Intensive and Critical Care Nursing
Volume 25, Issue 1 , Pages 21-30 , February 2009

Endotracheal suctioning of the adult intubated patient—What is the evidence?

  • Carsten M. Pedersen

      Affiliations

    • Intensive Care Unit, Frederiksberg Hospital, DK, Denmark
  • ,
  • Mette Rosendahl-Nielsen

      Affiliations

    • Intensive Care Unit, Rigshospitalet, DK, Denmark
  • ,
  • Jeanette Hjermind

      Affiliations

    • Bispebjerg Hospital, DK, Denmark
  • ,
  • Ingrid Egerod

      Affiliations

    • The University Hospitals Centre for Nursing and Care Research, Rigshospitalet, Department 7331, Blegdamsvej 9, DK-2100 Copenhagen O, Denmark
    • Corresponding Author InformationCorresponding author. Tel.: +45 35457365; fax: +45 35457399.

,Accepted 28 May 2008.

References 

  1. Ackerman MH. The effect of saline lavage prior to suctioning. Am J Crit Care. 1993;2(4):326–330
  2. Akgul S, Akyolcu N. Effects of normal saline on endotracheal suctioning. J Clin Nurs. 2002;11(6):826–830
  3. Almgren B, Wickerts CJ, Heinonen E, Hogman M. Side effects of endotracheal suction in pressure- and volume-controlled ventilation. Chest. 2004;125(3):1077–1080
  4. Almgren B. Endotracheal suction a reopened problem [dissertation].Uppsala: Acta Universitatis Upsaliensis; 2005.
  5. American Association of Respiratory Care . AARC clinical practice guidelines: endotracheal suctioning of mechanically ventilated adults and children with artificial airways. Respir Care. 1993;38(4):500–504
  6. Bergbom-Engberg I. Patients’ experiences of respirator treatment: a retrospective study of the influence of medical and nursing care factors on recall, experience of discomforts, and feelings of security or insecurity [dissertation]. Göteborg: University of Göteborg; 1989.
  7. Blackwood B. The practice and perception of intensive care staff using the closed suctioning system. J Adv Nurs. 1998;28(5):1020–1029
  8. Blackwood B, Webb CH. Closed tracheal suctioning systems and infection control in the intensive care unit. J Hosp Infect. 1998;39(4):315–321
  9. Blackwood B. Normal saline instillation with endotracheal suctioning: primum non nocere (first do no harm). J Adv Nurs. 1999;29(4):928–934
  10. Bostick J, Wendelgass ST. Normal saline instillation as part of the suctioning procedure: effects on PaO2 and amount of secretions. Heart Lung. 1987;16(5):532–537
  11. Branson RD, Cambell RS, Chatburn RL, Covington J. AARC clinical practice guideline: endotracheal suctioning of mechanically ventilated adults and children with artificial airways. Respir Care. 1993;38(5):500–504
  12. Celik SS, Elbas NO. The standard of suction for patients undergoing endotracheal intubation. Intensive Crit Care Nurs. 2000;16(3):191–198
  13. Celik SA, Kanan N. A current conflict: use of isotonic sodium cloride solution on endotracheal suctioning in critically ill patients. Dimens Crit Care Nurs. 2006;25(1):11–14
  14. Cereda M, Villa F, Colombo E, Greco G, Nacoti M, Pesenti A. Closed system endotracheal suctioning maintains lung volume during volume-controlled mechanical ventilation. Intensive Care Med. 2001;27(4):648–654
  15. Chirag S, Kollef MH. Endotracheal tube intraluminal loss among mechanically ventilated patients. Crit Care Med. 2004;31(1):120–125
  16. Clapham L, Harrison J, Raybould T. A multidisciplinary audit of manual hyperinflation technique (sigh breath) in a neurosurgical intensive care unit. Intensive Crit Care Nurs. 1995;11(5):265–271
  17. Cobley M, Atkins M, Jones PL. Environmental contamination during tracheal suction: a comparison of disposable conventional catheters with a multiple-use closed system device. Anaesthesia. 1991;46(11):957–961
