Endotracheal suctioning related pain and its influencing factors in postoperative patients with mechanical ventilation / 中华护理杂志

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.

Comparative Study of Two Different Approaches for Managing of Mechanically Ventilated Extremely Preterm Newborns.

Aim: To compare between the effects of routine suctioning and positioning to that of chest physiotherapy on mechanically ventilated newborns. Study Design: Prospective, randomized controlled study. Place and Duration of Study: AL-jahra Hospital, Ministry of Health, Kuwait between January 2012 and April 2013. Methodology: Sixty extremely preterm neonates with respiratory distress syndrome were enrolled in the study. They were mechanically ventilated. Their ages ranged from 4-6 days. They were divided into two equal groups (control and study). The control group received medical treatment, routine suctioning and positioning while the study group received the same medical treatment given to the control group in addition to the selected chest physical therapy program. Arterial blood gases (PaO2, PaCO2, pH) and vital signs (HR, RR, SAP, DAP) were measured. Cranial ultrasound and chest x-ray were done to diagnose any cerebral injuries or rib fractures. All measurements were recorded at baseline measurement, 2 days and 7 days post inclusion in the study. Results: Significant improvement was recorded in arterial blood gases (PaO2, PaCO2, pH) and vital signs (HR, RR, SAP, DAP) for the study group after 2 and 7 days (P< 0.05). In addition to significant differences were observed between both groups in (PaO2, PaCO2, pH, HR, RR, SAP, DAP) in favor of the study one (P< 0.05). No adverse effects regarding to the incidence of rib fractures or cerebral injury were recorded in the study group. Conclusion: Chest physiotherapy is an excellent supplement to the line of treatment of extremely preterm neonates who are mechanically ventilated with respiratory distress syndrome.

Curative effect of nasal irrigation combined with backslapping for sputum suctioning on respiratory tract infections in infants / 现代临床护理

Objective To study the curative effect of nasal irrigation combined with backslapping for sputum suctioning on respiratory tract infections in infants . Methods Two hundred and forty-seven infants with respiratory tract infections were enrolled in the study and divided into the control group and the experiment group by the medical record number . On the basis of routine care , the experiment group was treated with nasal irrigation to clear secretions . Result The time for rales and cough disappearing in the experiment group was shorter than that in the control group , and the difference was statistically significant ( P<0 . 05 ) . Conclusions Nasal irrigation combined with backslapping for sputum suctioning can effectively ease the main symptoms and signs , enhance the ventilation function , enhance sleep quality and promote the rehabilitation of the disease .

Effects of two methods for deep endotracheal sputum suction / 现代临床护理

Objective To explore the effects of two methods for deep endotracheal suction.Methods Forty patients who had ineffective airway clearance or lung infections or refused suction were randomly divided into observation group (n=21) and control group (n=19).Temporay airway was established by using oropharyngeal airway.Then,the control group received subglottic suction after pading the shoulder with ordinary pillow (≤10cm),while the observation group received subglottic suction after pading the shoulder with homemade pillow (=15cm).The two groups were compared in terms of sputum suction effect and mucosal injury.Results There was no incidence of mucosal injury in the observation group but three in the control group.The times of suctioning in the observation group were fewer than those of the control group and the volume for suctioning was larger as well (allP<0.05).Conclusion Deep endotracheal suction through oropharyngeal airway,shoulder elevation for 15cm,temporary indwelling of suction tubes can achieve better suction effect without corresponding complications.

Perception of artificial airway suction from patients and nurses: a literature review / 中国实用护理杂志

Objective To study the perception of patients and nurses for the artificial airway suction,in order to provide theoretical reference for building the artificial airway suction clinical practice guidelines.Methods CNKI,Wanfang,VIP,Pubmed,Science direct databases were searched for papers of patients and/or nurses' perception over the limited period of 2005 to 2013.The retrieved papers were analyzed.Results Nineteen eligible papers were identified.Extract relevant contents found the majority of patients retained the memory of that airway suction,mainly for pain,choking,suffocation,and eager to get the relevant knowledge and information.There were few researches on nurses' subjective feeling about airway suction.Conclusion We should pay attention to the perception of patients,while strengthening the research on nurses' perception of artificial airway suction and improve communication with patients,in order to relieve their discomfort experience,and could be helpful for the building of airway suction clinical practice guidelines.

Effect of multimodality chest physiotherapy on the rate of recovery and prevention of complications in patients with mechanical ventilation: A prospective study in medical and surgical intensive care units.

