title: Comparison of open and closed suction on safety, efficacy and nursing time in a paediatric intensive care unit.
abstract: BACKGROUND
  Endotracheal suctioning (ETS) is one of the most common procedures performed in the paediatric intensive care. The two methods of endotracheal suctioning used are known as open and closed suction, but neither method has been shown to be the superior suction method in the Paediatric Intensive Care Unit (PICU).
  
  
  OBJECTIVE
  The primary purpose was to compare open and closed suction methods from a physiological, safety and staff resource perspective.
  
  
  METHODS
  All paediatric intensive care patients with an endotracheal tube were included. Between June and September 2011 alternative months were nominated as open or closed suction months. Data were prospectively collected including suction events, staff involved, time taken, use of saline, and change from pre-suction baseline in heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO2). Blocked or dislodged ETTs were recorded as adverse events.
  
  
  RESULTS
  Closed suction was performed more often per day (7.2 vs 6.0, p<0.01), used significantly less nursing time (23 vs 38 min, p<0.01) and had equivalent rates of adverse events compared to open suction (5 vs 3, p<0.23). Saline lavage usage was significantly higher in the open suction group (18% vs 40%). Open suction demonstrated a greater reduction in SpO2 and nearly three times the incidence of increases in HR and MAP compared to closed suction. Reductions in MAP or HR were comparable across the two methods.
  
  
  CONCLUSIONS
  In conclusion, CS could be performed with less staffing time and number of nurses, less physiological disturbances to our patients and no significant increases in adverse events.
authors.affiliation: Paediatric Intensive Care Unit, Royal Children's Hospital, 50 Flemington Road, Parkville, 3052 VIC, Australia. Electronic address: janine.evans@rch.org.au.
authors.forename: Janine
authors.initials: J
authors.lastname: Evans
authors.affiliation: Unit 2, 36 Maidstone Street, Altona 3018, Australia. Electronic address: sophie.syddall@gmail.com.
authors.forename: Sophie
authors.initials: S
authors.lastname: Syddall
authors.affiliation: Paediatric Intensive Care Unit, Royal Children's Hospital, 50 Flemington Road, Parkville, 3052 VIC, Australia. Electronic address: warwick.butt@rch.org.au.
authors.forename: Warwick
authors.initials: W
authors.lastname: Butt
authors.affiliation: Royal Children's Hospital, 50 Flemington Road, Parkville, 3052 VIC, Australia; Department of Nursing, The University of Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Australia. Electronic address: sharon.kinney@rch.org.au.
authors.forename: Sharon
authors.initials: S
authors.lastname: Kinney
mesh_terms: D000293:Adolescent; D001992:Bronchoalveolar Lavage Fluid; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D061214:Patient Safety; D012121:Respiration, Artificial / Q000009:adverse effects / Q000451:nursing*; D013396:Suction / Q000009:adverse effects / Q000379:methods* / Q000451:nursing; D013997:Time Factors
keywords: Closed suction system; Endotracheal suction; Open suction system; Paediatric; Suction catheter