The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts

THE ASSOCIATIONBETWEEN NASOPHARYNGEAL SUCTION AND OXYGEN REQUIREMENT IN BRONCHIOLITIS PATIENTS.

Tami Zemlicka-DunnRRT, BS, Julie Ballard, RRT, BS, Quality Care Assessment Team (QCAT) members;John Salyer, RRT, MBA, FAARC. Respiratory Care Service, Primary Children?s MedicalCenter, School of Medicine, University of Utah.

Introduction:We have long believed that nasopharyngeal (NP) suctioning of the hypopharynxwith a catheter is an important part of the care of pediatric bronchiolitispatients. Indeed this has been our standard of care since 1997. However, manyothers use bulb suction or similar non-invasive techniques. We sought to determineif we could quantify the effect of NP suctioning on the ability to wean thesepatients. Our QCAT members regularly assess patients with bronchiolitis. Ourstandard of care during assessments includes initially weaning oxygen of patientsif possible based on pulse oximetry. Patients are then suctioned if necessaryand weaned if possible.

Methods: Datawere gathered using retrospective chart review for the period from Oct 2000to Apr 2001. Inclusion criteria were 1)diagnosis of bronchiolitis, 2) <24 months of age, 3) non-ICU admission, 4) documentation of floor suctioningwhile receiving oxygen. Data included whether suctioning episodes were the 1st,2nd or 3rd since being admitted to the floor for eachpatient, and whether or not suctioning resulted in weaning of the oxygen. Ourstandard of care is to wean patients at pulse oximetry levels > 88%.

Results: 421patients met the inclusion criteria, of which there were a total of 1,141 1st,2nd or 3rd suctioning interventions. During the study period we had no formalor informal reports of suctioning related morbidities.

Discussion:It is clear that even after traditional weaning by pulse oximeter, that NP suctioningin about 1/4 of these patients results in further weaning, even during subsequentsuctioning events. NP suctioning clearly has a positive effect on the need foroxygen. Some consider NP suctioning controversial in this population. We havebeen told it is ?too traumatic?, and ?not effective?. Our findings suggest thatit is effective, and our experience indicates that it is safe. We recommendthe use of NP suctioning in the care of bronchiolitis patients.

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