Background: Mechanically ventilated patients have an increased risk of complications leading to ventilation weaning more difficult resulting in excessive morbidity and mortality. Chest physiotherapy plays an important role in management of ventilated patients. However, these techniques have been studied on patients as a single entity or with combination of two techniques. The present study was designed to evaluate the effect of multimodality chest physiotherapy on the rate of recovery and prevention of complications in adult ventilated patients. Materials and Methods: Out of 173 patients who were randomly allocated to two groups, 86 patients received MH and suctioning in control group and 87 patients were treated with multimodality chest physiotherapy in the study group twice daily till they were extubated. All patients were followed up for the global outcomes and complications during mechanical ventilation. Results: There were significant improvements in terms of rate of recovery in study group compared to the control group (P = 0.000). Complication rates were higher with 61.6% in the control group as compared to 26.4% in the study group. Duration of hospitalization was longer in the study group (16 ± 9.40 days) as compared to the control group (12.8 ± 6.12 days). Successful weaning from mechanical ventilation was noted in 58 patients in the study group and 24 patients in the control group which was statistically significant. Conclusions: Multi-modality chest physiotherapy protocol has shown to prevent ventilator-associated pneumonia and enhance the clinical outcome in ventilated patients and may be recommended as a treatment option in ICU. It has also shown to enhance the weaning process and proved to be safe.

The impact of suctioning RBCs from a simulated operative site on mechanical fragility and hemolysis

BACKGROUND: Intraoperative cell salvage exerts shear stress upon RBCs, particularly as they are suctioned from the surgical field. Shear stress can result in overt hemolysis or it can cause sublethal injury to the suctioned RBCs. The mechanical fragility (MF) test uses shear stress to measure the extent of RBC sublethal injury. RBCs that have sustained sublethal injury are more susceptible to shear stress induced hemolysis. In this study we suctioned whole blood samples from an artificial surgical field to determine if pre-menopausal female RBCs would demonstrate greater resistance to hemolysis and less sublethal injury compared to that of males and post-menopausal females. METHODS: Ten CPD-preserved whole blood units from these 3 donor groups were obtained and samples suctioned at -150 mmHg from a simulated surgical field. The MF test was then performed and the % hemolysis calculated. In addition the MF test was serially performed on these whole blood units during the 21 days of storage. RESULTS: There were no differences in the extent of hemolysis or RBC shear stress resistance after suctioning between the 3 donor groups. During storage the pre-menopausal female RBCs demonstrated higher shear stress tolerance compared to the males or post-menopausal females at all of the time points. CONCLUSION: Although during static storage pre-menopausal female RBCs in CPD-preserved whole blood demonstrated higher shear stress tolerance, this enhanced resistance was not observed after suctioning from a simulated surgical field.

Influence of lung suctioning method on mechanical ventilation related pulmonary infection of patients after cardiac valve replacement / 中国实用护理杂志

Objective To observe the effect of lung suctioning method on mechanical ventilation related pulmonary infection of patients after cardiac valve replacement. Methods 102 patients of mechanical ventilation related pulmonary infection after cardiac valve replacement were randomly divided into the treatment group( 50 patients )and the control group( 52 patients ). The treatment group received intervention of lung suctioning method and the control group adopted routine sputum aspiration. The pulmonary infection rate and blood gas analysis before and after the treatment were observed and the cure rate and the positive rate of specimen of sputum were recorded. Results The pulmonary infection rate of the treatment group was lower than the control group;PaO2 and SaO2 were obviously different after treatment in the control group, but no difference in the treatment group. The cure rate of pulmonary infection patients in the treatment group was higher than those in the control group. Conclusions The intervention of lung suctioning method was a safe and effective method to improve hypoxemia and abate the rate of pulmonary infection.

Concept Analysis of Endotracheal Suctioning(ETS) / 간호학회지

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.

Meta-Analysis on the Effectiveness of Interventions Applied to Preventing Endotracheal Suction-Induced Hypoxemia / 간호학회지

PURPOSE: This study was conducted to investigate the effects of the suction-induced hypoxemia interventions. METHOD: 30 suction-induced hypoxemia interventions were reviewed for the purpose of meta-analysis. RESULT: The study showed that both preoxygenation and insufflation were the most frequently examined oxygenation time periods, and hyperoxygenation combined with hyperinflation was the most commonly applied oxygenation method in order to prevent suction-induced hypoxemia. The greatest effect was obtained by providing oxygenation before and after suctioning, whereas negative effect(the contrary results from the study hypotheses) was frequently obtained by applying insufflation only. Applying hyperoxygenation combined with hyperinflation had the greatest effect over that of applying hyperoxygenation only, even though the difference between effect sizes of both methods were statistically significant. CONCLUSION: The results of meta-analysis showed that the occurrence rate of hypoxemia after suctioning was significantly reduced with the overall interventions for hypoxemia (decreasing 40% of occurrence rate), independent with time periods or methods for providing oxygenation.

