Nurses Practices on Closed Endotracheal Tube Airway Suctioning at Kenyatta National Hospital Adult Critical Care Unit

Abstract

Background: In critical care settings, endotracheal tube airway suctioning (ETS) is an important procedure for airway management in patients under mechanical ventilation. It is important that nurses working in critical care settings have the necessary knowledge and skills on ETS because inappropriately or incorrectly performed ETS can cause serious complications. Objective: To determine the practices on closed endotracheal tube airway suctioning method among nurses at KNH adult critical care unit. Methods: This was an observational descriptive cross-sectional study conducted among nurses working in adult critical care unit at Kenyatta National Hospital. A hundred and eighty five (185) critical care nurses were recruited as study participants using census method. An observation checklist adopted from the WHO’s observational checklist on endotracheal suctioning procedures in critical care settings was used as the study tool. The checklist obtained data on the nurses’ practices before, during and after endotracheal suctioning. Nurses’ mean adherence scores of ≥ 75% showed desirable practice levels while those of < 75% denoted sub-optimal practice levels. The data was descriptively analysed using means and normal variation while the study hypothesis was probed using the multiple linear regression analysis at 95% confidence interval. Appropriate ethical principles were adhered to during the study. Results: The study achieved a response rate of 88.1%. The nurses’ pre-suction practices established to be sub-optimal included ascertaining and documenting the need for suctioning (mean = 60.1%); patient preparation - explaining to the patient about the ETS procedure and reassuring the patient (mean = 20.9%); patient’s chest auscultation before ETS (mean = 33.1%); offering pre-suctioning hyperoxygenation (mean = 21.5%) and checking the cuff pressure (mean = 28.2%). The nurses’ practices during suction established to be sub-optimal included avoiding routine normal saline instillation during endotracheal airway suctioning (mean = 44.8%); limiting the size of suction catheter to not more than half of internal diameter of the endotracheal tube (mean = 57.7%); limiting the number of suction passes to ≤ 2 per ETS procedure (mean = 64.8%); maintaining the duration of suction applied to airway to < 15 seconds (mean = 51.3%); maintaining the level of suction pressure to 80-150mmHg during suctioning (mean = 48.4%) and ensuring humidification by passing saline through the suction catheter (mean = 68.9%). The nurses’ post-suction practices established to be sub-optimal included ensuring post-suctioning hyperoxygenation (mean = 65.7%); providing oral care (mean = 27%); patient’s chest auscultation after endotracheal suctioning (mean = 52.8%); reassuring of the patient (mean = 37.4%); monitoring of patient’s vital signs post-suction (mean = 71.2%); maintaining an optimal cuff pressure post-suctioning (mean = 31.3%) and documentation of outcomes of the ETS procedure (mean = 35%). Conclusion: There were gaps/deficiencies in the practices on closed endotracheal tube airway suctioning among nurses working in adult critical care unit at KNH. Recommendations: There is need for regular on-job trainings, inductions and demonstrations on closed endotracheal tube airway suctioning procedures among critical care nurses working at KNH’s adult critical care unit so as to sharpen their ETS practice skills and competence