investigation of intensive care nurses’ knowledge and ... · İlkİn yilmaz, dİlek Özden,...

INVESTIGATION OF INTENSIVE CARE NURSES’ KNOWLEDGE AND ATTITUDES

REGARDING CLOSED SUCTIONING SYSTEMİLKİN YILMAZ, DİLEK ÖZDEN, GÜLŞAH GÜROL ARSLAN

DOKUZ EYLÜL UNIVERSITY, İZMİR, TURKEY

[email protected]

SUCTIONING

• Endotracheal suctioning is the

removal of secretions from

tracheobroncheal tree through an

artificial airway with the help of

mechanical suction device.

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Çelik and Elbaş 2000; Maggiore 2006; Sole et al. 2002

SUCTIONING-2

• The suctioning procedure performed to

remove secretions from the airway and to

keep it clean allowing patients to breathe

more effectively and comfortably.

• Nurses should do suctioning very carefully

and meticulously before, during, and

after suctioning.

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Çelik and Elbaş 2000; Maggiore 2006; Sole et al. 2002

Manysuctioning

complicationsHypoxemia Bradycardia Tachycardia

HypotensionCardiac

arrhythmia Cardiac arrestAtelectasis

BronchospasmIncreased

intracranial pressure

Nosocomial infection

Tracheobronchial injury

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Choong et al. 2003; Jongerden et al. 2012; Oh and Seo 2003

Open suctioning system

Closed suctioning system

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Cereda et al. 2001; Johnson et al. 1994; Jongerden et al. 2012, Özden and Görgülü 2014

• Although these advantages of the closed suctioning system are

known, literature findings show that it is not frequently preferred

method in clinics.

• There are lots of studies about nurses knowledge and attitudes

about endotracheal suctioning, however there are a small

number of studies which evaluate the effectiveness of closed

suctioning systems based on nurses' opinions.

Blackwood 1998; Carroll 2000; Fidan 2013; Day, Iles and Griffiths 2009; Adair et al. 2014; Day, Wainwright and Wilson-Barnett 2001; Day and Farnell 2002; Imaiso, Yamauchi 2009; Negro et al. 2014; Bülbül Maraş, Kocaçal Güler, Eşer and Köse 2017 02.05.2017

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AIMS

This study was conducted

to determine the knowledge levels of

nurses for closed suctioning systems

to investigate nurses attitudes and

reasons behindchoosing them.

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DESIGN

June 2016

March 2017

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Descriptive, cross-sectional

SETTING AND SAMPLE

Hospitals Intensive care units Total

Internal medicine Anesthesia

A 35 29 64 (100%)

B 35 - 35 (97.2%)

C - 52 52 (100%)

D - 27 27 (84.3%)

E 16 7 23 (33.3%)

Total 86 115 201 (79.44)

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STUDY INSTRUMENTS

•20-item structured and self-administeredquestionnaire

Closed Suctioning System Knowledge

Questionnaire

•21-item structured and self-administeredquestionnaire

Nurses Attitudes of Using Closed

Suctioning SystemQuestionnaire

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ETHICAL CONSIDERATION

Ethical approval was granted by the non-interventional research ethical board of the hospital.

All nurses were informed related to the objectives andmethods of the research, and they were provided written consent to participate in the study.

Participation was voluntary. Anonymity and confidentiality were assured.

Written and oral consent were obtained.

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DATA COLLECTION

After ethical and institutional permissions were obtained the participants were informed about the topic and methods of the study.

To prevent participants from answering the questions under each other’s influence, participants were asked to answer the questions in the setting they were in and during a time frame when the researcher is present.

It took approximately 15 minutes to answer the questions.

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DATA ANALYSIS

The Statistical Package For Social Sciences (SPSS) 22.0 program was used to evaluate the data.

Descriptive and deductive statistics were used to analyze the data.

The statistical significance value was taken as p<0.05.