Instillation of Normal Saline before Suctioning in Patients with Pneumonia

This study was conducted to investigate the effects of a no saline, a 2 ml and a 5 ml saline instillation prior to endotracheal suctioning on oxygen saturation in patients with pneumonia. The subjects in this study were 16 pneumonic patients with a tracheotomy tube, who had been admitted to the neuro-surgical intensive care unit at a university hospital in Seoul Korea. All three (0, 2 and 5 ml) saline instillation methods were applied to the 16 patients. The methods were randomly assigned to each patient. Each of the instillation methods was applied in a four-step sequence: 1) recording the level of oxygen saturation (baseline levels), 2) instilling normal saline, 3) supplying oxygen and suctioning, and 4) recording the level of oxygen saturation. The oxygen saturation was evaluated using pulse oximetry. The recovery times for oxygen saturation to return to baseline levels following suctioning were, just after suctioning, 45seconds after suctioning and in excess of 5 minutes with 0, 2 and 5 ml saline instillations, respectively. Instillation of normal saline before suctioning could have an adverse effect on oxygen saturation, and should be used carefully as a routine intervention in patients who have pneumonia.

National-Wide Survey on Endotracheal Suctioning in High-Risk Infants / 아동간호학회지

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.

The Effects of Chest Vibration Prior to Endotracheal Suctioning on Oxygenation and the Amount of Lung Secretions in Premature Infants with Respiratory Distress Syndrome / 간호학회지

No abstract available.

The Effects of Open Endotracheal Suctioning(ETS) and Close ETS on Oxygen Saturation and Heart Rate in Premature Infants with Respiratory Distress Syndrome / 간호학회지

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.

Effects of Intravenous Lidocaine on Intra-abdominal Pressure during Endotracheal Suctioning / 대한구급학회지

BACKGOUND: We evaluated the effect of intravenous lidocaine (1 mg/kg and 2 mg/kg) on intra-abdominal pressure (IAP) during endotracheal suctioning. METHODS: We studied 40 patients undergoing endotracheal intubation during mechanical ventilation. Group I (1 mg/kg) and group II (2 mg/kg)were given lidocaine double fashion. The endotracheal suctioning (ETS) was done 1, 3, 5 and 7 min after the injection of lidocaine. IAP, systolic blood pressure (SBP), diastolic blood preassure (DBP), and heart rate (HR) during ETS were recorded, IAP was measured using a transurethral bladder catheters. The cough response to ETS was classified as " cough score". RESULTS: Before administration of lidocaine, ETS produced significant increase in SBP, DBP, IAP and HR compared with baseline values in the two groups (p<0.05). Both groups showed no significant changes in SBP, DBP, and HR during the study. In group I, ETS produced a significant increase in IAP 5 and 7min after lidocaine treatment (p<0.05). There were significant differences between the two groups 5 and 7 min after lidocaine treatment (p<0.05). The score of cough decreased significantly in both groups 3 min after lidocaine treatment but there was a significant difference between the two groups at 7 min. CONCLUSIONS: We concluded that lidocaine pretreatment significantly blunted the increase in IAP, SBP DBP and HR caused by ETS and this effect lasts for 3 min in group I and 7 min in group II.

Prevention of Arterial Oxygen Desaturation during Endotracheal Suction / 대한마취과학회지

The purpose of this study was to determine the frequency and severity of arterial oxygen desaturation during and after endotracheal suctioning in a group of ventilator-dependent patients and to evaluate the efficacy of several maneuvers designed to minimize desaturation. All patients were ventilated with volume-typed ventilator and a synchronized intermittent mandatory ventilation(SIMV) mode was utilized. In a given patint, each study consisted of four seperate passes of the suction catheter. The oxygen status of the patient was monitored with a digital pulse oxymeter. The mean baseline SaO2 for the group with each suctioning technique was very similar and did not differ significantly. When patints were suctioned off the ventilator without extra breaths, a significant drop occurred in the mean SaO2 And when the patients were suctioned with prebreaths and postbreaths off the ventilator or were maintained on the ventilator and suctioned through the swivel adaptor, there was a significant desaturation with all three methods. However, the mean desaturation of 0.8 percent with the swivel adaptor was significantly less(p<0.05) than the mean desaturation with any of the other three methods.