Endotracheal suctioning of the adult intubated patient-What is the evidence?

Intensive and Critical Care Nursing

Volumn 25, Issue 1, 2009, Pages 21-30

  Pedersen, Carsten M ^a   Rosendahl Nielsen, Mette ^b   Hjermind, Jeanette ^c   Egerod, Ingrid ^b  

^a FREDERIKSBERG HOSPITAL   (Denmark)

^b Rigshospitalet   (Denmark)

^c BISPEBJERG HOSPITAL   (Denmark)

Author keywords

Endotracheal suctioning; Evidence based practice; Intensive care; Nursing; Suction

Indexed keywords

SODIUM CHLORIDE;

ADULT; ASEPSIS; DRUG INSTILLATION; ENDOTRACHEAL INTUBATION; EQUIPMENT DESIGN; EVIDENCE BASED NURSING; HUMAN; HYGIENE; INFECTION CONTROL; INSTRUMENTATION; LAVAGE; METHODOLOGY; NURSING; NURSING ASSESSMENT; NURSING EVALUATION RESEARCH; ORGANIZATION AND MANAGEMENT; OXYGEN THERAPY; PATIENT SELECTION; PRACTICE GUIDELINE; PRESSURE; REVIEW; RISK FACTOR; SUCTION;

ADULT; ASEPSIS; EQUIPMENT DESIGN; EVIDENCE-BASED NURSING; HUMANS; HYGIENE; INFECTION CONTROL; INSTILLATION, DRUG; INTUBATION, INTRATRACHEAL; IRRIGATION; NURSING ASSESSMENT; NURSING EVALUATION RESEARCH; OXYGEN INHALATION THERAPY; PATIENT SELECTION; PRACTICE GUIDELINES AS TOPIC; PRESSURE; RESEARCH DESIGN; RISK FACTORS; SODIUM CHLORIDE; SUCTION;

EID: 57649245279     PISSN: 09643397     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.iccn.2008.05.004     Document Type: Review

References (82)

