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Joo DH, Park HC, Kim JH, Yang SH, Kim TH, Kim HJ, Song MJ, Lim SY, Kim SA, Bae HW, Ahn YH, Yoon SM, Park J, Lee HY, Lee J, Lee SM, Lee JC, Cho YJ. Clinical Efficacy and Safety of an Automatic Closed-Suction System in Mechanically Ventilated Patients with Pneumonia: A Multicenter, Prospective, Randomized, Non-Inferiority, Investigator-Initiated Trial. Diagnostics (Basel) 2024; 14:1068. [PMID: 38893595 PMCID: PMC11172224 DOI: 10.3390/diagnostics14111068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/08/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Endotracheal suctioning is an essential but labor-intensive procedure, with the risk of serious complications. A brand new automatic closed-suction device was developed to alleviate the workload of healthcare providers and minimize those complications. We evaluated the clinical efficacy and safety of the automatic suction system in mechanically ventilated patients with pneumonia. In this multicenter, randomized, non-inferiority, investigator-initiated trial, mechanically ventilated patients with pneumonia were randomized to the automatic device (intervention) or conventional manual suctioning (control). The primary efficacy outcome was the change in the modified clinical pulmonary infection score (CPIS) in 3 days. Secondary outcomes were the frequency of additional suctioning and the amount of secretion. Safety outcomes included adverse events or complications. A total of 54 participants, less than the pre-determined number of 102, were enrolled. There was no significant difference in the change in the CPIS over 72 h (-0.13 ± 1.58 in the intervention group, -0.58 ± 1.18 in the control group, p = 0.866), but the non-inferiority margin was not satisfied. There were no significant differences in the secondary outcomes and safety outcomes, with a tendency for more patients with improved tracheal mucosal injury in the intervention group. The novel automatic closed-suction system showed comparable efficacy and safety compared with conventional manual suctioning in mechanically ventilated patients with pneumonia.
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Affiliation(s)
- Dong-Hyun Joo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Hyo Chan Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Joon Han Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Seo Hee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Tae Hun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Hyung-Jun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Myung Jin Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Sung Yoon Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
| | - Sung A Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (S.A.K.); (H.W.B.); (J.P.); (J.L.); (S.-M.L.)
| | - Hee Won Bae
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (S.A.K.); (H.W.B.); (J.P.); (J.L.); (S.-M.L.)
| | - Yoon Hae Ahn
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (Y.H.A.); (S.M.Y.); (H.Y.L.)
| | - Si Mong Yoon
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (Y.H.A.); (S.M.Y.); (H.Y.L.)
| | - Jimyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (S.A.K.); (H.W.B.); (J.P.); (J.L.); (S.-M.L.)
| | - Hong Yeul Lee
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (Y.H.A.); (S.M.Y.); (H.Y.L.)
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (S.A.K.); (H.W.B.); (J.P.); (J.L.); (S.-M.L.)
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (S.A.K.); (H.W.B.); (J.P.); (J.L.); (S.-M.L.)
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (Y.H.A.); (S.M.Y.); (H.Y.L.)
| | - Jung Chan Lee
- Department of Biomedical Engineering, Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (D.-H.J.); (H.C.P.); (J.H.K.); (S.H.Y.); (T.H.K.); (H.-J.K.); (M.J.S.); (S.Y.L.)
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Kılıç HK, Celen R. Knowledge levels and evidence-based approaches of undergraduate nursing students on suctioning practices: A cross-sectional study. NURSE EDUCATION TODAY 2024; 134:106097. [PMID: 38266430 DOI: 10.1016/j.nedt.2024.106097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/16/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Suctioning is one of the nursing interventions frequently applied in clinical and intensive care units. In order to perform suctioning correctly and effectively, it is important for nursing students to acquire and develop this skill during their undergraduate theoretical and practical education. OBJECTIVES The study aims to reveal the knowledge levels and evidence-based approaches of nursing students about suctioning practices. DESIGN The study is a descriptive and cross-sectional study. SETTINGS It was carried out in the Faculty of Nursing of two state universities in Konya between March and June 2022. PARTICIPANTS A total of 506 undergraduate students participated in the study. METHODS Data were collected using the Personal Information Form, the Knowledge of Suctioning Questionnaire, and the Attitude towards Evidence-Based Nursing Questionnaire. Data were analyzed by calculating number, percentage, mean, and standard deviation, and using the multiple linear regression analysis. RESULTS The mean Attitude towards Evidence-Based Nursing Questionnaire score of the students was found to be 63.04 ± 7.91, and their mean Knowledge of Suctioning Questionnaire score was 33.46 ± 14.63. 83.8 % of the students obtained a low score from the questionnaire. Senior students had high scores on the Attitude towards Evidence-Based Nursing Questionnaire, which are significant predictive variables affecting the level of knowledge about suctioning (p < 0.05). CONCLUSIONS It was found that the high scores of the students on the Attitude towards Evidence-Based Nursing Questionnaire had an effect on their level of suctioning knowledge. The study also revealed that being a fourth-year student and receiving training on suctioning affected the level of suctioning knowledge.
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Affiliation(s)
| | - Raziye Celen
- Department of Pediatric Nursing, Faculty of Nursing, Selcuk University, Konya, Turkey.
