Comparison of Airway Management Practices Between Registered Nurses and Respiratory Care Practitioners

2014 ◽  
Vol 23 (3) ◽  
pp. 191-200 ◽  
Author(s):  
Mary Lou Sole ◽  
Melody Bennett
Keyword(s):  
Mechanical Ventilation ◽  
Airway Management ◽  
Registered Nurses ◽  
Endotracheal Tube ◽  
Oral Hygiene ◽  
Shared Responsibility ◽  
Current Evidence ◽  
Respiratory Care ◽  
Endotracheal Suctioning ◽  
Current Practices

BackgroundAirway management, an essential component of care for patients receiving mechanical ventilation, is multifaceted and includes oral hygiene and suctioning, endotracheal suctioning, and care of endotracheal tubes. Registered nurses and respiratory care personnel often share responsibilities for airway management. Knowledge of current practices can help facilitate evidence-based practices to optimize care of patients receiving mechanical ventilation.ObjectivesTo describe current practices for airway management of intubated patients and determine if practices differ between registered nurses and respiratory care practitioners.MethodsA descriptive, comparative design was used. Registered nurses and respiratory care practitioners who provided direct care to intubated patients receiving mechanical ventilation were recruited to complete an online survey of self-reported practices.ResultsA total of 85 participants completed the survey. Most were experienced caregivers with a bachelor’s degree and certification or registration in their field. Selected practices have improved, including increasing oxygen saturation before endotracheal suctioning, maintaining pressure of endotracheal tube cuffs, and providing oral hygiene and suctioning. The practices of registered nurses and respiratory care practitioners differed in many ways. The nurses assumed responsibility for oral antisepsis, whereas the respiratory care practitioners managed the endotracheal tube. The 2 groups shared responsibility for oral and endotracheal suctioning. Knowledge of current guidelines for endotracheal suctioning was lacking.ConclusionsPractices in airway management have improved, but opportunities exist to develop shared policies and procedures based on current evidence.

Endotracheal suctioning: time-worn ritual or timely intervention?

1995 ◽  
Vol 4 (2) ◽  
pp. 100-105 ◽  
Author(s):  
B Copnell ◽  
D Fergusson
Keyword(s):  
Registered Nurses ◽  
Endotracheal Tube ◽  
Theoretical Knowledge ◽  
Objective Data ◽  
Blood Gas ◽  
Hemodynamic Changes ◽  
Endotracheal Suctioning ◽  
Experienced Nurses ◽  
Single Criterion

BACKGROUND: Although many investigators have assessed the technique of endotracheal tube suctioning, the tissue of how frequently it should be performed remains controversial. No objective data is available to determine the answer. OBJECTIVE: To determine the criteria nurses use to make decisions regarding endotracheal suctioning. METHOD: Twenty-four registered nurses of varying levels of experience were asked a series of open-ended questions related to their theoretical knowledge, their ability to apply this knowledge, their suctioning practice, and how they made decisions regarding suctioning. RESULTS: All participants believed their patients required suctioning every 1 to 3 hours, with 17 performing it every 2 to 3 hours. Twenty criteria of which nine related to frequency were used in determining suctioning requirements. Eleven related to recognizing the need for immediate suctioning and were concerned with changes in the patient's condition. Common significant changes included desaturation, hemodynamic changes, loss of color, and blood gas changes. No single criterion was identified by all nurses. No differences were apparent between experienced and less experienced nurses. CONCLUSIONS: The large number of criteria identified suggests that the decision to suction is a complex one. It is a concern that many nurses rely on a deterioration in the patient's condition to indicate when suctioning is required. A policy of suctioning as necessary is provision of clear guidelines and education of all staff.

Current Practice in Airway Management: A Descriptive Evaluation

2010 ◽  
Vol 19 (2) ◽  
pp. 168-173 ◽  
Author(s):  
Rebecca Kjonegaard ◽  
Willa Fields ◽  
Major L. King
Keyword(s):  
Mechanical Ventilation ◽  
Airway Management ◽  
Registered Nurses ◽  
Management Practices ◽  
Current Practice ◽  
Ventilator Associated Pneumonia ◽  
Convenience Sample ◽  
Evidence Based Practices ◽  
Respiratory Therapists ◽  
Care Workers

Background Ventilator-associated pneumonia, a common complication of mechanical ventilation, could be reduced if health care workers implemented evidence-based practices that decrease the risk for this complication. Objectives To determine current practice and differences in practices between registered nurses and respiratory therapists in managing patients receiving mechanical ventilation. Methods A descriptive comparative design was used. A convenience sample of 41 registered nurses and 25 respiratory therapists who manage critical care patients treated with mechanical ventilation at Sharp Grossmont Hospital, La Mesa, California, completed a survey on suctioning techniques and airway management practices. Descriptive and inferential statistics were used to analyze the data. Results Significant differences existed between nurses and respiratory therapists for hyperoxygenation before suctioning (P =.03). In the 2 groups, nurses used the ventilator for hyper-oxygenation more often, and respiratory therapists used a bag-valve device more often (P =.03). Respiratory therapists instilled saline (P <.001) and rinsed the closed system with saline after suctioning (P =.003) more often than nurses did. Nurses suctioned oral secretions (P <.001) and the nose of orally intubated patients (P =.01), brushed patients’ teeth with a toothbrush (P<.001), and used oral swabs to clean the mouth (P <.001) more frequently than respiratory therapists did. Conclusion Nurses and respiratory therapists differed significantly in the management of patients receiving mechanical ventilation. To reduce the risk of ventilator-associated pneumonia, both nurses and respiratory therapists must be consistent in using best practices when managing patients treated with mechanical ventilation.

