Closed Tracheal Suction Systems: Effectiveness and Nursing Implications

Abstract

Closed tracheal suction systems (CTSS) are currently being used to minimize complications associated with endotracheal suctioning. Advantages of CTSS include improved oxygenation, decreased clinical signs of hypoxemia, maintenance of positive end-expiratory pressure, infection control, convenience, cost, and reduced patient anxiety. Some concerns related to use of CTSS include autocontamination, decreased effectiveness, difficult to use, excess negative pressure, and airway trauma. Strategies for reducing these and other concerns are shared. Recommendations for nursing practice and nursing research are discussed

The practice and perception of intensive care staff using the closed suctioning system

“…Over the 8-week study period, in nearly half of the total responses the CSS was reported as not always being effective in removing patients' secretions. This is in keeping with the perceptions of other critical care staff (Noll et al 1990, Crimlisk et al 1994. In reality, however, one cannot presume that this concern is a consequence of using the CSS because the inability to remove secretions effectively may be related to other factors such as suction pressures, the tenacity of secretions, airway humidity and the patient's hydration status.…”

“…This connoisseurship', or`tacit knowledge' of suctioning has been referred to only brie¯y in the literature. Noll et al (1990) reported that many nurses expressed concern that, when using the CSS, they lost the same`feel' for suctioning which they had when using the conventional catheter. Carlon et al (1987 p. 525) also reported that the main disadvantage cited by 52 nurses using the CSS was thè reduction in the subjective perception of the direction toward which the catheter tip was moving'.…”

“…• does not adequately remove patients’ secretions ( Noll et al . 1990 , DePew & Noll 1993, Crimlisk et al .…”

“…The physiological bene®ts of the CSS are important to the critically ill patient, but despite the bene®ts, some concerns have been raised in relation to its use. Some authors reported concerns raised by nurses and physiotherapists that the CSS: does not adequately remove patients' secretions (Noll et al 1990, DePew & Noll 1993, Crimlisk et al 1994; can be dif®cult to use and manipulate (Noll et al 1990, Witmer et al 1991; does not provide the same`feel' associated with conventional suctioning (Carlon et al 1987, Noll et al 1990, DePew & Noll 1993, Crimlisk et al 1994; and may require higher suction pressures (DePew & Noll 1993, Crimlisk et al 1994.…”

How I Learned My ABCs: Action, Back to Basics, Collaboration, Discovery

“…Because little had been published on closed suctioning, we then wrote one of the first nursing articles on the subject. 3 Now we know that closed suction is widely used for endotracheal suctioning 4 and does not increase the risk for VAP. 5 I remain interested in outcomes and issues associated with closed suctioning.…”