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Effects of Endotracheal Suctioning Procedure Steps Applied in Intensive Care on Suctioning Complications

Yıl 2023, Cilt: 7 Sayı: 1, 101 - 114, 31.01.2023
https://doi.org/10.46237/amusbfd.1139842
Bu makale için 31 Ocak 2024 tarihinde bir düzeltme yayımlandı. https://dergipark.org.tr/tr/pub/amusbfd/issue/83040/1429994

Öz

Objective: Suctioning procedures that are not carried out under guidelines lead to complications. The aim of the study is to determine suctioning procedure mistakes and complications related the procedure in an intensive care unit (ICU) where no standard suctioning guidelines were applied.
Methods: The study was used an observational research design in a tertiary ICU. The procedure steps of nurses during suctioning were observed; blood pressure, heart rate, respiratory rate, peripheral oxygen saturation, tidal volume values, development of arrhythmia and hemorrhagic secretion were monitored in patients just before and at the first and the fifth minutes after suctioning.
Results: A total of 210 suctioning procedures performed by 35 nurses on 45 patients were observed. Nurses’ frequent mistakes were applying suction pressure above 150 mmHg (99.5%) for more than 10 seconds (63.3%), not applying hyperoxygenation before and after suctioning (98.1%, 96.2), applying deep suctioning (97.6%), applying total suctioning procedure for more than 15 seconds (72.9%). Applying suctioning pressure for more than 10 seconds increased the risk of tachycardia by 3.074 times, hemorrhagic secretion risk by 2.790 times, tachypnea risk by 2.024 times, and desaturation risk by 5.496 times in the first minute. Applying suctioning pressure for more than 15 seconds increased the risk of diastolic hypotension by 15.108 times, the arrhythmia by 2.630 times in the first minute; tachycardia by 3.725 times, tachypnea by 2.750 times in the fifth minute.
Conclusion: Many incorrect procedures applied by nurses, which did not comply with the suctioning standards, led to significant physiological changes in patients.

