Endotracheal Suctioning Knowledge And Practice Among Critical Care Practitioners In Intensive Care Units

1.1 BACKGROUND OF THE STUDY

Endotracheal suctioning is a clinical procedure that helps to clear airways in the respiratory system by mechanically removing accumulated pulmonary secretions in patients with artificial airways (Sharma, Sarin & Bala, 2014). Critically ill patients with artificial airways require endotracheal suctioning to remove secretions and prevent airway obstruction, without which the patient may experience inadequate oxygenation and ventilation. Endotracheal intubation is an artificial airway that inhibits cough reflex and interferes with normal muco-ciliary function, therefore increasing airway secretion production and decreasing the ability to clear such secretions (The Royal Children’s Hospital Melbourne, 2012). Although endotracheal suctioning is an essential way of maintaining ventilation and oxygenation in patients with such artificial airways, it can result in adverse effects and serious complications when performed inappropriately or incorrectly (Kelleher & Andrews, 2008).

Day, Farrell and Hayes (2012) observed that the mean score for knowledge was 11.1 and majority of the subjects failed to perform suctioning as accurately as they had claimed. Similarly, in Cairo, a study by Nahla (2013) revealed that less than half of the nurses recognized closed system suctioning as recommended, while the rest were unfamiliar with closed system suctioning. Heyland, Cook and Dodek (2012) also reported on prevention of ventilator associated pneumonia practice in Canadian critical care units that nurses were familiar with closed suctioning practices because such practices were common in 88% of the ICUs. Sierra (2010) reported that in Spain open tracheal suctioning was reported in 96% of the ICUs and added that closed suction systems are not commonly used, and thus nurses were unfamiliar with those systems. More than half of the nurses in the study knew that frequent change in suction systems, and kinetic beds decrease the risk and occurrence of pneumonia. While only 48% of nurses knew that semi-recumbent positioning help in prevention of pneumonia. A major responsibility of critical care practitioners is the management of critically ill patients with life threatening conditions that require dealing with the airway (Cattano and Cavallo, 2010). Endotracheal suctioning provides a direct opening for micro aspiration of secretions (Nseir, et al, 2011). 

Pery and Porter (2009) explained that endotracheal suctioning clears secretion from the airway of patients who cannot mobilize and expectorate them without assistance. Darrel, Farnell, Haynes, utilized triangulated method of observation, interview and questionnaire methods to explore nurses’ theoretical knowledge and practical competence in endotracheal suctioning. Sole and Bennett (2014) conducted a comparison of airway management practices between registered nurses and respiratory care practitioners. A study was conducted by Mathew (2011) to determine the effectiveness of planned teaching programme on knowledge and practices of endotracheal suctioning procedure among staff nurses in the different units of selected hospital in Mangalore. the findings of Sharma, Sarin and Bala (2014) that indicated that nursing personnel had below average knowledge and poor practices regarding endotracheal suctioning during reimplementation phase were consistent with the findings of the study conducted by Dayalan, Fernadesh and Harayan (2010) to explore the nurse’s knowledge and competence regarding endotracheal suctioning in acute and high dependency ward areas in India There are observations that the critical care practitioners do not often adhere to the recommended procedures by the World Health Organisation and their level of competence in endotracheal suctioning practices is below expectation (Akram, Negin, Mohsen & Mohammadreza, 2012; Bighamian, Zarkeshan & Rafieeano, 2010; George & Sequiera, 2010).

1.2 Statement of the Problem

Hospital acquired infections such as Ventilator Assisted Pneumonia (VAP) among critical care patients is a major healthcare challenge. Incidence of hospital acquired infections has continued to rise, especially in the developing countries, despite advancements in health technology (Ulu-Kilic & Ahmed, 2013). Although they account for fewer than 10% of total beds in most hospitals, more than 20% of all nosocomial infections are acquired in ICUs (Ulu-Kilic & Ahmed, 2013). This study investigates endotracheal suctioning knowledge and practice among critical care practitioners in intensive care units in University of Calabar Teaching Hospital, Calabar, Cross River State.

1.3 Objectives of the Study

The aim of this study is to assess endotracheal suctioning knowledge and practice among critical care practitioners in intensive care units in University of Calabar Teaching Hospital, Calabar, Cross River State. The specific objectives of the study is to:

1. Identify knowledge of endotracheal suctioning procedure among critical care practitioners’ in University of Calabar Teaching Hospital (UCTH), Calabar.

1.4 Significance of the Study

This study would be of immense benefit to health personnel/workers (physicians and nurses), researchers and the entire society. Physicians and nurses working in ICU in conjunction with hospital management would through the findings of this study prepare protocol for endotracheal suctioning in UCTH, Calabar. This will enable them adhere to recommended suctioning techniques. Researchers would benefit from this study because it will serve as a reference material and it will add to existing literature on knowledge, practice and competence of endotracheal suctioning in the management of patients in critical care units.

1.5 Scope of the Study

The focus of this study is to assess endotracheal suctioning knowledge and practice among critical care practitioners in intensive care units in University of Calabar Teaching Hospital, Calabar, Cross River State. It will involve both nurses and physicians that work in the critical care unit of UCTH, Calabar.