1. Ackerman M.H. The effect of saline lavage prior to suctioning. Am J Crit Care 2 4 (1993) 326-330
2. Akgul S., and Akyolcu N. Effects of normal saline on endotracheal suctioning. J Clin Nurs 11 6 (2002) 826-830
3. Almgren B., Wickerts C.J., Heinonen E., and Hogman M. Side effects of endotracheal suction in pressure- and volume-controlled ventilation. Chest 125 3 (2004) 1077-1080
4. Almgren B. Endotracheal suction a reopened problem [dissertation].Uppsala: Acta Universitatis Upsaliensis; 2005.
5. American Association of Respiratory Care. AARC clinical practice guidelines: endotracheal suctioning of mechanically ventilated adults and children with artificial airways. Respir Care 38 4 (1993) 500-504
6. Bergbom-Engberg I. Patients' experiences of respirator treatment: a retrospective study of the influence of medical and nursing care factors on recall, experience of discomforts, and feelings of security or insecurity [dissertation]. Göteborg: University of Göteborg; 1989.
7. Blackwood B. The practice and perception of intensive care staff using the closed suctioning system. J Adv Nurs 28 5 (1998) 1020-1029
8. Blackwood B., and Webb C.H. Closed tracheal suctioning systems and infection control in the intensive care unit. J Hosp Infect 39 4 (1998) 315-321
9. Blackwood B. Normal saline instillation with endotracheal suctioning: primum non nocere (first do no harm). J Adv Nurs 29 4 (1999) 928-934
10. Bostick J., and Wendelgass S.T. Normal saline instillation as part of the suctioning procedure: effects on PaO2 and amount of secretions. Heart Lung 16 5 (1987) 532-537
11. Branson R.D., Cambell R.S., Chatburn R.L., and Covington J. AARC clinical practice guideline: endotracheal suctioning of mechanically ventilated adults and children with artificial airways. Respir Care 38 5 (1993) 500-504
12. Celik S.S., and Elbas N.O. The standard of suction for patients undergoing endotracheal intubation. Intensive Crit Care Nurs 16 3 (2000) 191-198
13. Celik S.A., and Kanan N. A current conflict: use of isotonic sodium cloride solution on endotracheal suctioning in critically ill patients. Dimens Crit Care Nurs 25 1 (2006) 11-14
14. Cereda M., Villa F., Colombo E., Greco G., Nacoti M., and Pesenti A. Closed system endotracheal suctioning maintains lung volume during volume-controlled mechanical ventilation. Intensive Care Med 27 4 (2001) 648-654
15. Chirag S., and Kollef M.H. Endotracheal tube intraluminal loss among mechanically ventilated patients. Crit Care Med 31 1 (2004) 120-125
16. Clapham L., Harrison J., and Raybould T. A multidisciplinary audit of manual hyperinflation technique (sigh breath) in a neurosurgical intensive care unit. Intensive Crit Care Nurs 11 5 (1995) 265-271
17. Cobley M., Atkins M., and Jones P.L. Environmental contamination during tracheal suction: a comparison of disposable conventional catheters with a multiple-use closed system device. Anaesthesia 46 11 (1991) 957-961
18. Combes P., Fauvage B., and Oleyer C. Nosocomial pneumonia in mechanically ventilated patients, a prospective randomised evaluation of the Stericath closed suctioning system. Intensive Care Med 26 7 (2000) 878-882
19. Czarnik R.E., Stone K.S., Everhart Jr. C.C., and Preusser B.A. Differential effects of continuous versus intermittent suction on tracheal tissue. Heart Lung 20 2 (1991) 144-151
20. Danish Standards. Infection control in the health care sector. Part 2: Requirements for hand washing practice for the prevention of nokocomial infection. DS 2451-2. 1st ed. Charlottenlund: Danish Standards; 2001.
21. Darvas J.A., and Hawkins L.G. The closed tracheal suction catheter: 24 h or 48 h change?. Aust Crit Care 16 3 (2003) 86-92
22. Day T., Wainwright S.P., and Wilson-Barnett J. An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units. J Clin Nurs 10 5 (2001) 682-696
23. Day T., Farnell S., and Wilson-Barnett J. Suctioning: a review of current research recommendations. Intensive Crit Care Nurs 18 2 (2002) 79-89
24. Demers R.R., and Saklad M. Minimizing the harmful effects of mechanical aspiration. Heart Lung 2 4 (1973) 542-545
25. Department of Health, UK. Saving Lives, reducing infection, delivering clean and safe care. DoH 2007. http://www.dh.gov.uk.
26. Deppe S.A., Kelly J.W., Thoi L.L., Chudy J.H., Longfield R.N., Ducey J.P., et al. Incidence of colonization, nosocomial pneumonia, and mortality in critically ill patients using a Trach Care closed-suction system versus an open-suction system: prospective, randomized study. Crit Care Med 18 12 (1990) 1389-1393
27. Dellinger R.P., Levy M.M., Carlet J.M., Bion J., Parker M.M., Jaeschke R., et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 36 1 (2008) 296-327
28. Dodek P., Keenan S., Cook D., Heyland D., Jacka M., Hand L., et al. Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med 141 4 (2004) 305-313
