Efficacy of the closed suction applied to patients in intensive care units with different techniques: A nonrandomized controlled trial

Zuhal Gülsoy; Şerife Karagözoğlu

doi:10.7197/cmj.vi.596113

Research Article

Efficacy of the closed suction applied to patients in intensive care units with different techniques: A nonrandomized controlled trial

Year 2020, , 290 - 300, 27.10.2020

Zuhal Gülsoy , Şerife Karagözoğlu

https://doi.org/10.7197/cmj.vi.596113

Abstract

Objective: The present study was conducted to investigate the effects of the closed suction system and different suction techniques in which oxygen and saline instillation were administered individually or in combination on the efficacy of suction, cardiopulmonary indicators, feelings and pain experienced by patients after suction.

Method: This study was planned as an experimental and cross-sectional one. The study had a single group, and a pre- and post-test design (n=43). This study was planned as a single blind in line with the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND). The study data were collected using the Data Collection Form aiming to assess hemodynamics, cardiopulmonary indicators and comfort and the Visual Analog Scale for Pain to assess pain. Parameters were measured before, during and at the 1st,3rd,5th,7th and 10th minutes after suction using different techniques, and the patients were asked how they felt during the suction. Although the processes were implemented by the researcher, data were recorded not by the researcher but by the other two nurses who voluntarily worked at the clinic.

Results: It was found that the standard suction technique could be better tolerated. The administration of oxygen and saline instillation before suction individually or in combination caused anxiety in patients and affected study parameters statistically significantly.

Conclusions: There was a statistically significant difference between aspiration with SI and other aspiration methods, but this difference was still within normal limits. The patients drew attention to relaxation after suction despite the discomfort they experienced during suction, it can be said that tracheal suction has a vital importance in ensuring the maintenance of airway patency and oxygenation, even though it is a discomforting and painful procedure.

Keywords

Closed endotracheal suctioning, hemodynamic effects, oxygen saturation, pain, saline instillation

Supporting Institution

Yok

Project Number

Yok

Thanks

I would like to thank the intensive care nurses Derya DEDE and Seher AK, who voluntarily supported the recording of the data in this study, and Ziynet Çınar, Faculty Member of the Department of Basic Medical Sciences / Biostatistics, who contributed greatly to the statistical analysis of the study.

