Development of Clinical Criteria to Assess the
Indications for Performing Endo-tracheal Suctioning
Angela Lutz, RRT-NPS,
Kenneth Miller, RRT-NPS, Linda Cornman, RRT-NPS,
Daniel Ray, MD, Kenton Clay, RRT,
Steven Pyne, RRT, Joseph Groller, RRT,
Nancy Ayers, RRT-NPS, AC-E. Lehigh
Valley Hospital, Allentown, PA 18105.
Introduction: Performing endo-tracheal suctioning can be very therapeutic and
improve gas exchange. However, often endo-tracheal suctioning is
performed as a part of routine airway care without much regard to
assessment. Endo-tracheal suctioning can cause adverse clinical
events leading to cardiac instability. Also, airway trauma can occur
even under the best technique or healthy airway tissue with repeated
passages. Often the frequency and outcome of suctioning is poorly
documented or evaluated. To address this issue, we developed clinical
assessment criteria for performing endo-tracheal suctioning and to
ensure proper documentation of the outcome of
the procedure.
Methods: Over a
one year period we reviewed our current suctioning practices and
reviewed the literature for current recommendations and practices. We
found that in our own practice endo-tracheal suctioning was based
more on routine practice than clinical assessment. Literature
findings contain a dearth of information on clinical assessment and
dealt more with technique and adverse effects than outcomes.
Secondary to our findings we developed clinical criteria based on
assessment on when to perform endo-tracheal suctioning and how to
document clinical outcome.
Results: Endo-tracheal suctioning was to be based on the following:
Evidence of impaired gas
exchange noted by decrease in Sp02 and/or elevation in ETCO2 with an
obstructive waveform.
Ventilator waveform analysis
noted by a saw-tooth pattern on the expiratory phase
of
the time/flow curve.
Increase in RAW or decrease in
compliance noted by increase in PIP and Plateau pressure.
Reduction of exhaled tidal
volume during pressure ventilation including: APRV, PCV, PSV.
Evidence of
increase work of breathing noted by increase in respiratory rate,
accessory muscle use, P01>4 and reduction in exhaled
tidal volume.
Perform suctioning assessment
every eight(8) hours if
ventilated
via High Frequency Percussive Ventilation.H.
Secretions are visible or audible in the artificial airway.
A thirty three percent reduction in
routine suctioning was noted and a ninety percent compliance with
documentation of assessment and outcome was achieved.
Conclusion: Based on our clinical experience, developing sound assessment-based
clinical criteria for performing any intervention is essential to
provide optimal airway care. Future ventures will include teaching
all of the clinical team to utilize our assessment-based criteria
when considering performing
endo-tracheal suctioning.