29. Dyhr T., Bonde J., and Larsson A. Lung recruitment manoeuvres are effective in regaining lung volume and oxygenation after open endotracheal suctioning in acute respiratory distress syndrome. Crit Care 7 1 (2003) 55-62
30. Fernandez M.D., Piacentini E., Blanch L., and Fernandez R. Changes in lung volume with three systems of endotracheal suctioning with and without pre-oxygenation in patients with mild-to-moderate lung failure. Intensive Care Med 30 12 (2004) 2210-2215
31. Freytag C.C., Thies F.L., Konig W., and Welte T. Prolonged application of closed in-line suction catheters increases microbial colonization of the lower respiratory tract and bacterial growth on catheter surface. Infection 31 1 (2003) 31-37
32. George R.B. Duration of suctioning: an important variable. Respir Care 28 4 (1983) 457-459
33. Gjengedal E. Understanding a world of critical illness: a phenomenological study of the experiences of respirator patients and their caregivers [dissertation]. Bergen: Department of Public Health and Primary Health Care, Division for Nursing Science, University of Bergen; 1994.
34. Glass C., Grap M.J., Corley M.C., and Wallace D. Nurses' ability to achieve hyperinflation and hyperoxygenation with a manual resuscitation bag during endotracheal suctioning. Heart Lung 22 2 (1993) 158-165
35. Glass C., and Grap M.J. Ten tips for safer suctioning. Am J Nurs 95 5 (1995) 51-53
36. Glass C., Grap M.J., and Sessler C.N. Endotracheal tube narrowing after closed-system suctioning: prevalence and risk factors. Am J Crit Care 8 2 (1999) 93-100
37. Gray J.E., MacIntyre N.R., and Kronenberger W.G. The effects of bolus normal-saline instillation in conjunction with endotracheal suctioning. Respir Care 35 8 (1990) 785-790
38. Guglielminotti J., Alzieu M., Maury E., Guidet B., and Offenstadt G. Bedside detection of retained tracheobronchial secretions in patients receiving mechanical ventilation: is it time for tracheal suctioning?. Chest 118 4 (2000) 1095-1099
39. Hagler D.A., and Traver G.A. Endotracheal saline and suction catheters: sources of lower airway contamination. Am J Crit Care 3 6 (1994) 444-447
40. Hanley M.V., Ruud T., and Butler J. What happens to endotracheal instillations? [abstract]. Am Rev Respir Dis 117 4 II (1978) 124
41. Isea J.O., Poyant D., O'Donnell C., Faling L.J., Karlinsky J., and Celli B.R. Controlled trial of a continuous irrigation suction catheter vs. conventional intermittent suction catheter in clearing bronchial secretions from ventilated patients. Chest 103 4 (1993) 1227-1230
42. Jablonski R.S. The experience of being mechanically ventilated. Qual Health Res 4 2 (1994) 186-207
43. Johnson K.L., Kearney P.A., Johnson S.B., Niblett J.B., MacMillan N.L., and McClain R.E. Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med 22 4 (1994) 658-666
44. Jongerden I.P., Rovers M.M., Grypdonck M.H., and Bonten M.J. Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: a meta-analysis. Crit Care Med 35 1 (2007) 260-270
45. Khatib M., Jamaleddine G., Abdallah A., and Ibrahim Y. Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU. Chest 116 1 (1999) 172-175
46. Kinloch D. Instillation of normal saline during endotracheal suctioning: effects on mixed venous oxygen saturation. Am J Crit Care 8 4 (1999) 231-240
47. Kollef M.H., Prentice D., Shapiro S.D., Fraser V.J., Silver P., Trovillion E., et al. Mechanical ventilation with or without daily changes of in-line suction catheters. Am J Respir Crit Care Med 156 2 Pt 1 (1997) 466-472
48. Lascoki S., Qin L., Sartorius A., Fouillat D., Remerand F., and Rouby J. Open and closed-circuit endotracheal suctioning in acute lung injury. Anesthesiology 104 1 (2006) 39-47
49. Lindgren S., Almgren B., Hogman M., Lethvall S., Houltz E., Lundin S., et al. Effectiveness and side effects of closed and open suctioning: an experimental evaluation. Intensive Care Med 30 8 (2004) 1630-1637
50. Lookinland S., and Appel P.L. Hemodynamic and oxygen transport changes following endotracheal suctioning in trauma patients. Nurs Res 40 3 (1991) 133-139
51. Lorente L., Lecuona M., Martin M.M., Garcia C., Mora M.L., and Sierra A. Ventilator-associated pneumonia using a closed versus an open tracheal suction system. Crit Care Med 33 1 (2005) 115-119
52. Maggiore S.M., Lellouche F., Pigeot J., Taille S., Deye N., Durrmeyer X., et al. Prevention of endotracheal suctioning-induced alveolar derecruitment in acute lung injury. Am J Respir Crit Care Med 167 9 (2003) 1215-1224
53. Maggiore S.M. Endotracheal suctioning, ventilator-associated pneumonia, and costs: open or closed issue?. Intensive Care Med 32 4 (2006) 244-248
54. McKelvie S. Endotracheal suctioning. Nurs Crit Care 3 5 (1998) 244-248
55. O'Neal P.V., Grap M.J., Thomson C., and Dudley W. Level of dyspnoea experienced in mechanically ventilated adults with and without saline instillation prior to endotracheal suctioning. Intensive Crit Care Nurs 17 6 (2001) 356-363
