SUCTIONING THERAPY IN CRITICALLY ILL PATIENTS

Suctioning Therapy in Critically Ill Patients

(Name of the writer)

(Name of the institution)

Abstract

The purpose of this secondary data analysis of findings from a larger procedural pain study was to examine several factors related to pain during tracheal suctioning. In addition to tracheal suctioning, other procedures studied included turning, wound drain removal, femoral catheter removal, placement of a central venous catheter, and wound dressing change. A total of 755 patients underwent the tracheal suctioning procedure that was performed primarily in intensive care units (93%). A 0-10 numeric rating scale, a behavioural observation tool, and a modified McGill Pain Questionnaire-Short Form were used for pain assessment. Pain intensity scores were significantly greater during the tracheal suctioning procedure (M = 3.96, S.D. = 3.3) than prior to (M = 2.14, S.D. = 2.8) or after (M = 1.98, S.D. = 2.7) tracheal suctioning. Few patients received analgesics prior to or during the procedure. Surgical, younger, and non-white patients reported higher pain intensities. Although mean pain intensity during tracheal suctioning was mild, almost the half of the patients reported moderate-to-severe pain. Individualized pain management must be performed by healthcare providers in order to respond to patients' needs as they undergo painful procedures such as tracheal suctioning. the aims of this secondary analysis were to describe and compare patients' pain perception and responses across different phases of the tracheal suctioning procedure; examine relationships between patients' pain perceptions and responses to tracheal suctioning and the following factors: patient's age, diagnosis, gender, ethnicity, pre- and during-procedure analgesic and sedative use; and relate physiological data and analgesic use to tracheal suctioning pain. This paper reviews the literature relating to suctioning to identify current research recommendations for safer suctioning practice. Although there have been a number of publications relating to suctioning in recent years, few authors have examined what happens in actual practice. This paper identifies the potential pitfalls in practice and makes recommendations for future research into nurses' suctioning practices.

Table of Contents

Abstractii

Background of the Research1

Rationale for Selection of Area of Nursing Practice1

Aim of the Research2

Methodology2

Limitations3

SEARCH STRATEGY4

CHAPTER 02: LITERATURE REVIEW5

Review of the literature5

Prior to suctioning5

Assessment5

Patient preparation6

Hyperoxygenation7

Hyperinflation9

Instillation of normal saline11

Maintenance of asepsis13

During suctioning14

Catheter selection14

Depth of insertion15

Negative pressure15

Duration of procedure17

Number of passes17

Post-suctioning17

ETT Suctioning: How Does It Really Work?20

Instillation of Saline21

Frequency—How Often?22

The Role of Preoxygenation24

Insertion Depth: Is There Still Debate?25

Closed vs. Open ETT Techniques27

Hyperoxygenation28

Hyperinflation30

CHAPTER 03: METHODOLOGY33

Design & Methods33

Sample and settings36

Instruments37

Procedure37

CHAPTER 04: DISCUSSION39

Sample39

Tracheal suctioning pain39

Pain intensity39

Pain quality42

Pharmacologic interventions44

Discussion45

CHAPTER 05: CONCLUSION48

RECOMMENDATIONS51

IMPLICATION52

REFERENCES54

CHAPTER 01: INTRODUCTION

Background of the Research

Suctioning is described as the mechanical aspiration of pulmonary secretions from a patient with an artificial airway in position. In a healthy patient, the action of ciliated cells in the airways, the local immune system, and the cough reflex are essential for the destruction and removal of micro-organisms as well as clearing debris from the lungs. However, in the critically or acutely ill patient, these functions may be severely compromised, resulting in an excessive production of secretions, which may prove difficult to expectorate. Endotracheal and tracheostomy tubes form artificial airways, which bypass the normal physiological processes and inhibit the cough reflex. This leaves the respiratory tract vulnerable to ...