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Schmollgruber S, Korsah EK, Brokken V. Normal saline instillation before endotracheal suctioning: What is the evidence? Intensive Crit Care Nurs 2023; 79:103533. [PMID: 37619307 DOI: 10.1016/j.iccn.2023.103533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Shelley Schmollgruber
- Department of Nursing Education, University of the Witwatersrand Johannesburg, South Africa.
| | - Emmanual Kwame Korsah
- Division of Clinical Associates, Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
| | - Vivien Brokken
- Department of Nursing Education, University of the Witwatersrand Johannesburg, South Africa
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Chang SJ, Kim E, Kwon YO, Im H, Park K, Kim J, Jeong D, Kim D, Park JH. Benefits and harms of normal saline instillation before endotracheal suctioning in mechanically ventilated adult patients in intensive care units: A systematic literature review and meta-analysis. Intensive Crit Care Nurs 2023; 78:103477. [PMID: 37384975 DOI: 10.1016/j.iccn.2023.103477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES This systematic review aimed to identify the effects of normal saline instillation before endotracheal suctioning on clinical outcomes in critically ill patients on a mechanical ventilator. RESEARCH METHODOLOGY This review was based on the guidelines of the National Evidence-based Healthcare Collaborating Agency in Korea and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Six electronic databases were searched for relevant literature. Other sources were also searched, including the reference lists of identified reports and previous systematic reviews. After the initial literature search, a two-step retrieval process was performed to select eligible studies. Then, data were collected using a newly developed form, and the risk of bias was assessed using the checklists of the Joanna Briggs Institute. Data were analyzed using both narrative syntheses and meta-analyses. RESULTS In total, 16 studies: 13 randomized controlled trials and three quasi-experimental studies, were included. From the narrative syntheses, instilling normal saline before endotracheal suctioning was associated with a decrease in oxygen saturation, prolonged time for oxygen saturation to recover to baseline, decreased arterial pH, increased secretion amount, reduced incidence of ventilator-associated pneumonia, increased heart rate, and increased systolic blood pressure. Meta-analyses showed a significant difference in heart rate at five minutes after suctioning but no significant differences in oxygen saturation at two and five minutes after suctioning and heart rate at two minutes after suctioning. CONCLUSION This systematic review indicated that instilling normal saline before performing endotracheal suctioning has more harmful effects than benefits. IMPLICATIONS FOR CLINICAL PRACTICE As recommended in the current guidelines, it is necessary to refrain from routine normal saline instillation before endotracheal suctioning.
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Affiliation(s)
- Sun Ju Chang
- College of Nursing & The Research Institute of Nursing Science, Seoul National University, Seoul, South Korea.
| | - Eunhye Kim
- Department of Nursing, Seoul National University Hospital, Daehak-ro 103, Jongro-gu, Seoul 406-799, South Korea.
| | - Young Ok Kwon
- Department of Nursing, Seoul National University Hospital, Daehak-ro 103, Jongro-gu, Seoul 406-799, South Korea.
| | - Hyomin Im
- Department of Nursing, Seoul National University Hospital, Daehak-ro 103, Jongro-gu, Seoul 406-799, South Korea.
| | - Kyunghee Park
- Department of Nursing, Seoul National University Hospital, Daehak-ro 103, Jongro-gu, Seoul 406-799, South Korea.
| | - Jina Kim
- Department of Nursing, Seoul National University Hospital, Daehak-ro 103, Jongro-gu, Seoul 406-799, South Korea.
| | - Dawoon Jeong
- Department of Nursing, Seoul National University Hospital, Daehak-ro 103, Jongro-gu, Seoul 406-799, South Korea
| | - Dain Kim
- Department of Nursing, Seoul National University Hospital, Daehak-ro 103, Jongro-gu, Seoul 406-799, South Korea
| | - Ju Hee Park
- Department of Nursing, Seoul National University Hospital, Daehak-ro 103, Jongro-gu, Seoul 406-799, South Korea.
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Alkubati SA, Al-Sayaghi KM, Alrubaiee GG, Hamid MA, Saleh KA, Al-Qalah T, Al-Sadi AK. Adherence of critical care nurses to endotracheal suctioning guidelines: a cross-sectional study. BMC Nurs 2022; 21:312. [PMID: 36376904 PMCID: PMC9664682 DOI: 10.1186/s12912-022-01092-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background Endotracheal suctioning (ETS) is one of the most common invasive procedures performed by critical care nurses (CCNs) to remove accumulated pulmonary secretions, ensure airway patency for adequate ventilation and oxygenation as well as prevent atelectasis in intubated patients. Objectives To assess the practice of CCNs in intensive care units (ICUs) before, during, and after performing the ETS procedure and identify factors affecting their practice. Methods A cross-sectional and non-participant observational design was conducted in the ICUs of four hospitals in Hodeida city, Yemen. The data were collected using a 25-item observational checklist in the period from May to August 2019. Results More than half (55%) of CCNs scored undesirable (< 50%) regarding their adherence to ETS practice guidelines while the rest scored moderate (50–75%), with none of showing desirable adherence (> 70%) to the guidelines. There was no significant association between gender, age, education level, or length of experience of CCNs in the ICUs and their practice during performance ETS procedures. However, training (p = 0.010) and receiving information about ETS (p = 0.028) significantly improved the CCNs’ practice. Conclusion Most CCNs at the ICUs of Hodeida hospitals do not adhere to evidence-based practice guidelines when performing ETS procedures, possibly resulting in numerous adverse effects and complications for patients. CCNs receiving information and training show better ETS practice than do their counterparts. Therefore, it is necessary to provide the nursing staff with clear guidelines, continuous education and monitoring to improve their practices.
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