The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

Development of Clinical Criteria to Assess the Indications for Performing Endo-tracheal Suctioning

Angela Lutz, RRT-NPS, Kenneth Miller, RRT-NPS, Linda Cornman, RRT-NPS,
Daniel Ray, MD, Kenton Clay, RRT, Steven Pyne, RRT, Joseph Groller, RRT,
Nancy Ayers, RRT-NPS, AC-E. Lehigh Valley Hospital, Allentown, PA 18105.

Introduction: Performing endo-tracheal suctioning can be very therapeutic and improve gas exchange. However, often endo-tracheal suctioning is performed as a part of routine airway care without much regard to assessment. Endo-tracheal suctioning can cause adverse clinical events leading to cardiac instability. Also, airway trauma can occur even under the best technique or healthy airway tissue with repeated passages. Often the frequency and outcome of suctioning is poorly documented or evaluated. To address this issue, we developed clinical assessment criteria for performing endo-tracheal suctioning and to ensure proper documentation of the outcome of
the procedure.

Methods: Over a one year period we reviewed our current suctioning practices and reviewed the literature for current recommendations and practices. We found that in our own practice endo-tracheal suctioning was based more on routine practice than clinical assessment. Literature findings contain a dearth of information on clinical assessment and dealt more with technique and adverse effects than outcomes. Secondary to our findings we developed clinical criteria based on assessment on when to perform endo-tracheal suctioning and how to document clinical outcome.

Results: Endo-tracheal suctioning was to be based on the following:

  1. Evidence of impaired gas exchange noted by decrease in Sp02 and/or elevation in ETCO2 with an obstructive waveform.
  2. Ventilator waveform analysis noted by a saw-tooth pattern on the expiratory phase of the time/flow curve.
  3. Increase in RAW or decrease in compliance noted by increase in PIP and Plateau pressure.
  4. Reduction of exhaled tidal volume during pressure ventilation including: APRV, PCV, PSV.
  5. Evidence of increase work of breathing noted by increase in respiratory rate, accessory muscle use, P01>4 and reduction in exhaled tidal volume.
  6. Patient diagnosis of: Pneumonia, inhalation, pulmonary edema.
  7. Perform suctioning assessment every eight(8) hours if ventilated via High Frequency Percussive Ventilation.H. Secretions are visible or audible in the artificial airway.A thirty three percent reduction in routine suctioning was noted and a ninety percent compliance with documentation of assessment and outcome was achieved.

Based on our clinical experience, developing sound assessment-based clinical criteria for performing any intervention is essential to provide optimal airway care. Future ventures will include teaching all of the clinical team to utilize our assessment-based criteria when considering performing endo-tracheal suctioning.
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