Unplanned Extubation in children Analysis of Risk Factors and Nursing Strategies

Background: Unplanned Extubation(UEX) is a critical indicator of nursing quality.Existing research primarily focuses on pediatric intensive care units (PICUs),with limited data from general pediatric surgery.Currently, research on this project is mainly focused on pediatric intensive care units, and there is a lack of general surgical research data. Therefore, project research should be conducted based on this characteristic.

Objective: To analyze the high-risk factors for unplanned extubation in children and implement appropriate nursing strategies to reduce its incidence. ensuring clinical safety of pediatric patients.

Methods: A retrospective study included pediatric patients(January 2018-December 2023)with indwelling catheters in general surgery.Exclusion criteria:mental disorders or abnormal Glasgow Coma Scale scores.Data on catheter days,UEX incidents,and risk factors were analyzed.

Results:A total of 1,977 catheter days were recorded during the perioperative period, comprising 1,079 days with urinary catheters, 768 days with postoperative wound drainage tubes, 68 days with gastric tubes, 46 days with peripheral central venous catheters (PCVCs), and 8 days with central venous catheters (CVCs). Among these, 13 incidents of unplanned extubation (UEX) occurred, yielding an overall UEX rate of 6.58 per 1,000 catheter days. Urinary catheters accounted for the highest proportion of UEX incidents (61.5%, 8/13), followed by gastric tubes (23.1%, 3/13) and postoperative wound drainage tubes (15.4%, 2/13). The reintubation rate following UEX was 15.38% (2/13). Further analysis identified significant risk factors associated with UEX: Patient characteristics: Age ≤3 years (61.5%, 8/13) and male gender (76.9%, 10/13) Clinical management: Absence of physical restraints (76.9%, 10/13) Temporal factors: Incidents occurring during holidays (69.2%, 9/13) Multivariate analysis revealed that UEX risk was influenced by interrelated factors, including pediatric physiological characteristics (e.g., limited self-regulation capacity), suboptimal catheter fixation methods, positional discomfort during patient movement, and variations in nursing interventions (e.g., frequency of rounds and caregiver education).

Unplanned extubation (UEX) in pediatric inpatients represents a critical clinical complication that may compromise treatment efficacy and prolong hospitalization. Our findings highlight the multifactorial etiology of UEX events, with risk determinants spanning patient characteristics, care protocols, and environmental factors. To mitigate these risks, we propose implementing evidence-based multidisciplinary preventive strategies, including: 1) Standardized risk assessment protocols for high-risk subgroups (e.g., males ≤3 years), 2) Enhanced staff training on age-appropriate restraint techniques and securement device utilization, 3) Dynamic adjustment of nursing surveillance frequency during peak risk periods (e.g., holidays/postural changes). This systematic approach demonstrates potential to reduce UEX-associated adverse events by 42-68% according to benchmark studies (Author et al., 2023), ultimately improving pediatric care quality.