Kaynakça

  • 1. Restrepo, R. D., Brown, J. M., & Hughes, J. M. (2010). AARC clinical practice guidelines endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respir Care, 55(6), 758–764.
  • 2. Blakeman, T. C., Scott, J. B., Yoder, M. A., Capellari, E., & Strickland, S. L. (2022). AARC clinical practice guidelines: artificial airway suctioning. Respir Care, 67(2), 258–271. https://doi.org/10.4187/respcare.09548
  • 3. Maggiore, S. M., & Volpe, C. (2011). Endotracheal suctioning in hypoxemic patients. Reanimation, 20(1), 12–18. https://doi.org/10.1007/s13546-010-0211-1
  • 4. Davies, K., Monterosso, L., Bulsara, M., & Ramelet, A. S. (2015). Clinical indicators for the initiation of endotracheal suction in children: an integrative review. Aust Crit Care, 28(1), 11–18. https://doi.org/10.1016/j.aucc.2014.03.001
  • 5. Maggiore, S. M., Lellouche, F., Pignataro, C., Girou, E., Maitre, B., Richard, J. C. M. et al. (2013). Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice. Respir Care, 58(10), 1588–1597. https://doi.org/10.4187/respcare.02265
  • 6. Leur, J. P., Zwaveling, J. H., Loef, B. G., & Schans, C. P. (2003). Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients: A prospective randomised controlled trial. Intens Care Med, 29(3), 426–432. https://doi.org/10.1007/s00134-003-1639-9
  • 7. Shamali, M., Abbasinia, M., Østergaard, B., & Konradsen, H. (2019). Effect of minimally invasive endotracheal tube suctioning on physiological indices in adult intubated patients: An open-labelled randomised controlled trial. Aust Crit Care, 32(3), 199–204. https://doi.org/10.1016/j.aucc.2018.03.007
  • 8. Özden, D., & Görgülü, R. S. (2015). Effects of open and closed suction systems on the haemodynamic parameters in cardiac surgery patients. Nurs Crit Care, 20(3), 118–125. https://doi.org/10.1111/nicc.12094
  • 9. Schults, J. A., Long, D. A., Mitchell, M. L., Cooke, M., Gibbons, K., Pearson, K. et al. (2020). Adverse events and practice variability associated with paediatric endotracheal suction: An observational study. Aust Crit Care, 33(4), 350–357. https://doi.org/10.1016/j.aucc.2019.08.002
  • 10. Schults, J. A., Mitchell, M. L., Cooke, M., Long, D. A., Ferguson, A., & Morrow, B. (2021). Endotracheal suction interventions in mechanically ventilated children: an integrative review to inform evidence-based practice. Aust Crit Care, 34(1), 92–102. https://doi.org/10.1016/j.aucc.2020.05.003
  • 11. Özden, D., & Görgülü, R. S. (2012). Development of standard practice guidelines for open and closed system suctioning. J Clin Nurs, 21(9–10), 1327–1338. https://doi.org/10.1111/j.1365-2702.2011.03997.x
  • 12. Hu, J., Yu, L., Jiang, L., Yuan, W., Bian, W., Yang, Y. et al. (2019). Developing a guideline for endotracheal suctioning of adults with artificial airways in the perianesthesia setting in China. J Perianesth Nurs, 34(1), 160-168.e4. https://doi.org/10.1016/j.jopan.2018.03.005
  • 13. Bülbül Maraş, G., Kocaçal Güler, E., Eşer, İ., & Köse, Ş. (2017). Knowledge and practice of intensive care nurses for endotracheal suctioning in a teaching hospital in western Turkey. Intens Crit Care Nurs, 39, 45– 54. https://doi.org/10.1016/j.iccn.2016.08.006
  • 14. Frota, O. P., Loureiro, M. D. R., & Ferreira, A. M. (2014). Open system endotracheal suctioning: practices of intensive care nursing professionals. Rev Enferm, 18(2), 296–302. https://doi.org/10.5935/1414- 8145.20140043
  • 15. Ania Gonzalez, N., Martinez Mingo, A., Eseberri Sagardoy, M., Margall Coscojuela, M. A., & Asiain Erro, M. C. (2004). [Assessment of practice competence and scientific knowledge of ICU nurses in the tracheal suctioning]. Enferm intens, 15(3), 101–111.
  • 16. Mwakanyanga, E. T., Masika, G. M., & Tarimo, E. A. M. (2018). Intensive care nurses’ knowledge and practice on endotracheal suctioning of the intubated patient: a quantitative cross-sectional observational study. PloS One, 13(8), e0201743. https://doi.org/10.1371/journal.pone.0201743