  18. Combes P, Fauvage B, Oleyer C. Nosocomial pneumonia in mechanically ventilated patients, a prospective randomised evaluation of the Stericath closed suctioning system. Intensive Care Med. 2000;26(7):878–882
  19. Czarnik RE, Stone KS, Everhart CC, Preusser BA. Differential effects of continuous versus intermittent suction on tracheal tissue. Heart Lung. 1991;20(2):144–151
  20. Danish Standards. Infection control in the health care sector. Part 2: Requirements for hand washing practice for the prevention of nokocomial infection. DS 2451-2. 1st ed. Charlottenlund: Danish Standards; 2001.
  21. Darvas JA, Hawkins LG. The closed tracheal suction catheter: 24h or 48h change?. Aust Crit Care. 2003;16(3):86–92
  22. Day T, Wainwright SP, Wilson-Barnett J. An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units. J Clin Nurs. 2001;10(5):682–696
  23. Day T, Farnell S, Wilson-Barnett J. Suctioning: a review of current research recommendations. Intensive Crit Care Nurs. 2002;18(2):79–89
  24. Demers RR, Saklad M. Minimizing the harmful effects of mechanical aspiration. Heart Lung. 1973;2(4):542–545
  25. Department of Health, UK. Saving Lives, reducing infection, delivering clean and safe care. DoH 2007. http://www.dh.gov.uk.
  26. Deppe SA, Kelly JW, Thoi LL, Chudy JH, Longfield RN, Ducey JP, et al. Incidence of colonization, nosocomial pneumonia, and mortality in critically ill patients using a Trach Care closed-suction system versus an open-suction system: prospective, randomized study. Crit Care Med. 1990;18(12):1389–1393
  27. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36(1):296–327
  28. Dodek P, Keenan S, Cook D, Heyland D, Jacka M, Hand L, et al. Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med. 2004;141(4):305–313
  29. Dyhr T, Bonde J, Larsson A. Lung recruitment manoeuvres are effective in regaining lung volume and oxygenation after open endotracheal suctioning in acute respiratory distress syndrome. Crit Care. 2003;7(1):55–62
  30. Fernandez MD, Piacentini E, Blanch L, Fernandez R. Changes in lung volume with three systems of endotracheal suctioning with and without pre-oxygenation in patients with mild-to-moderate lung failure. Intensive Care Med. 2004;30(12):2210–2215
  31. Freytag CC, Thies FL, Konig W, Welte T. Prolonged application of closed in-line suction catheters increases microbial colonization of the lower respiratory tract and bacterial growth on catheter surface. Infection. 2003;31(1):31–37
  32. George RB. Duration of suctioning: an important variable. Respir Care. 1983;28(4):457–459
  33. Gjengedal E. Understanding a world of critical illness: a phenomenological study of the experiences of respirator patients and their caregivers [dissertation]. Bergen: Department of Public Health and Primary Health Care, Division for Nursing Science, University of Bergen; 1994.
  34. Glass C, Grap MJ, Corley MC, Wallace D. Nurses’ ability to achieve hyperinflation and hyperoxygenation with a manual resuscitation bag during endotracheal suctioning. Heart Lung. 1993;22(2):158–165
  35. Glass C, Grap MJ. Ten tips for safer suctioning. Am J Nurs. 1995;95(5):51–53
  36. Glass C, Grap MJ, Sessler CN. Endotracheal tube narrowing after closed-system suctioning: prevalence and risk factors. Am J Crit Care. 1999;8(2):93–100
  37. Gray JE, MacIntyre NR, Kronenberger WG. The effects of bolus normal-saline instillation in conjunction with endotracheal suctioning. Respir Care. 1990;35(8):785–790
  38. Guglielminotti J, Alzieu M, Maury E, Guidet B, Offenstadt G. Bedside detection of retained tracheobronchial secretions in patients receiving mechanical ventilation: is it time for tracheal suctioning?. Chest. 2000;118(4):1095–1099
  39. Hagler DA, Traver GA. Endotracheal saline and suction catheters: sources of lower airway contamination. Am J Crit Care. 1994;3(6):444–447
