status of endotracheal suctioning related pain in mechanically ventilated patients and its change in their first 24 hours staying in ICU after surgery,and to explore the influencing factors.Methods A total of 101 patients were enrolled in this study.Patients' endotracheal suctioning related pain was assessed with Chinese version of Behavioral Pain Scale(C-BPS) and Richmond Agitation-Sedation Scale(RASS).Each patient was assessed 6 times:5 min before suctioning,during suctioning,5 min,10 min,15 min,20 min after suctioning.Results The practice of endotracheal suctioning could obviously increase patients' pain intensity.The medium score of pain intensity during endotracheal suctioning was 8.The highest score of pain intensity was 12.There were 100 patients(99.0％) with pain.There were 94 patients(93.1％) with significant pain.At 5 min after endotracheal suctioning,the pain intensity score returned to the level of that in 5 min before endotracheal suctioning.Multiple regression demonstrated that patients with lower levels of sedation,more drainage tubes,history of previous surgery,had lower pain scores.Conclusion Endotracheal suctioning can significantly increase patients' pain intensity.RASS score,the number of drainage tubes and the history of previous surgery can affect patients' pain intensity score.
ABSTRACT
PURPOSE: Concept analysis was performed on the behavioral concept of endotracheal suctioning (ETS), to identify the goal, to develop astandardized clinical protocol, to identify the antecedents and consequences, and to differentiate the improper use of ETS. METHOD: Walker & Avant's concept analysis was employed using clinical guidelines, books and review articles in which the procedures of ETS were written in detail and published in Pubmed within the last 20 years. RESULT: The macro-goal of ETS was to remove accumulated respiratory secretions. Three defining attributes of ETS were identified; catheter, suctioning and asepsis. Each attribute involved empirical referents, such as the size and depth of thecatheter, the suction pressure, duration and method for suctioning. The antecedents of ETS were identical to the clinical evidences for the need of ETS such as the nursing assessment data. The consequences of ETS serve as an evaluation criteria on the effectsof ETS based on the goal of ETS. CONCLUSION: The concept analysis of ETS demonstrates an example of considering a specific nursing protocol of ETS as a behavioral concept, applying concept analysis to it to identify it's key behavioral components as defining attributes and empirical referents and then developing and applying the standard ETS protocol.
Subject(s)
Humans , Intubation, IntratrachealABSTRACT
The goal of respiratory management in high risk infants is to maintain proper oxygenation by supporting respiration, therefore to minimize the secondary complications and to promote the maximum growth and development. While on artificial ventilator to achieve this goal, the infants require endotracheal suctioning(ETS) to remove lung secretions. however, the negative effects of ETS in neoates have been documented and include hypoxia, bradycardia, mucosal damage, increased intracranial pressure, and death result. The purpose of the study was to investigate how ETS is currently performed in NICU, which would be beneficial to develop the standardized ETS protocol and to apply it to these population. A national-wide survey on clinical protocol of ETS was performed to 149 neonatal nurses with the average of 3 years and 6 months experience in neonatal nursing, 34.2% of whom was bachelor in nursing. The results showed that about 89% of the nurses initiate ETS primarily based on the need of the subjects. The aseptic regulation on ETS was used in 83.9% of the subjects. There was no regulation on the length of catheter in 32.9% and on ID/OD ratio in 17.4%. Many nurses administered hyperoygenation/hyperinflation/hyperventilation based on personal knowhow, rather than scientific rationals(77.2%, 40.9%, 75.2%, retrospectively). About 41% of the nurse regulate subjectively the suction power, while 73.8% of them rotate the subject's head during suctioning and the half of the nurses was favorable in adapting the closed-suctioning protocol. With the findings of the study, the current clinical application of ETS in neonates appears to be based on adult care practices, or personal preference, rather than scientific validation of the safety and effectiveness of the procedure. This study support the needs for developing and applying the standardized ETS protocolin conjunction with the consideration given to the physiologic characteristics of the neonates in respiratory distress.
Subject(s)
Adult , Humans , Infant , Infant, Newborn , Hypoxia , Bradycardia , Catheters , Clinical Protocols , Growth and Development , Head , Intracranial Pressure , Lung , Neonatal Nursing , Nursing , Oxygen , Respiration , Suction , Ventilators, Mechanical , Child HealthABSTRACT
No abstract available.
Subject(s)
Humans , Infant, Newborn , Infant, Premature , Lung , Oxygen , Suction , Thorax , VibrationABSTRACT
Prematurity is the main cause for respiratory distress syndrome(RDS) in neonates. The goal in the treatment of RDS is to maintain respiration with adequate oxygenation. ETS needs to be performed to remove lung secretions in the ventilated premature infants with RDS. Oxygen saturation(SpO2) and heart rate(HR) were compared in 22 premature infants with RDS using two types of ETS: open ETS versus close ETS. The results showed there was no significant difference in the SpO2 and HR returned to the baseline within 1 minute after suctioning. But in some case, there was a significantly greater incidence in the decrease of SpO2 below 90% occurred in the open ETS than in the close ETS. It implies that closed ETS may be beneficial to premature infants who tend to develop desaturation easily.