56. Odell A., Allder A., Bayne R., Everett C., Scott S., Still B., et al. Endotracheal suction for adult, non-head-injured, patients. A review of the literature. Intensive Crit Care Nurs 9 4 (1993) 274-278
57. Oh H., and Seo W. A meta-analysis of the effects of various interventions in preventing endotracheal suction-induced hypoxemia. J Clin Nurs 12 6 (2003) 912-924
58. Patak L., Gawlinski A., Fung I., Doering L., and Berg J. Patients' reports of health care practitioner interventions that are related to communication during mechanical ventilation. Heart Lung 33 (2004) 308-321
59. Rabitsch W., Kostler W.J., Fiebiger W., Dielacher C., Losert H., Sherif C., et al. Closed suctioning system reduces cross-contamination between bronchial system and gastric juices. Anesth Analg 99 3 (2004) 886-892
60. Reynolds P., Hoffman L.A., Schlichtig R., Davies P.A., and Zullo T.G. Effects of normal saline instillation on secretion volume, dynamic compliance and oxygen saturation. Am Rev Res Dis 141 4 Suppl. 2 (1990) A574
61. Robson W.P. To bag or not to bag? Manual hyperinflation in intensive care. Intensive Crit Care Nurs 14 5 (1998) 239-243
62. Rogge J.A., Bunde L., and Baun M.M. Effectiveness of oxygen concentrations of less than 100% before and after endotracheal suctioning in patients with chronic obstructive pulmonary disease. Heart and Lung 18 January (1) (1989) 64-71
63. Rolfe G. Insufficient evidence: the problems of evidence-based nursing. Nurse Educ Today 19 6 (1999) 433-442
64. Rosen M., and Hillard E.K. The effects of negative pressure during tracheal suction. Anesth Analg 41 (1962) 50-57
65. Rycroft-Malone J., Seers K., Titchen A., Harvey G., Kitson A., and McCormack B. What counts as evidence in evidence-based practice?. J Adv Nurs 47 1 (2004) 81-90
66. Sackett D.L., Rosenberg W., Gray J.A.M., and Haynes R.B. Evidence based medicine: what it is and what it isn't. BMJ 312 (1996) 71-72
67. Scoble M.K., Copnell B., Taylor A., Kinney S., and Shann F. Effect of reusing suction catheters on the occurrence of pneumonia in children. Heart Lung 30 3 (2001) 225-233
68. Shah C., and Kollef M.H. Endotracheal tube intraluminal volume loss among mechanically ventilated patients. Crit Care Med 32 1 (2004) 120-125
69. Sole M.L., Byers J.F., Ludy J.E., Zhang Y., Banta C.M., and Brummel K. A multisite survey of suctioning techniques and airway management practices. Am J Crit Care 12 3 (2003) 220-230
70. Statens Serum Institut. Råd og anvisninger om infektionsprofylakse i relation til ventilations-og respirationsudstyr i sundhedssektoren [engelsk oversættelse af titel]. 1. ed. Copenhagen: Central Department for Hospital Hygiene, SSI; 2001.
71. Stenqvist O., Lindgren S., Karason S., Sondergaard S., and Lundin S. Warning! Suctioning. A lung model evaluation of closed suctioning systems. Acta Anaesthesiol Scand 45 2 (2001) 167-172
72. Tenaillon A. Tracheobronchial suctions during mechanical ventilation. Update Intensive Care Emerg Med 10 (1990) 196-200
73. Thomson L., Morton R., and Cuthbertson S. Tracheal suctioning of adults with an artificial airway. Best Practice 4 4 (2000) 1-6
74. Tiffin N.H., Keim M.R., and Frewen T.C. The effects of variations in flow trough an insufflating catheter and endotracheal-tube and suction-catheter size on test-lung pressures. Respir Care 35 9 (1990) 889-897
75. Topeli A., Harmanci A., Cetinkaya Y., Akdeniz S., and Unal S. Comparison of the effect of closed versus open endotracheal suction systems on the development of ventilator-associated pneumonia. J Hosp Infect 58 1 (2004) 14-19
76. Van de Leur J.P., Zwaveling J.H., Loef B.G., and Van der Schans C.P. Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients: a prospective randomised controlled trial. Intensive Care Med 29 3 (2003) 426-432
77. Van de Leur J.P., Zwaveling J.H., Loef B.G., and Van der Schans C.P. Patient recollection of airway suctioning in the ICU: routine versus a minimally invasive procedure. Intensive Care Med 29 3 (2003) 433-436
78. Witmer M.T., Hess D., and Simmons M. An evaluation of the effectiveness of secretion removal with the Ballard closed-circuit suction catheter. Respir Care 36 8 (1991) 844-848
79. Wood C.J. Can nurses safely assess the need for endotracheal suction in short-term ventilated patients, instead of using routine techniques?. Intensive Crit Care Nurs 14 4 (1998) 170-178
80. Wood C.J. Endotracheal suctioning: a literature review. Intensive Crit Care Nurs 14 3 (1998) 124-136
81. Young C.S. Recommended guide lines for suction. Physiotherapy 70 3 (1984) 106-108
82. Zeitoun S.S., de Barros A.L., and Diccini S. A prospective, randomized study of ventilator-associated pneumonia in patients using a closed vs. open suction system. J Clin Nurs 12 4 (2003) 484-489