| Description |
The purpose of this study was to describe how neonatal endotracheal suctioning (ETS) is performed in two local Level III neonatal intensive care units. The following suctioning components were examined: (a) numbers of catheter insertions, (b) head rotation, (c) depth of catheter insertion, (d) irrigant administration, (e) negative pressure application, and (f) oxygen delivery. Informed consent was obtained from the 50 nurses and from parents of infants observed during the suctioning procedure. Data collection included a questionnaire about the nurses' background and direct observation of the suctioning procedure. The nurses had an average of 10 years experience, with 7.2 years in neonatal Nursing;. The nurses' background and experience were similar at both institutions. The mean gestational age of the infants was 29 weeks; the mean postnatal age was 21.5 days; and the mean postnatal weight was 1,437 grams. There was a mean of 3.7 catheter insertions per procedure (range = one to five), with a total of 186 catheter insertions during the 50 procedures. Deep and shallow suction groups were created based on mean catheter-insertion depth per procedure. Shallow suctioning ws performed during 9 procedures, and deep suctioning was performed in the remaining 41 procedures. Overall, in 79% of the 186 catheter insertions, the suction catheter was inserted further the 0.5 cm beyond the tip of the endotracheal tube (ETT). Sixty-eight percent of the infants experienced head rotation as part of the suction procedure. Normal saline was used as an irrigant in all but 2 procedures. Irrigant was administered before 51% of the catheter insertions. The mean negative pressure setting of the suction apparatus was 97 mm Hg. Thirty-nine procedures utilized manual ventilation with a two-person suctioning method. Eleven procedures used the ventilator with a one-person suctioning method. Only 20% of the nurses reported changing the inspired oxygen before suctioning. Deep suctioning and head rotation were prevalent in this study despite complications documented with this practice. Shallow suctioning without a change in head position should be routine practice, unless clinical evidence is present to justify deep suctioning. Although hyperoxygenation has been shown to decrease the amount of hypoxemia during suctioning, it was used minimally. |
