| Abstrakt: |
Introduction. Endotracheal suctioning is a frequently applied nursing intervention as a basic method of securing airway penetration to improve the respiratory function of critically ill patients with an artificial airway. The usual technique is based on the insertion of a suction catheter through the artificial airway to the tracheobronchial tree, and the removal of the secretions with the application of negative pressure. Often, this technique is accompanied by instillation of normal saline solution to the trachea in order to make the flow and removal of the secretions from the airways easier. This technique is controversial, however, since the advantages are considered probably no superior to the complications. Aim. The aim of this study was to compare the effectiveness and safety of two suctioning techniques, with and without saline instillation, and to evaluate the circulatory and respiratory disorders resulting from the two procedures Material - Method. This study was conducted in the general intensive care units (ICU) of two general hospitals in Attica. The study group consisted of 85 mechanically ventilated patients, with a median age of 63 years, who were hospitalized in the ICU for a mean duration of 12.6 days. Data were collected over a period of 3½ years, from June 2004 to November 2007. Two methods of suctioning were applied to each patient, namely, with and without normal saline instillation. The effectiveness of the techniques was considered from the weight of the drained secretions, and the safety as assessed by monitoring the haemodynamic (arterial blood pressure, pulse) and respiratory (partial pressure of oxygen in arterial blood) parameters. The value of each parameter was registered immediately before and one minute after the suction. The relevant data were recorded by the use of a two unit demographic and clinical data form. The first unit included the characteristics of the ICUs and patients and the second unit the vital signs and partial pressure values, before and after suctioning and the weight of the secretions removed by suctioning for each method. Statistical analysis was conducted using SPSS for Windows (version 15) statistical software (SPSS Inc., Chicago, IL). The Wilcoxon method and t test were applied for the statistical process, the significance value for p was 0.05. Results. ?he use of normal saline instillation was associated with a significant increase of pulse rate (p=0.001) after the application of suction, in contrast with suction with no normal saline instillation (p=0.559). A significant decrease in partial pressure of oxygen in arterial blood was observed on suction, both with normal saline instillation (p<0.001) and without instillation (p=0.003). Arterial blood pressure showed no change during the two methods of suctioning (p=0.231 with instillation and p=0.589 without instillation). The differences in safety of the two techniques were not statistically significant; the comparative differences of arterial blood pressure (p=0.158), pulse rate (p=0.451) and partial pressure of oxygen in arterial blood were not statistically significant. Normal saline instillation resulted in a statistically significant increase of the weight of the secretions removed on suction, compared to no instillation (p<0.001). Conclusion. The suctioning of secretions is a common nursing practice, applied to mechanically ventilated patients in order to clear their airways. The instillation of normal saline solution in the trachea during suctioning increases the amount of the secretions removed, and it does not appear to be less safe than suctioning without saline instillation as it does not lead to significant differences in the haemodynamic and respiratory parameters. Further clinical studies need to be performed in order to investigate whether restrictions such as sample numbers and ventilator parameters interfere with the results. [ABSTRACT FROM AUTHOR] |
