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.