References

1. Haghighat S, Yazdannik A. The practice of intensive care nurses using the closed suctioning system: An observational study. Iranian Journal of Nursing and Midwifery Research. 2015; 20(5):619-625.
2. Craven D.E, Chroneou A, Zias N, Hjalmarson K.I. Ventilator associated tracheobronchitis the impact of targeted antibiotic therapy on patient outcomes. Chest. 2009; 135(2): 521-528.
3. Lucchini A, Zanella A, Bellani G. Tracheal Secretion Management in the Mechanically Ventilated Patient: Comparison of Standard Assessment and an Acoustic Secretion Detector. Respiratory Care. 2011; 56(5):596-603.
4. Safdar N, Crnich C.J, Mak D.G. The Pathogenesis of Ventilator Associated Pneumonia. its Relevance to Developing Effective Strategies. For Respir Care. 2005; 50(6):725-739.
5. Guglielminotti J, Alzieu M, Maury E, Guidet B, Offenstadt G. Bedside detection of retained tracheobronchial secretions in patients receiving mechanical ventilation. Clinical Investigations in Critical Care. 2000; 118: 1095-1099.
6. Beuret P, Roux C, Constan A, Mercat A, Brochard L. Discrepancy between guidelines and practice of tracheal suctioning in mechanically ventilated patients; A french multicenter observational study. Intensive care med. 2013; 39: 1335-1336.
7. Hamishehar H, Shadvar K, Taghizahed M, Golzari S.E, Mojtahedzahed M, Soleimanpour H, Mahmoodpoor, A. Ventilator associated pneumonia in patients admitted to intensive care units: Using open or closed endotracheal suctioning. Anesthesiology and Pain Medicine. 2014; 4(5): e21649.
8. Giakoumidakis K, Kostaki Z, Patelarou E, Baltopoulos G, Brokalaki H. Oxygen Saturation and Secretion Weight After Endotracheal Suctioning. British Journal of Nursing. 2011; 20(21). 1344-1345.
9. Khamis G, Waziry O, Abdel- Halim A.B, El-Sayed M. Effect of Closed Versus Open Suction System on Cardiopulmonary Parameters Ventilated Neonates. Journal of American Science. 2011; 7(4): 525-534.
10. Pedersen M.C, Rosandalh-Neilsen M, Hjerment J, Egerod I. Endotracheal suctioning of the adult intubated patient; What is the evidence? Intensive and Critical Care Nursing 2009; 25( 1):21-30.
11. American association for respiratory care: AARC clinical practice guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways. Respir Care 2010; 55(6): 758-764.
12. Corley A, Sharpe N, Caruan R.L, Spooner A, Fraser C.F. Lung volume changes during cleaning of closed endotracheal suction catheters: A randomized crossover study using electrical impedance tomography. Respiratory care. 2014; 59 (4): 497-503
13. Ntoumenopoulos G. Endotracheal Suctioning May or May Not Have an Impact. Respiratory Care. 2013; 58(10): 1707-1710
14. Bousarri M.P, Shirvani Y, Kashani S.A, Nasab N.M. The effect of expiratory rib cage compression before endotracheal suctioning on the vital sign in patients under mechanical ventilation. Iranian journal of nursing and midwifery research. 2014; 19 (3): 285-289.
15. Day T, Farrnell S, Haynes S, Wainwright S, Wilson-Barnett J. Tracheal suctioning: an exploration of nurses’s knowledge and competense in acute and high dependency ward areas. Journal of advanced nursing. (2002); 39(1): 35-45.
16. Jin-Heon J, Sung-Jin N, Young-Jae C, Yeon Joo L, Se Joong K, In-Ae S. et al. A Closed-Suction Catheter with a Pressure Valve Can Reduce Tracheal Mucosal Injury in Intubated Patients. The Korean Journal of Critical Care Medicine. 2014; 29(1):7-12.
17. Palazzo S.G.C, Soni B. Pressure Changes During Tracheal Suctioning a Laboratory Study. Anaesthesia. 2013; 68. 576-584.
18. Selby P.J, Chapman J.A, Etazadi-Amoli J, Dalley D, Boyd N.FThe development of a method for assessing the quality of life of cancer patients. British Journol of Cancer . 1984; 50(1):13–22.
19. Eti-Aslan F. Ağrı Doğası ve Kontrolü (2. Baskı). [The nature and control of pain] İstanbul,Türkiye: Akademisyen Tıp Kitapevi. 2014.
20. Seymour C.W, Cross B.C, Crok C.R, Gallop R.L, Fuch B.D. Physiologic Impact of Closed –Ststem Endotracheal Suctioning in Spontaneously Breathing Patients Receiving Mechanical Ventilation. Respiratory Care 2009; 54: 367-373.
21. Afshari A, Safari M, Oshvandi K, Soltanian A.R. The effect of the open and closed system suctions on cardiopulmonary parameters. Time and costs in patients under mechanical ventilation. Nurs Midwifery Stud. 2014; 3(2):e14097. Epub 2014 Jun 15
22. Liu X.W, Jin Y, Ma T, Qu B, Liu Z. Differential Effects of Endotracheal Suctioning on Gas Exchanges in Patients with Acute Respiratory Failure under Pressure-Controlled and Volume-Controlled Ventilation. BioMed Research International. 2015; Article ID 941081, 1-6.
23. Sahinoglu H. Yogun Bakim Sorunlari ve Tedavileri. Türkiye Klinikleri. 2. Baskı Ankara. 2003; 786-815.
24. Demir, F., Dramali, A. (2005) Requirement For 100% Oxygen Before and After Closed Suction.[Kapalı Emme Öncesi ve Sonrasında% 100 Oksijen İçin Gereksinim].Journal of Advenced Nursing 51(3):245-251.
25. Faraji A, Khatony A, Moradi G, Abdi A, Rezaei M. Open and Closed Endotracheal Suctioning and Arterial Blood Gas Values: A Single-Blind Crossover Randomized Clinical Trial. Hindawi Publishing Corporation Critical Care Research and Practice. 2015 Article ID 470842, 7 pages.
26. Akgül S, Akyolcu N . Endotrakeal Aspirasyonda Serum Fizyolojiğin Etkileri. [The effects of saline on endotracheal suction]. Yoğun Bakım Hemşireliği Dergisi. 2000;. 4 (2), 80-85. Retrieved from http://dergipark.gov.tr/ybhd/issue/26471/278654
27. Rotondi A.J, Chelluri L, Sirio C, Mendelsohn A, Schulz R, Belle S, et alPatients’ Recollections of Stressful Experiences While Receiving Prolonged Mechanical Ventilation In An Intensive Care Unit. Critical Care Medicine .2002; 30(4): 746-752
28. Odhner M, Wegman D, Freeland N, Steinmetz A, Ingersoll G.L. Assessing Pain Control in Nonverbal Critically ill Adults. Dimens Crit Care Nurs. 2003; 22(6):260-267.