  • 17. Zainib, T., Afzal, M., Sarwar, H., & Waqas, A. (2017). The gap between knowledge and practices in standard endotracheal suctioning of ıntensive care unit nurses in Children’s Hospital Lahore. Saudi J Med Pharm Sci, 3(6A), 454–463. https://doi.org/10.21276/sjmps
  • 18. Majeed, M. H. (2017). Assessment of knowledge and practices of intensive care unit nurses about endotracheal suctioning for adult patients in Baghdad Teaching Hospitals, Iraq. Int J Res Med Sci, 5(4), 1396– 1404.
  • https://doi.org/10.18203/2320/6012.ijrms20171234
  • 19. Haghighat, S., & Yazdannik, A. (2015). The practice of intensive care nurses using the closed suctioning system: An observational study. Iranian J Nurs Midwifery Res, 20(5), 619. https://doi.org/10.4103/1735- 9066.164509
  • 20. Lindgren, S., Almgren, B., Högman, M., Lethvall, S., Houltz, E., Lundin, S. et al. (2004). Effectiveness and side effects of closed and open suctioning: an experimental evaluation. Intens Care Med, 30(8), 1630–1637. https://doi.org/10.1007/s00134-003-2153-9
  • 21. Wang, R., Shen, J., Liu, D., & Li, C. M. (2016). [ The effect and injury to the airways of different sputum aspiration pressure in a rat model of mucus hypersecretion ]. Chinese J Tuberc Respir Dis, 39(7), 534–538. https://doi.org/10.3760/cma.j.issn.1001-0939
  • 22. Gilder, E., Parke, R. L., & Jull, A. (2019). Endotracheal suction in intensive care: A point prevalence study of current practice in New Zealand and Australia. Aust Crit Care, 32(2), 112–115. https://doi.org/10.1016/j.aucc.2018.03.001
  • 23. Türkmen, E. (2017). Hemodinamik monitörizasyon. Durmaz Akyol A. Yoğun bakım hemşireliği. 1. basım (ss. 183–199). İstanbul: İstanbul Tıp Kitabevleri.
  • 24. Halk Sağlığı Genel Müdürlüğü. Yaşam bulguları ile ilgili önemli göstergeler nelerdir? https://sagligim.gov.tr/hasta-yaralinin-ve-olay-yerinin-degerlendirilmesi/yasam-bulgulari-ile-ilgili-onemli-gostergeler- nelerdir.html (Erişim Tarihi: 30 Haziran 2022).
  • 25. American Heart Association. (2017). Healthy and unhealthy blood pressure ranges. https://www.heart.org/-/media/files/health-topics/high-blood-pressure/hbp-rainbow-chart-english-pdf- ucm_499220.pdf (Erişim Tarihi: 30 Haziran 2022).
  • 26. Medline Plus. (2020). Vital signs. https://medlineplus.gov/ency/article/002341.htm (Erişim Tarihi: 30 Haziran 2022).
  • 27. Leite, C. R. M., Sizilio, G. R. A., Neto, A. D. D., Valentim, R. A. M., & Guerreiro, A. M. G. (2011). A fuzzy model for processing and monitoring vital signs in ICU patients. BioMedical Engineer, 10(1), 68. https://doi.org/10.1186/1475-925X-10-68
  • 28. Gilder, E., Parke, R. L., McGuinness, S., & Jull, A. (2019). Study protocol: a randomized controlled trial assessing the avoidance of endotracheal suction in cardiac surgical patients ventilated for ≤ 12 hr. J Adv Nurs, 75(9), 2006–2014. https://doi.org/10.1111/jan.13994
  • 29. Credland, N. (2016). How to perform open tracheal suction via an endotracheal tube. Nurs Stand, 30(35), 36–38. https://doi.org/10.7748/ns.30.35.36.s46
  • 30. Russian, C. J., Gonzales, J. F., & Henry, N. R. (2014). Suction catheter size: an assessment and comparison of 3 different calculation methods. Respir Care, 59(1), 32–38. https://doi.org/10.4187/respcare.02168
  • 31. Jiang, W. (2013). [The tendency of changes in blood oxygen saturation and arrhythmia: a clinical report of 500 cases]. Chinese Crit Care Med 25(2), 112–114. https://doi.org/10.3760/cma.j.issn.2095- 4352.2013.02.016
  • 32. Shamali, M., Babaii, A., Abbasinia, M., Shahriari, M., Kaji, M. A., & Gradel, K. O. (2017). Effect of minimally invasive endotracheal tube suctioning on suction- related pain, airway clearance and airway trauma in intubated patients : a randomized controlled trial. Nurs Midwifery Stud, 6(2), e35909. https://doi.org/10.5812/nmsjournal.35909

