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Is paediatric endotracheal suctioning by nurses evidence based? An International Survey
Laura L Rad1, Bernie Carter2,3, Martha A Q Curley4,5,6
1PICU, Alder Hey Children's Hospital, Liverpool, UK.
Insights
Pediatric nurses worldwide show variation in endotracheal suctioning (ETS) practices. While many apply some evidence-based recommendations, only 26% consistently use all four key components during suctioning in intensive care units.
Area of Science:
- Pediatric critical care nursing
- Respiratory therapy
- Evidence-based practice in healthcare
Background:
- Endotracheal suctioning (ETS) is a critical intervention for intubated pediatric patients to maintain airway patency.
- It is a frequent procedure in pediatric intensive care units (PICUs), necessitating adherence to best practices.
- Variations in ETS techniques can impact patient outcomes and safety.
Purpose of the Study:
- To evaluate the adherence of pediatric nurses to evidence-based practice (EBP) recommendations for endotracheal suctioning.
- To identify international variations in pediatric endotracheal suctioning practices.
- To assess the implementation of specific EBP components in PICUs globally.
Main Methods:
- A cross-sectional electronic survey was administered to pediatric intensive care unit nurses.
- The survey captured data on endotracheal suctioning episodes, focusing on four American Association for Respiratory Care (AARC) EBP recommendations.
- Participants were nurses performing ETS on children aged 0-17 years, excluding preterm neonates, across 20 countries.
Main Results:
- 446 surveys were completed, revealing significant international variation in ETS practices.
- While most nurses (80%) reported local guidelines, only 26% adhered to all four EBP components (pre-oxygenation, catheter size, depth, continuous suction).
- Individual EBP components were inconsistently applied, with pre-oxygenation (63%), appropriate catheter size (59%), shallow depth (71%), and continuous suction (78%) showing varied compliance.
Conclusions:
- Paediatric endotracheal suctioning practices exhibit considerable international variability.
- Despite awareness of EBP recommendations, consistent application of all key components remains low among nurses.
- There is a need for enhanced focus on implementing comprehensive EBP guidelines for ETS in pediatric intensive care settings.
Background:
Endotracheal suction (ETS) is essential in intubated patients to prevent tube occlusion and is one of the most common nursing interventions performed in intensive care.
Aims And Objectives:
To explore how paediatric ETS practices reflect evidence-based practice (EBP) recommendations in paediatric intensive care units (PICU) worldwide.
Study Design And Methods:
A cross-sectional electronic survey linked to a real patient suction episode. Nurses completed the survey following a recent ETS episode. Evidence-based practice (EBP) was defined based on four of the American Association for Respiratory Care (AARC) best evidence recommendations: pre-oxygenation before suction, use of a suction catheter no more than half the diameter of the tracheal tube, shallow depth of suction, and the continuous suction applied upon withdrawal of the catheter. Participants included PICU nurses who performed ETS in children (0-17 years) excluding preterm neonates.
Results:
Four hundred forty-six complete surveys were received from 20 countries. Most nurses (80%, 367/446) reported that their units had local guidelines for ETS. The most common reason for suctioning (44%) was audible/visible secretions. Over half of ETS episodes (57%) used closed suction. When exploring the individual components of suction, 63% (282/446) of nurses pre-oxygenated their patient prior to suction, 71% (319/446) suctioned no further than 0.5 cm past end of the endotracheal tube (ETT), 59% (261/446) used a catheter no more than half the diameter of the ETT, and 78% (348/446) used continuous negative pressure. 24% of nurses gave patients an additional bolus of sedative, analgesic, and/or muscle-relaxant medication prior to suction; this decision was not related to the child's history of instability with suction, as there was no significant difference in those who reported patients had a history of being unstable with suction (P = .80). 26% (117/446) of nurses complied with all four EBP components in the reported suctioning episode.
Conclusions:
Considerable variation in paediatric endotracheal suctioning practices exists internationally. Although most nurses applied single components of evidence-based recommendations during ETT suctioning, just a quarter applied all four elements.
Relevance To Clinical Practice:
Nurses need to consider and strive to apply EBP principles to common nursing interventions such as ETS.
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