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RESULTS

Table 1. The distribution of the nurses' descriptive characteristics n %

Gender

Female 160 79.6

Male 41 20.4

Age (mean age=30.53 ± 6.25 years)

20-29 yrs 108 53.7

30-39 yrs 75 37.3

40-49 yrs 18 9.0

Education level

Vocational high school of health 24 11.9

Associate degree 15 7.5

Graduate and higher 162 80.6

Intensive Care Units

Internal Medicine ICU 86 42.8

Anesthesiology ICU 115 57.2

Total intensive care experience (mean= 5.79 ± 5.30 yrs)

1- 5 years 119 59.2

6 - 10 years 55 27.4

11 years and longer 27 13.4

Having received in-service training about closed suctioning

systems

Yes 74 36.8

No 127 63.202.05.2017

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Table 2. The distribution of the nurses' mean knowledge scores with respect to their descriptive characteristics

Mean scores= 30.53 ± 6.25 (0-100 points) n X ± SS test p

Age groups

20-29 years 108 34.81±14.91

30-39 years 75 35.13±13.17 1.396 H 0.498

40-49 years 18 34.16±18.08

Gender

Female 160 35.06±14.17 0.359 t 0.720

Male 41 34.14±16.00

Education level

Vocational high school of health 24 30.20±16.64

Associate degree 15 32.66±9.79 2.998H 0.223

Graduate and higher 162 35.77±14.48

t: Student t-testH: Kruskal-Wallis test 02.05.2017

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Table 2. The distribution of the nurses' mean knowledge scores with respect to their descriptive characteristics

n X ± SS test p

Institution worked in

University hospital 87 35.28±12.83 0.360 t 0.719

State hospital 114 34.56±15.74

Intensive Care Unit

Internal Medicine ICU 86 40.75±13.60 5.285 t 0.000*

Anesthesiology ICU 115 30.47±13.66

Total work years

1- 5 years 88 34.77±15.47

6 - 10 years 64 36.48±13.38 0.819 F 0.442

11 years and longer 49 32.95±14.24

Total intensive care experience

1- 5 years 119 36.17±14.78

6 - 10 years 55 32.00±13.38 3.428 H 0.180

11 years and longer 27 35.00±15.31

t: Student t-testF: One-way ANOVA analysisH: Kruskal-Wallis test

*p<0.001

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The nurses' attitudes towards closed aspiration systems

UseSecretion suctioningcapasity

Contamination Time and cost Complication

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Table 3. The answers nurses gave for the suggestions regarding closedsuctioning systems

I agree I do not agree I am undecided

n % n % n %

Use

It can be used in all patients have artificialairways.

117 58.2 47 23.4 37 18.4

It can only be used in isolated patients. 42 20.9 127 63.2 32 15.9

The transparent sheath around the catheter doesn’t allow it to insert into the airway. 31 15.4 128 63.7 42 20.9

The catheter is hard to use. 20 10.0 141 70.1 40 19.9

The CSS duration is shorter. 120 59.7 43 21.4 38 18.9

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n % n % n %

Suctioning capasity

It is not the appropriate method for suctioning excessive secretions.

41 20.4 119 59.2 41 20.4

It suctions secretions more effectively. 82 40.8 51 25.4 68 33.8

It is ineffective for suctioning thick and sticky secretions.

100 49.8 47 23.4 54 26.9

Coude tip catheters are ineffective for suctioning secretions. 48 23.9 80 39.8 73 36.3

Straight tip catheters are effective for suctioning secretions.

74 36.8 55 27.4 72 35.8


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n % n % n %

Contamination

There is no need to clean it with saline after the procedure. 82 40.8 87 43.3 32 15.9

The risk of the Ventilator Associated

Pneumonia decreases by using closedsuctioning system.

133 66.2 21 10.4 47 23.4

It prevents secretions to contaminate the patient.

160 79.6 13 6.5 28 13.9

It prevents secretions to contaminate the nurse.

175 87.1 3 1.5 23 11.4

It prevents secretions to contaminate the environment.

