An observational study on the open-system endotracheal suctioning practices of critical care nurses.
OBJECTIVE
The purpose of this study was to investigate open system endotracheal suctioning (ETS) practices of critical care nurses. Specific objectives were to examine nurses' practices prior to, during and post-ETS and to compare nurses' ETS practices with current research recommendations.


BACKGROUND
ETS is a potentially harmful procedure that, if performed inappropriately or incorrectly, might result in life-threatening complications for patients. The literature suggests that critical care nurses vary in their suctioning practices; however, the evidence is predominantly based on retrospective studies that fail to address how ETS is practiced on a daily basis.


METHODS
In March 2005, a structured observational study was conducted using a piloted 20-item observational schedule on two adult intensive-care units to determine how critical care nurses (n = 45) perform ETS in their daily practice and to establish whether the current best practice recommendations for ETS are being adhered to.


RESULTS
The findings indicate that participants varied in their ETS practices; did not adhere to best practice suctioning recommendations; and consequently provided lower-quality ETS treatment than expected. Significant discrepancies were observed in the participants' respiratory assessment techniques, hyperoxygenation and infection control practices, patient reassurance and the level of negative pressure used to clear secretions.


CONCLUSIONS
The findings suggest that critical care nurses do not adhere to best practice recommendations when performing ETS. The results of this study offer an Irish/European perspective on critical care nurses' daily suctioning practices.


CONCLUSIONS
As a matter of urgency, institutional policies and guidelines, which are based on current best practice recommendations, need to be developed and/or reviewed and teaching interventions developed to improve nurses' ETS practices, particularly in regard to auscultation skills, hyperoxygenation practices, suctioning pressures and infection control measures.
Kelleher
Sean
S
Catherine McAuley School of Nursing & Midwifery, Brookfield Health Sciences Complex, University College Cork, Ireland. s.kelleher@ucc.ie
Andrews
Tom
T
D000328:Adult; D001314:Auscultation / Q000451:nursing / Q000592:standards; D019985:Benchmarking; D002983:Clinical Competence / Q000592:standards*; D015400:Clinical Nursing Research; D003422:Critical Care / Q000379:methods* / Q000592:standards; D019983:Guideline Adherence / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D017053:Infection Control / Q000592:standards; D007442:Intubation, Intratracheal / Q000451:nursing* / Q000592:standards; D007494:Ireland; D009730:Nursing Assessment / Q000592:standards; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000193:education* / Q000523:psychology / Q000592:standards; D010102:Oxygen Inhalation Therapy / Q000451:nursing / Q000592:standards; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000592:standards; D013396:Suction / Q000193:education / Q000379:methods / Q000451:nursing* / Q000592:standards