Yoğun Bakımda Uygulanan Endotrakeal Aspirasyon İşlem Basamaklarının Aspirasyon Komplikasyonlarına Etkisi

Yıl 2023, Cilt: 7 Sayı: 1, 101 - 114, 31.01.2023
https://doi.org/10.46237/amusbfd.1139842
Bu makale için 31 Ocak 2024 tarihinde bir düzeltme yayımlandı. https://dergipark.org.tr/tr/pub/amusbfd/issue/83040/1429994

Öz

Amaç: Rehber önerileri doğrultusunda yapılmayan aspirasyon işlemleri komplikasyonlara yol açmaktadır. Çalışmanın amacı, aspirasyon standardı uygulanmayan bir yoğun bakım ünitesinde aspirasyon işlem basamaklarında sıklıkla yapılan hataları belirlemek ve aspirasyon komplikasyonlarını incelemektir.
Yöntem: Çalışma üçüncü basamak bir yoğun bakım ünitesinde gözlemsel desende yürütülmüştür. Hemşirelerin aspirasyon sırasındaki işlem basamakları gözlenmiş; hastaların aspirasyondan hemen önce ve sonrasındaki birinci ve beşinci dakikalarda kan basıncı, kalp atım hızı, solunum sayısı, periferal oksijen satürasyonu, tidal volüm değerleri, aritmi, hemorajik sekresyon gelişimi takip edilmiştir.
Bulgular: Toplam 35 hemşirenin 45 hastada uyguladığı 210 aspirasyon işlemi izlenmiştir. Hemşirelerin en sık yaptığı uygulama hataları 150 mmHg üstü aspiratör basıncını (%99.5) 10 sn’den fazla uygulama (%63.3), aspirasyon öncesi ve sonrası hiperoksijenasyon uygulamama (%98.1, %96.2), derin aspirasyon uygulama (%97.6), aspirasyonun toplam süresinin 15 sn’den fazla sürmesi (%72.9) olarak belirlenmiştir. On saniyeden fazla aspiratör basıncı uygulamak birinci dakikada taşikardi görülme riskini 3.074, hemorajik sekresyon riskini 2.790, takipne riskini 2.024, desatürasyon riskini 5.496 kat arttırmıştır. Toplam aspirasyon süresini 15 sn’den fazla uygulamak birinci dakikada diyastolik hipotansiyon riskini 15.108, aritmi riskini 2.630, beşinci dakikada taşikardi görülme riskini 3.725, takipne riskini 2.750 kat arttırmıştır.
Sonuç: Bu çalışmanın sonuçları, hemşirelerin aspirasyon standardına uygun olmayan birçok hatalı işlem yaptığını, hatalı yapılan her işlemin hastalarda önemli fizyolojik değişimlere yol açtığını göstermektedir.  

