title: An Association Between Pain and American Association of Respiratory Care 2010 Guidelines During Tracheal Suctioning.
abstract: BACKGROUND
  Tracheal suctioning is recalled by mechanically ventilated patients as the most painful procedure during their stay in the intensive care unit.
  
  
  OBJECTIVE
  The aim of this study was to evaluate whether the implementation of American Association of Respiratory Care suction guidelines positively affects the levels of patients' pain.
  
  
  METHODS
  This is a prospective observational study on adult patients admitted to 2 general intensive care units. Pain levels in sedated mechanically ventilated patients were recorded before, during, and after tracheal suctioning, using the Critical Care Pain Observation Tool (CPOT).
  
  
  RESULTS
  Forty-seven patients were enrolled, with a mean age of 61.72 (±18.46) years. Median CPOT value was 0 (quartile 1 [Q1] [25%], 0; quartile 3 [Q3] [75%], 0; min, 0; max, 2) during the procedure. The Critical Care Pain Observation Tool reached a median value of 3, while 5 minutes after suctioning. Postprocedural CPOT median score was 0 (Q1 [25%], 0; Q3 [75%], 0; min, 0; max, 2). The median number of passes during suctioning was 1 (Q1, 1; Q3, 2). The sizes of suction catheters used in the recorded procedures were as follows: 12F in 27 cases (57%), 14F in 18 cases (38%), and 10F in 2 cases (5%). The median size of the endotracheal tube was 7.5 mm (Q1, 7.5; Q3, 8). The correct ratio between endotracheal tube diameter and suction catheter was used in 24 procedures (51%).
  
  
  CONCLUSIONS
  Despite the low number of patients, this study showed that the implementation of the American Association of Respiratory Care 2010 endotracheal suctioning guidelines into practice helps to reduce procedural-induced pain. Therefore, training and continuing education are important for clinical staff performing tracheal suctioning.
authors.affiliation: Alberto Lucchini, RN, is nurse chief, General Intensive Care Unit, San Gerardo University Hospital, Monza, and is coordinator, Anesthesia and Intensive Care, University of Milano-Bicocca, Milan, Italy. Marta Canesi, RN-MSN, Pediatric Oncohematology Ward/BMTC, Fondazione MBBM, Monza, Italy. Gaia Robustelli, RN-MSN, is a staff nurse, Intensive Care Unit, Treviglio-Caravaggio Hospital, Treviglio, Italy. Roberto Fumagalli, MD, is a director, Department of Experimental Medicine, University of Milano-Bicocca, Milan. Stefano Bambi, PhD, MSN, RN, is a staff nurse, Intensive Care Unit, Azienda Ospedaliero Universitaria Careggi, and is PhD student in nursing science, University of Florence, Florence, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Lucchini
authors.forename: Marta
authors.initials: M
authors.lastname: Canesi
authors.forename: Gaia
authors.initials: G
authors.lastname: Robustelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Fumagalli
authors.forename: Stefano
authors.initials: S
authors.lastname: Bambi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D010146:Pain; D011446:Prospective Studies; D012121:Respiration, Artificial; D013396:Suction; D014481:United States