Year 2020, , 290 - 300, 27.10.2020

Zuhal Gülsoy , Şerife Karagözoğlu

https://doi.org/10.7197/cmj.vi.596113

Abstract

Project Number

Yok

References

1. Haghighat S, Yazdannik A. The practice of intensive care nurses using the closed suctioning system: An observational study. Iranian Journal of Nursing and Midwifery Research. 2015; 20(5):619-625.
2. Craven D.E, Chroneou A, Zias N, Hjalmarson K.I. Ventilator associated tracheobronchitis the impact of targeted antibiotic therapy on patient outcomes. Chest. 2009; 135(2): 521-528.
3. Lucchini A, Zanella A, Bellani G. Tracheal Secretion Management in the Mechanically Ventilated Patient: Comparison of Standard Assessment and an Acoustic Secretion Detector. Respiratory Care. 2011; 56(5):596-603.
4. Safdar N, Crnich C.J, Mak D.G. The Pathogenesis of Ventilator Associated Pneumonia. its Relevance to Developing Effective Strategies. For Respir Care. 2005; 50(6):725-739.
5. Guglielminotti J, Alzieu M, Maury E, Guidet B, Offenstadt G. Bedside detection of retained tracheobronchial secretions in patients receiving mechanical ventilation. Clinical Investigations in Critical Care. 2000; 118: 1095-1099.
6. Beuret P, Roux C, Constan A, Mercat A, Brochard L. Discrepancy between guidelines and practice of tracheal suctioning in mechanically ventilated patients; A french multicenter observational study. Intensive care med. 2013; 39: 1335-1336.
7. Hamishehar H, Shadvar K, Taghizahed M, Golzari S.E, Mojtahedzahed M, Soleimanpour H, Mahmoodpoor, A. Ventilator associated pneumonia in patients admitted to intensive care units: Using open or closed endotracheal suctioning. Anesthesiology and Pain Medicine. 2014; 4(5): e21649.
8. Giakoumidakis K, Kostaki Z, Patelarou E, Baltopoulos G, Brokalaki H. Oxygen Saturation and Secretion Weight After Endotracheal Suctioning. British Journal of Nursing. 2011; 20(21). 1344-1345.
9. Khamis G, Waziry O, Abdel- Halim A.B, El-Sayed M. Effect of Closed Versus Open Suction System on Cardiopulmonary Parameters Ventilated Neonates. Journal of American Science. 2011; 7(4): 525-534.
10. Pedersen M.C, Rosandalh-Neilsen M, Hjerment J, Egerod I. Endotracheal suctioning of the adult intubated patient; What is the evidence? Intensive and Critical Care Nursing 2009; 25( 1):21-30.
11. American association for respiratory care: AARC clinical practice guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways. Respir Care 2010; 55(6): 758-764.
12. Corley A, Sharpe N, Caruan R.L, Spooner A, Fraser C.F. Lung volume changes during cleaning of closed endotracheal suction catheters: A randomized crossover study using electrical impedance tomography. Respiratory care. 2014; 59 (4): 497-503
13. Ntoumenopoulos G. Endotracheal Suctioning May or May Not Have an Impact. Respiratory Care. 2013; 58(10): 1707-1710
14. Bousarri M.P, Shirvani Y, Kashani S.A, Nasab N.M. The effect of expiratory rib cage compression before endotracheal suctioning on the vital sign in patients under mechanical ventilation. Iranian journal of nursing and midwifery research. 2014; 19 (3): 285-289.
15. Day T, Farrnell S, Haynes S, Wainwright S, Wilson-Barnett J. Tracheal suctioning: an exploration of nurses’s knowledge and competense in acute and high dependency ward areas. Journal of advanced nursing. (2002); 39(1): 35-45.