Kaynakça

  • 1. Restrepo, R. D., Brown, J. M., & Hughes, J. M. (2010). AARC clinical practice guidelines endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respir Care, 55(6), 758–764.
  • 2. Blakeman, T. C., Scott, J. B., Yoder, M. A., Capellari, E., & Strickland, S. L. (2022). AARC clinical practice guidelines: artificial airway suctioning. Respir Care, 67(2), 258–271. https://doi.org/10.4187/respcare.09548
  • 3. Maggiore, S. M., & Volpe, C. (2011). Endotracheal suctioning in hypoxemic patients. Reanimation, 20(1), 12–18. https://doi.org/10.1007/s13546-010-0211-1
  • 4. Davies, K., Monterosso, L., Bulsara, M., & Ramelet, A. S. (2015). Clinical indicators for the initiation of endotracheal suction in children: an integrative review. Aust Crit Care, 28(1), 11–18. https://doi.org/10.1016/j.aucc.2014.03.001
  • 5. Maggiore, S. M., Lellouche, F., Pignataro, C., Girou, E., Maitre, B., Richard, J. C. M. et al. (2013). Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice. Respir Care, 58(10), 1588–1597. https://doi.org/10.4187/respcare.02265
  • 6. Leur, J. P., Zwaveling, J. H., Loef, B. G., & Schans, C. P. (2003). Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients: A prospective randomised controlled trial. Intens Care Med, 29(3), 426–432. https://doi.org/10.1007/s00134-003-1639-9
  • 7. Shamali, M., Abbasinia, M., Østergaard, B., & Konradsen, H. (2019). Effect of minimally invasive endotracheal tube suctioning on physiological indices in adult intubated patients: An open-labelled randomised controlled trial. Aust Crit Care, 32(3), 199–204. https://doi.org/10.1016/j.aucc.2018.03.007
  • 8. Özden, D., & Görgülü, R. S. (2015). Effects of open and closed suction systems on the haemodynamic parameters in cardiac surgery patients. Nurs Crit Care, 20(3), 118–125. https://doi.org/10.1111/nicc.12094
  • 9. Schults, J. A., Long, D. A., Mitchell, M. L., Cooke, M., Gibbons, K., Pearson, K. et al. (2020). Adverse events and practice variability associated with paediatric endotracheal suction: An observational study. Aust Crit Care, 33(4), 350–357. https://doi.org/10.1016/j.aucc.2019.08.002
  • 10. Schults, J. A., Mitchell, M. L., Cooke, M., Long, D. A., Ferguson, A., & Morrow, B. (2021). Endotracheal suction interventions in mechanically ventilated children: an integrative review to inform evidence-based practice. Aust Crit Care, 34(1), 92–102. https://doi.org/10.1016/j.aucc.2020.05.003
  • 11. Özden, D., & Görgülü, R. S. (2012). Development of standard practice guidelines for open and closed system suctioning. J Clin Nurs, 21(9–10), 1327–1338. https://doi.org/10.1111/j.1365-2702.2011.03997.x
  • 12. Hu, J., Yu, L., Jiang, L., Yuan, W., Bian, W., Yang, Y. et al. (2019). Developing a guideline for endotracheal suctioning of adults with artificial airways in the perianesthesia setting in China. J Perianesth Nurs, 34(1), 160-168.e4. https://doi.org/10.1016/j.jopan.2018.03.005
  • 13. Bülbül Maraş, G., Kocaçal Güler, E., Eşer, İ., & Köse, Ş. (2017). Knowledge and practice of intensive care nurses for endotracheal suctioning in a teaching hospital in western Turkey. Intens Crit Care Nurs, 39, 45– 54. https://doi.org/10.1016/j.iccn.2016.08.006
  • 14. Frota, O. P., Loureiro, M. D. R., & Ferreira, A. M. (2014). Open system endotracheal suctioning: practices of intensive care nursing professionals. Rev Enferm, 18(2), 296–302. https://doi.org/10.5935/1414- 8145.20140043
  • 15. Ania Gonzalez, N., Martinez Mingo, A., Eseberri Sagardoy, M., Margall Coscojuela, M. A., & Asiain Erro, M. C. (2004). [Assessment of practice competence and scientific knowledge of ICU nurses in the tracheal suctioning]. Enferm intens, 15(3), 101–111.
  • 16. Mwakanyanga, E. T., Masika, G. M., & Tarimo, E. A. M. (2018). Intensive care nurses’ knowledge and practice on endotracheal suctioning of the intubated patient: a quantitative cross-sectional observational study. PloS One, 13(8), e0201743. https://doi.org/10.1371/journal.pone.0201743
  • 17. Zainib, T., Afzal, M., Sarwar, H., & Waqas, A. (2017). The gap between knowledge and practices in standard endotracheal suctioning of ıntensive care unit nurses in Children’s Hospital Lahore. Saudi J Med Pharm Sci, 3(6A), 454–463. https://doi.org/10.21276/sjmps
