This study was carried out to determine endotracheal suctioning knowledge and practice among critical care practitioners in intensive care units of University of Calabar Teaching Hospital. The objectives of the study were to identify critical care practitioners’ knowledge of endotracheal suctioning, evaluate adherence to procedure in endotracheal suctioning, assess their competence in performing endotracheal suctioning, determine if there is an association between knowledge and competence in performing endotracheal suctioning and determine if there are differences in knowledge and practice between the critical care practitioners. A descriptive survey and observational designs were adopted for the study .A total population study of 96 respondents was used for the study. The instrument for data collection was a structured questionnaire and observational checklist. The face and content validity were determined by the supervisor, and two consultant Anaesthetists in UCTH. The results were presented in tables as percentages. Pearson Chi-square test was used to determine the association between the knowledge distribution for doctors and nurses, a Chi-Square Test of Association revealed no significant difference between them, p = .803 at 0.05 level of significance. Majority of practitioners Age between 31-35 years (85.2%) had low knowledge while few (14.8%) had high knowledge. Likewise, practitioners between 36-40 years, (85.2%) had low knowledge while few (14.8%) had high knowledge and those above 40 years, (48.8%), had low knowledge while (51.2%) had high knowledge. However, findings from the study revealed that few physicians, (21.7%) had inadequate adherence to practice of endotracheal suctioning procedure while majority (78.3%) had moderately adequate adherence. Likewise, nurses, (40.7%) had inadequate adherence while (59.3%) had moderately adequate adherence. Out of the 50 critical care practitioners that were assessed using the check-list, all had poor competence in endotracheal suctioning procedure. In conclusion, the overall knowledge of practitioner was low and there was no difference between knowledge and practice among practitioners. However, knowledge did not significantly influence practice of critical care practitioners. It was recommended that a fully equipped modern laboratory be put in place for continuous practice and simulation.
Background to 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).
Patients on mechanical ventilation are vulnerable to disease complications such as alveolar hypoventilation, alveolar hyperventilation, fluid and electrolyte imbalance, pneumothorax and ventilator associated pneumonia, a most common infectious complication accounting for about 47% of all infections among critical care patients (Sharma, Sarin & Bala, 2014). In spite of the fact that most of the technical aspects of managing mechanical ventilator is the responsibility of respiratory care practitioners (physiotherapist who specialized in respiratory care), nurses provide holistic care to patients, including the management of clinical symptoms and responses to mechanical ventilator support (Chlan, 2011).
Critical care practitioners (anesthetists and nurses) are professionals that provide evidence-based assistance in critical care units of healthcare facilities in order to promote quality healthcare services to clients. Such practitioners monitor client’s responses to ventilation intervene to maintain oxygenation and ventilation and ensure that the complex needs of critically ill patients are met. It is very important that critical care practitioners are aware of endotracheal suctioning procedure and are able to practice according to current evidence based recommendations. Knowledge and experience can determine a critical care practitioner’s ability to adequately perform endotracheal tube suctioning. However, some researchers have documented that some critical care practitioners do not have sufficient knowledge about the current recommendations for endotracheal suctioning and, their practice is often based on rituals and traditions (Frota, Loureiro & Ferreira, 2013). Others observed 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).
Also, it was reported in a multisite survey of suctioning techniques and airway management practices by Sole, Byers and Ludy (2009) that the management practices were inadequate; compliance with hand washing guidelines was 82%, wearing gloves was 75%, elevating head of bed was 50%, and proper oral care protocol was 50%. Day, Farrell and Hayes (2012) observed that the mean score for knowledge was 11.1 and 10.3 for practice among critical care practitioner; 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.
Despite the recognition that endotracheal suctioning is an effective technique that clears the airways by mechanically removing accumulated pulmonary secretions in critically ill patients with artificial airways, the adherence to established guidelines on endotracheal suctioning by critical care practitioners is not impressive. Studies by Day, Farnell, Haynes, Wainwright and Wilson-Barnett (2012); Negro, Ranzani and Manara (2014) have shown that critical care practitioners’ lack of adequate knowledge about endotracheal suctioning may be a barrier to adhere to evidenced based guidelines.
The researcher is unaware of any empirical evidence of endotracheal suctioning knowledge and practices of critical care practitioners and has not come across any study on endotracheal tube suctioning in Nigeria. Hence, this research was undertaken to evaluate the effectiveness of endotracheal suctioning in terms of knowledge and practices of critical care practitioners in University of Calabar Teaching Hospital, Calabar.