  40. Hanley MV, Ruud T, Butler J. What happens to endotracheal instillations? [abstract]. Am Rev Respir Dis. 1978;117(4 II):124
  41. Isea JO, Poyant D, O’Donnell C, Faling LJ, Karlinsky J, Celli BR. Controlled trial of a continuous irrigation suction catheter vs. conventional intermittent suction catheter in clearing bronchial secretions from ventilated patients. Chest. 1993;103(4):1227–1230
  42. Jablonski RS. The experience of being mechanically ventilated. Qual Health Res. 1994;4(2):186–207
  43. Johnson KL, Kearney PA, Johnson SB, Niblett JB, MacMillan NL, McClain RE. Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med. 1994;22(4):658–666
  44. Jongerden IP, Rovers MM, Grypdonck MH, Bonten MJ. Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: a meta-analysis. Crit Care Med. 2007;35(1):260–270
  45. Khatib M, Jamaleddine G, Abdallah A, Ibrahim Y. Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU. Chest. 1999;116(1):172–175
  46. Kinloch D. Instillation of normal saline during endotracheal suctioning: effects on mixed venous oxygen saturation. Am J Crit Care. 1999;8(4):231–240
  47. Kollef MH, Prentice D, Shapiro SD, Fraser VJ, Silver P, Trovillion E, et al. Mechanical ventilation with or without daily changes of in-line suction catheters. Am J Respir Crit Care Med. 1997;156(2 Pt 1):466–472
  48. Lascoki S, Qin L, Sartorius A, Fouillat D, Remerand F, Rouby J. Open and closed-circuit endotracheal suctioning in acute lung injury. Anesthesiology. 2006;104(1):39–47
  49. Lindgren S, Almgren B, Hogman M, Lethvall S, Houltz E, Lundin S, et al. Effectiveness and side effects of closed and open suctioning: an experimental evaluation. Intensive Care Med. 2004;30(8):1630–1637
  50. Lookinland S, Appel PL. Hemodynamic and oxygen transport changes following endotracheal suctioning in trauma patients. Nurs Res. 1991;40(3):133–139
  51. Lorente L, Lecuona M, Martin MM, Garcia C, Mora ML, Sierra A. Ventilator-associated pneumonia using a closed versus an open tracheal suction system. Crit Care Med. 2005;33(1):115–119
  52. Maggiore SM, Lellouche F, Pigeot J, Taille S, Deye N, Durrmeyer X, et al. Prevention of endotracheal suctioning-induced alveolar derecruitment in acute lung injury. Am J Respir Crit Care Med. 2003;167(9):1215–1224
  53. Maggiore SM. Endotracheal suctioning, ventilator-associated pneumonia, and costs: open or closed issue?. Intensive Care Med. 2006;32(4):244–248
  54. McKelvie S. Endotracheal suctioning. Nurs Crit Care. 1998;3(5):244–248
  55. O’Neal PV, Grap MJ, Thomson C, Dudley W. Level of dyspnoea experienced in mechanically ventilated adults with and without saline instillation prior to endotracheal suctioning. Intensive Crit Care Nurs. 2001;17(6):356–363
  56. Odell A, Allder A, Bayne R, Everett C, Scott S, Still B, et al. Endotracheal suction for adult, non-head-injured, patients. A review of the literature. Intensive Crit Care Nurs. 1993;9(4):274–278
  57. Oh H, Seo W. A meta-analysis of the effects of various interventions in preventing endotracheal suction-induced hypoxemia. J Clin Nurs. 2003;12(6):912–924
  58. Patak L, Gawlinski A, Fung I, Doering L, Berg J. Patients’ reports of health care practitioner interventions that are related to communication during mechanical ventilation. Heart Lung. 2004;33:308–321
  59. Rabitsch W, Kostler WJ, Fiebiger W, Dielacher C, Losert H, Sherif C, et al. Closed suctioning system reduces cross-contamination between bronchial system and gastric juices. Anesth Analg. 2004;99(3):886–892
  60. Reynolds P, Hoffman LA, Schlichtig R, Davies PA, Zullo TG. Effects of normal saline instillation on secretion volume, dynamic compliance and oxygen saturation. Am Rev Res Dis. 1990;141(4 Suppl. 2):A574