scholarly journals Airway management in a patient with an intratracheal tumor near the carina by a two-stage operation

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110145
Author(s):  
Chaerim Oh ◽  
Hyun Joo Kim
Keyword(s):  
Mechanical Ventilation ◽  
Airway Management ◽  
General Anesthesia ◽  
Distal Part ◽  
High Flow ◽  
Tracheal Resection ◽  
Two Stage ◽  
Partial Obstruction ◽  
Surgical Access ◽  
Surgical Field

In patients with intratracheal tumors, airway management while maintaining oxygenation and providing surgical access to the airway can be challenging. Here, we present a case of a two-stage operation to remove an intratracheal tumor causing partial obstruction near the carina. In the otorhinolaryngology department, a biopsy was performed during apnea under high-flow nasal oxygenation support. A few days later, a thoracic surgeon performed tracheal resection after sternotomy under general anesthesia. Mechanical ventilation was performed by inserting a sterile endotracheal tube in the resected distal part of the trachea in the surgical field for tracheal end-to-end anastomosis. Airway was successfully secured through close communication between teams of anesthesiologists and surgeons.

scholarly journals Pulmonary atelectasis in newborns with clinically treatable diseases who are on mechanical ventilation: clinical and radiological aspects

2018 ◽  
Vol 51 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Mariana Chiaradia Dominguez ◽  
Beatriz Regina Alvares
Keyword(s):  
Mechanical Ventilation ◽  
Endotracheal Tube ◽  
Left Lung ◽  
Hyaline Membrane Disease ◽  
Relevant Information ◽  
Tube Placement ◽  
Cross Sectional ◽  
Pulmonary Atelectasis ◽  
Radiology Reports ◽  
Endotracheal Tube Placement

Abstract Objective: To analyze the radiological aspects of pulmonary atelectasis in newborns on mechanical ventilation and treated in an intensive care unit, associating the characteristics of atelectasis with the positioning of the head and endotracheal tube seen on the chest X-ray, as well as with the clinical variables. Materials and Methods: This was a retrospective cross-sectional study of 60 newborns treated between 1985 and 2015. Data were collected from medical records and radiology reports. To identify associations between variables, we used Fisher's exact test. The level of significance was set at p < 0.05. Results: The clinical characteristics associated with improper positioning of the endotracheal tube were prematurity and a birth weight of less than 1000 g. Among the newborns evaluated, the most common comorbidity was hyaline membrane disease. Atelectasis was seen most frequently in the right upper lobe, although cases of total atelectasis were more common in the left lung. Malpositioning of the head showed a trend toward an association with atelectasis in the left upper lobe. Conclusion: Pulmonary atelectasis is a common complication in newborns on mechanical ventilation. Radiological evaluation of the endotracheal tube placement provides relevant information for the early correction of this condition.

Mechanical ventilation and respiratory care

2018 ◽  
pp. 255-266
Author(s):  
Bastia Luca ◽  
Magni Federico ◽  
Pozzi Matteo ◽  
Giuseppe Citerio
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Care

scholarly journals Predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Aiko Tanaka ◽  
Akinori Uchiyama ◽  
Yu Horiguchi ◽  
Ryota Higeno ◽  
Ryota Sakaguchi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Spontaneous Breathing Trial ◽  
Leak Test ◽  
Endotracheal Suctioning ◽  
Cuff Leak ◽  
The Impact

AbstractThe cuff leak test (CLT) has been widely accepted as a simple and noninvasive method for predicting post-extubation stridor (PES). However, its accuracy and clinical impact remain uncertain. We aimed to evaluate the reliability of CLT and to assess the impact of pre-extubation variables on the incidence of PES. A prospective observational study was performed on adult critically ill patients who required mechanical ventilation for more than 24 h. Patients were extubated after the successful spontaneous breathing trial, and CLT was conducted before extubation. Of the 191 patients studied, 26 (13.6%) were deemed positive through CLT. PES developed in 19 patients (9.9%) and resulted in a higher reintubation rate (8.1% vs. 52.6%, p < 0.001) and longer intensive care unit stay (8 [4.5–14] vs. 12 [8–30.5] days, p = 0.01) than patients without PES. The incidence of PES and post-extubation outcomes were similar in patients with both positive and negative CLT results. Compared with patients without PES, patients with PES had longer durations of endotracheal intubation and required endotracheal suctioning more frequently during the 24-h period prior to extubation. After adjusting for confounding factors, frequent endotracheal suctioning more than 15 times per day was associated with an adjusted odds ratio of 2.97 (95% confidence interval, 1.01–8.77) for PES. In conclusion, frequent endotracheal suctioning before extubation was a significant PES predictor in critically ill patients. Further investigations of its impact on the incidence of PES and patient outcomes are warranted.

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