title: The practice of intensive care nurses using the closed suctioning system: An observational study.
abstract: BACKGROUND
  Endotracheal suctioning (ETS) is an essential procedure performed for mechanically ventilated patients. ETS can be either performed by open or closed suctioning system (CSS). There may be some concern on how closed-system ETS is practiced by intensive care nurses. This study was designed to investigate closed-system ETS practices of critical care nurses and to compare their practice with standard recommendations.
  
  
  METHODS
  A prospective observational study was conducted during August and December 2012 to establish how critical care nurses (N = 40) perform different steps in a typical ETS practice and to compare it with the current best practice recommendations through a 23-item structured checklist. The results were categorized into three sections: Pre-suctioning, suctioning, and post-suctioning practices.
  
  
  RESULTS
  Pre-suctioning, suctioning, and post-suctioning practices mean scores were 7.5, 11.75, and 8.5, respectively, out of 16, 16, and 12, respectively. The total suctioning practice score was 27.75 out of 44. Most discrepancies were observed in the patients' assessment and preparation, infection control practices, and use of an appropriate catheter. Spearman correlation coefficient indicated a significant statistical positive correlation between suctioning education period and suctioning practice score (P < 0.0001) and between working experience and suctioning practice score (P = 0.02).
  
  
  CONCLUSIONS
  The findings revealed that critical care nurses do not fully adhere to the best practice recommendation in CSS. We recommend that standard guidelines on ETS practice be included in the current education of critical care nurses.
authors.affiliation: Department of Critical Care Nursing, Medical Students Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Somayeh
authors.initials: S
authors.lastname: Haghighat
authors.affiliation: Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: AhmadReza
authors.initials: A
authors.lastname: Yazdannik
keywords: Intensive care units; Iran; intratracheal; nurses; practice; suction