  61. Robson WP. To bag or not to bag? Manual hyperinflation in intensive care. Intensive Crit Care Nurs. 1998;14(5):239–243
  62. Rogge JA, Bunde L, Baun MM. Effectiveness of oxygen concentrations of less than 100% before and after endotracheal suctioning in patients with chronic obstructive pulmonary disease. Heart and Lung. 1989;18(January (1)):64–71
  63. Rolfe G. Insufficient evidence: the problems of evidence-based nursing. Nurse Educ Today. 1999;19(6):433–442
  64. Rosen M, Hillard EK. The effects of negative pressure during tracheal suction. Anesth Analg. 1962;41:50–57
  65. Rycroft-Malone J, Seers K, Titchen A, Harvey G, Kitson A, McCormack B. What counts as evidence in evidence-based practice?. J Adv Nurs. 2004;47(1):81–90
  66. Sackett DL, Rosenberg W, Gray JAM, Haynes RB. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312:71–72
  67. Scoble MK, Copnell B, Taylor A, Kinney S, Shann F. Effect of reusing suction catheters on the occurrence of pneumonia in children. Heart Lung. 2001;30(3):225–233
  68. Shah C, Kollef MH. Endotracheal tube intraluminal volume loss among mechanically ventilated patients. Crit Care Med. 2004;32(1):120–125
  69. Sole ML, Byers JF, Ludy JE, Zhang Y, Banta CM, Brummel K. A multisite survey of suctioning techniques and airway management practices. Am J Crit Care. 2003;12(3):220–230
  70. Statens Serum Institut. Råd og anvisninger om infektionsprofylakse i relation til ventilations-og respirationsudstyr i sundhedssektoren [engelsk oversættelse af titel]. 1. ed. Copenhagen: Central Department for Hospital Hygiene, SSI; 2001.
  71. Stenqvist O, Lindgren S, Karason S, Sondergaard S, Lundin S. Warning! Suctioning. A lung model evaluation of closed suctioning systems. Acta Anaesthesiol Scand. 2001;45(2):167–172
  72. Tenaillon A. Tracheobronchial suctions during mechanical ventilation. Update Intensive Care Emerg Med. 1990;10:196–200
  73. Thomson L, Morton R, Cuthbertson S. Tracheal suctioning of adults with an artificial airway. Best Practice. 2000;4(4):1–6
  74. Tiffin NH, Keim MR, Frewen TC. The effects of variations in flow trough an insufflating catheter and endotracheal-tube and suction-catheter size on test-lung pressures. Respir Care. 1990;35(9):889–897
  75. Topeli A, Harmanci A, Cetinkaya Y, Akdeniz S, Unal S. Comparison of the effect of closed versus open endotracheal suction systems on the development of ventilator-associated pneumonia. J Hosp Infect. 2004;58(1):14–19
  76. Van de Leur JP, Zwaveling JH, Loef BG, Van der Schans CP. Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients: a prospective randomised controlled trial. Intensive Care Med. 2003;29(3):426–432
  77. Van de Leur JP, Zwaveling JH, Loef BG, Van der Schans CP. Patient recollection of airway suctioning in the ICU: routine versus a minimally invasive procedure. Intensive Care Med. 2003;29(3):433–436
  78. Witmer MT, Hess D, Simmons M. An evaluation of the effectiveness of secretion removal with the Ballard closed-circuit suction catheter. Respir Care. 1991;36(8):844–848
  79. Wood CJ. Can nurses safely assess the need for endotracheal suction in short-term ventilated patients, instead of using routine techniques?. Intensive Crit Care Nurs. 1998;14(4):170–178
  80. Wood CJ. Endotracheal suctioning: a literature review. Intensive Crit Care Nurs. 1998;14(3):124–136
  81. Young CS. Recommended guide lines for suction. Physiotherapy. 1984;70(3):106–108
  82. Zeitoun SS, de Barros AL, Diccini S. A prospective, randomized study of ventilator-associated pneumonia in patients using a closed vs. open suction system. J Clin Nurs. 2003;12(4):484–489

PII: S0964-3397(08)00056-6

doi: 10.1016/j.iccn.2008.05.004

Intensive and Critical Care Nursing
Volume 25, Issue 1 , Pages 21-30 , February 2009