174 86.6 5 2.5 22 10.9


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n % n % n %

Time and cost

Nurses spend less time while suctioning procedure.

167 83.1 8 4.0 26 12.9

It decreases cost of care not to use equipment such as sterile gloves, masks or glasses. 153 76.1 11 5.5 37 18.4

The high price of the catheter increases the cost of care.

65 32.3 72 35.8 64 31.8

It takes lots of time when I need to change

them respectively closed and open systems forsubglottic secretions and vice versa. 73 36.3 81 40.3 47 23.4


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n % n % n %

Complication

It prevents hypoxemia, atelectasis and cardiac arrhythmia.

91 45.3 39 19.4 71 35.3

Coude type suction catheter increases the risk of bleeding complication. 54 26.9 53 26.4 94 46.8


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CONCLUSIONSBased on the findings of the study it was determined that the nurses'

knowledge about closed system aspiration was insufficient.

While most of the nurses reported that the transparent sheath around the catheter allow it inserted into the tube and it was easy to use, only nearly

half of the nurses expressed that the catheter was ineffective for suctioning the thick and sticky secretions.

A major part of the nurses reported that this catheter reducedcontamination risks of the patient, the environment, and the nurse.

A major part of the nurses considered that closed system aspiration wastime and cost-effective.

We suggest that trains in clinics should do regularly, in periodic time under the guidance of clinical best practice guidelines about CSS.

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REFERENCES

• Blackwood B. The Practice and Perception of Intensive Care Staff Using the Closed Suctioning System. JAN, 1998; 28(5): 1020-1029.

• Caroll P. Should Suctioning be Left to the Nurse? Am J Crit Care, 2000; 9(2): 85-86.

• Cereda M, Villa F, Colombo E, Greco G, Nacoti M, Pesenti A. Closed System Endotracheal Suctioning Maintains Lung Volume DuringVolume-Controlled Mechanical Ventilation. Intensive Care Med, 2001; 27: 648-654.

• Choong K, Chatrkaw P, Frndova H, Cox PN. Comparison of Loss in Lung Volume with Open versus In-line Catheter Endotracheal Ssuctioning. Pediatr Crit Care Med, 2003; 4(1): 69-73.

• Çelik SŞ, Elbaş NÖ. The Standard of Suction for Patients undergoing Endotracheal Intubation. Intensive Crit Care Nurs, 2000;16: 191-198.

• Johnson KL, Kearney PA, Johnson SB, Niblett JB, Macmillan NL, McClain NL. Closed versus Open Endotracheal Suctioning: Costs and Physiologic Consequences. Crit Care Med, 1994; 22(4): 658-665.

• Jongerden IP, Kesecioglu J, Speelberg B, Buiting AG, Leverstein-van Hall MA, Bonten MJ. Changes in Heart Rate, Mean Arterial Pressure, and Oxygen Saturation after Open and Closed Endotracheal Suctioning: A Prospective Observational Study. J Crit Care, 2012; 27: 647–654.

• Maggiore SM. Endotracheal Suctioning, Ventilator-associated Pneumonia, and Costs: Open or Closed Issue? Intensive Care Med, 2006; 32: 485-487.

• Oh H, Seo H. A Meta-analysis of the Effects of Various Interventions in Preventing Endotracheal Suction-induced Hypoxemia. J Clin Nurs, 2003; 12: 912-924.

• Özden D, Görgülü S. Effects of Open and Closed Suction Systems on the Haemodynamic Parameters in Cardiac Surgery Patients. Nurs CritCare, 2014; 20(3): 118-125.

• Sole ML, Byers JF, Ludy JE, Zang Y, Banta CB, Brummel K. A Multisite Survey of Suctioning Tecniques and Airway Management Practices. Am J Crit Care, 2002; 12(3): 220-232.

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• Teşekkürler…

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investigation of intensive care nurses’ knowledge and ... · İlkİn yilmaz, dİlek Özden,...

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