  • 18. Majeed, M. H. (2017). Assessment of knowledge and practices of intensive care unit nurses about endotracheal suctioning for adult patients in Baghdad Teaching Hospitals, Iraq. Int J Res Med Sci, 5(4), 1396– 1404.
  • https://doi.org/10.18203/2320/6012.ijrms20171234
  • 19. Haghighat, S., & Yazdannik, A. (2015). The practice of intensive care nurses using the closed suctioning system: An observational study. Iranian J Nurs Midwifery Res, 20(5), 619. https://doi.org/10.4103/1735- 9066.164509
  • 20. Lindgren, S., Almgren, B., Högman, M., Lethvall, S., Houltz, E., Lundin, S. et al. (2004). Effectiveness and side effects of closed and open suctioning: an experimental evaluation. Intens Care Med, 30(8), 1630–1637. https://doi.org/10.1007/s00134-003-2153-9
  • 21. Wang, R., Shen, J., Liu, D., & Li, C. M. (2016). [ The effect and injury to the airways of different sputum aspiration pressure in a rat model of mucus hypersecretion ]. Chinese J Tuberc Respir Dis, 39(7), 534–538. https://doi.org/10.3760/cma.j.issn.1001-0939
  • 22. Gilder, E., Parke, R. L., & Jull, A. (2019). Endotracheal suction in intensive care: A point prevalence study of current practice in New Zealand and Australia. Aust Crit Care, 32(2), 112–115. https://doi.org/10.1016/j.aucc.2018.03.001
  • 23. Türkmen, E. (2017). Hemodinamik monitörizasyon. Durmaz Akyol A. Yoğun bakım hemşireliği. 1. basım (ss. 183–199). İstanbul: İstanbul Tıp Kitabevleri.
  • 24. Halk Sağlığı Genel Müdürlüğü. Yaşam bulguları ile ilgili önemli göstergeler nelerdir? https://sagligim.gov.tr/hasta-yaralinin-ve-olay-yerinin-degerlendirilmesi/yasam-bulgulari-ile-ilgili-onemli-gostergeler- nelerdir.html (Erişim Tarihi: 30 Haziran 2022).
  • 25. American Heart Association. (2017). Healthy and unhealthy blood pressure ranges. https://www.heart.org/-/media/files/health-topics/high-blood-pressure/hbp-rainbow-chart-english-pdf- ucm_499220.pdf (Erişim Tarihi: 30 Haziran 2022).
  • 26. Medline Plus. (2020). Vital signs. https://medlineplus.gov/ency/article/002341.htm (Erişim Tarihi: 30 Haziran 2022).
  • 27. Leite, C. R. M., Sizilio, G. R. A., Neto, A. D. D., Valentim, R. A. M., & Guerreiro, A. M. G. (2011). A fuzzy model for processing and monitoring vital signs in ICU patients. BioMedical Engineer, 10(1), 68. https://doi.org/10.1186/1475-925X-10-68
  • 28. Gilder, E., Parke, R. L., McGuinness, S., & Jull, A. (2019). Study protocol: a randomized controlled trial assessing the avoidance of endotracheal suction in cardiac surgical patients ventilated for ≤ 12 hr. J Adv Nurs, 75(9), 2006–2014. https://doi.org/10.1111/jan.13994
  • 29. Credland, N. (2016). How to perform open tracheal suction via an endotracheal tube. Nurs Stand, 30(35), 36–38. https://doi.org/10.7748/ns.30.35.36.s46
  • 30. Russian, C. J., Gonzales, J. F., & Henry, N. R. (2014). Suction catheter size: an assessment and comparison of 3 different calculation methods. Respir Care, 59(1), 32–38. https://doi.org/10.4187/respcare.02168
  • 31. Jiang, W. (2013). [The tendency of changes in blood oxygen saturation and arrhythmia: a clinical report of 500 cases]. Chinese Crit Care Med 25(2), 112–114. https://doi.org/10.3760/cma.j.issn.2095- 4352.2013.02.016
  • 32. Shamali, M., Babaii, A., Abbasinia, M., Shahriari, M., Kaji, M. A., & Gradel, K. O. (2017). Effect of minimally invasive endotracheal tube suctioning on suction- related pain, airway clearance and airway trauma in intubated patients : a randomized controlled trial. Nurs Midwifery Stud, 6(2), e35909. https://doi.org/10.5812/nmsjournal.35909
Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

İlkin Yılmaz 0000-0001-5470-9048

Dilek Özden 0000-0001-8139-5558

Gülşah Gürol Arslan 0000-0001-8893-5625

Yayımlanma Tarihi 31 Ocak 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 7 Sayı: 1

Kaynak Göster

APA Yılmaz, İ., Özden, D., & Gürol Arslan, G. (2023). Yoğun Bakımda Uygulanan Endotrakeal Aspirasyon İşlem Basamaklarının Aspirasyon Komplikasyonlarına Etkisi. Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 7(1), 101-114. https://doi.org/10.46237/amusbfd.1139842