16. Jin-Heon J, Sung-Jin N, Young-Jae C, Yeon Joo L, Se Joong K, In-Ae S. et al. A Closed-Suction Catheter with a Pressure Valve Can Reduce Tracheal Mucosal Injury in Intubated Patients. The Korean Journal of Critical Care Medicine. 2014; 29(1):7-12.
17. Palazzo S.G.C, Soni B. Pressure Changes During Tracheal Suctioning a Laboratory Study. Anaesthesia. 2013; 68. 576-584.
18. Selby P.J, Chapman J.A, Etazadi-Amoli J, Dalley D, Boyd N.FThe development of a method for assessing the quality of life of cancer patients. British Journol of Cancer . 1984; 50(1):13–22.
19. Eti-Aslan F. Ağrı Doğası ve Kontrolü (2. Baskı). [The nature and control of pain] İstanbul,Türkiye: Akademisyen Tıp Kitapevi. 2014.
20. Seymour C.W, Cross B.C, Crok C.R, Gallop R.L, Fuch B.D. Physiologic Impact of Closed –Ststem Endotracheal Suctioning in Spontaneously Breathing Patients Receiving Mechanical Ventilation. Respiratory Care 2009; 54: 367-373.
21. Afshari A, Safari M, Oshvandi K, Soltanian A.R. The effect of the open and closed system suctions on cardiopulmonary parameters. Time and costs in patients under mechanical ventilation. Nurs Midwifery Stud. 2014; 3(2):e14097. Epub 2014 Jun 15
22. Liu X.W, Jin Y, Ma T, Qu B, Liu Z. Differential Effects of Endotracheal Suctioning on Gas Exchanges in Patients with Acute Respiratory Failure under Pressure-Controlled and Volume-Controlled Ventilation. BioMed Research International. 2015; Article ID 941081, 1-6.
23. Sahinoglu H. Yogun Bakim Sorunlari ve Tedavileri. Türkiye Klinikleri. 2. Baskı Ankara. 2003; 786-815.
24. Demir, F., Dramali, A. (2005) Requirement For 100% Oxygen Before and After Closed Suction.[Kapalı Emme Öncesi ve Sonrasında% 100 Oksijen İçin Gereksinim].Journal of Advenced Nursing 51(3):245-251.
25. Faraji A, Khatony A, Moradi G, Abdi A, Rezaei M. Open and Closed Endotracheal Suctioning and Arterial Blood Gas Values: A Single-Blind Crossover Randomized Clinical Trial. Hindawi Publishing Corporation Critical Care Research and Practice. 2015 Article ID 470842, 7 pages.
26. Akgül S, Akyolcu N . Endotrakeal Aspirasyonda Serum Fizyolojiğin Etkileri. [The effects of saline on endotracheal suction]. Yoğun Bakım Hemşireliği Dergisi. 2000;. 4 (2), 80-85. Retrieved from http://dergipark.gov.tr/ybhd/issue/26471/278654
27. Rotondi A.J, Chelluri L, Sirio C, Mendelsohn A, Schulz R, Belle S, et alPatients’ Recollections of Stressful Experiences While Receiving Prolonged Mechanical Ventilation In An Intensive Care Unit. Critical Care Medicine .2002; 30(4): 746-752
28. Odhner M, Wegman D, Freeland N, Steinmetz A, Ingersoll G.L. Assessing Pain Control in Nonverbal Critically ill Adults. Dimens Crit Care Nurs. 2003; 22(6):260-267.

There are 28 citations in total.

Details

Primary Language	English
Subjects	Health Care Administration
Journal Section	Medical Science Research Articles
Authors	Zuhal Gülsoy 0000-0002-6866-5215 Şerife Karagözoğlu 0000-0002-9558-0786
Project Number	Yok
Publication Date	October 27, 2020
Acceptance Date	September 15, 2020
Published in Issue	Year 2020

Cite

AMA	Gülsoy Z, Karagözoğlu Ş. Efficacy of the closed suction applied to patients in intensive care units with different techniques: A nonrandomized controlled trial. CMJ. October 2020;42(3):290-300. doi:10.7197/cmj.vi.596113

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