The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

Endotracheal Suction and Normal Saline Instillation Scope of Practice in a Pediatric ICU: Results of a Multidisciplinary Survey.

Ruben D Restrepo MD RRT, Joel C Davis RRT NPS, David C Heitz BA RRT NPS, Clay H Corley RRT, Atul Vats MD FAAP. Children’s Healthcare of Atlanta at Egleston, Atlanta, Georgia



Background:
Endotracheal suction (ETS) is one of the most common procedures carried out in the intensive care units. ETS is used to clear the airway of secretions that accumulate around the end of the endotracheal tube (ETT). The existent scientific evidence does not support normal saline instillation (NSI) before ETS as being beneficial to improve secretion removal on the intubated patient; however, it is a widespread practice in critical care units. Although ETS and NSI are commonly considered routine procedures by respiratory therapists (RT) and nurses (RN), the determination of its indications and procedural steps vary considerably.

Purpose:
The primary goal of this study was to gain a better understanding of the current practice on ETS and NSI in the PICU and to determine variation in the procedure between RTs and RNs.

Setting:
A 21-bed PICU at a university affiliated children’s hospital.

Design:
Non-random sample survey.

Population and Sample:
The population consisted of 90 PICU RTs (n=20) and RNs (n=70).

Instrument:
The survey was a practice-based written questionnaire that consisted of 12 items. These items were selected to evaluate variables researched on previous studies on ETS and NSI.

Data Analysis:
Frequency distributions of responses to multiple choice items were compiled. Ratings and percentages were calculated for nominal data.

Results:
A total of 54 questionnaires were returned, for a response rate of 60%. Fifteen RTs (28%) and 39 RNs (72%) participated in the study. The top 5 indications for ETS chosen by RTs and RNs were all based on patient assessment. An average of 43% of the RNs and 9% of the RTs reported no knowledge of the recommended suction pressure. While 73% of clinicians reported use of the “shallow” suction technique (pre-measured), 21% of the RNs surveyed reported inserting the suction catheter until resistance was met. Thirty percent of the participants who confirmed routine NSI before ETS reported that the main indication for the use of saline was in order to break tenacious secretions.

Discussion and Conclusions:
Our study indicates there are differences in knowledge and practice among clinicians regarding certain aspects of ETS and NSI in the PICU. Our findings are consistent with the results reported on similar national surveys. A teaching intervention may be necessary to improve knowledge and standardize the procedure of ETS and NSI.

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