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Patterns of instability associated with endotracheal suctioning in infants with singleventricle physiology

Baines, Paul; Guerrero, Rafael; Phys, Grad Dip; Tume, Lyvonne N; Johnson, Robert; Ritson, Paul; Scott, Elaine; Arnold, Philip; Walsh, Laura

Patterns of instability associated with endotracheal suctioning in infants with singleventricle physiology Thumbnail


Authors

Paul Baines

Rafael Guerrero

Grad Dip Phys

Lyvonne Tume Lyvonne.Tume@uwe.ac.uk
Associate Professor in Child Health

Robert Johnson

Paul Ritson

Elaine Scott

Philip Arnold

Laura Walsh



Abstract

© 2017 American Association of Critical-Care Nurses. Background In infants with single-ventricle physiology, endotracheal suctioning poses risks because of the instability between pulmonary and systemic blood flow. Objective To examine processes and adverse events associated with endotracheal suctioning in the first 48 hours after 3 surgical procedures: the Norwood or Norwood- Sano procedure, pulmonary artery banding, and the modified Blalock-Taussig shunt. Methods Prospective observational study in a pediatric intensive care unit. Results Bedside nurses collected data from 211 episodes of endotracheal suctioning in 24 infants. Most (62%,130/211) suction episodes were unplanned; 38% (81/211) were planned. The most common reason for unplanned suctioning was arterial desaturation (48%, 62/130 episodes). The infants' oxygen saturation levels before suctioning ranged from 27% to 86%. Serious adverse events occurred in 9% (19/211) of suction episodes. In 8 (42%) of the episodes involving a serious adverse event, the patient received no additional intravenous bolus of analgesic or muscle relaxant before suctioning; in 8 episodes (42%), the patient received both an analgesic and a relaxant; in 3 episodes (16%), the patient received either an analgesic or a relaxant but not both. More adverse events occurred with open suctioning (68%, 13/19) than with closed suctioning (32%, 6/19). Most adverse events (68%, 13/19) occurred during the night shift. Conclusions Significant hemodynamic instability and adverse events occur during routine suctioning in infants with single-ventricle physiology after surgical palliation.

Citation

Phys, G. D., Guerrero, R., Baines, P., Tume, L. N., Johnson, R., Ritson, P., …Walsh, L. (2017). Patterns of instability associated with endotracheal suctioning in infants with singleventricle physiology. American Journal of Critical Care, 26(5), 388-394. https://doi.org/10.4037/ajcc2017844

Journal Article Type Article
Acceptance Date Nov 1, 2016
Online Publication Date Sep 1, 2017
Publication Date Sep 1, 2017
Deposit Date Jul 24, 2017
Publicly Available Date Sep 2, 2018
Journal American Journal of Critical Care
Print ISSN 1062-3264
Publisher American Association of Critical Care Nurses
Peer Reviewed Peer Reviewed
Volume 26
Issue 5
Pages 388-394
DOI https://doi.org/10.4037/ajcc2017844
Keywords tracheal suction, post-operative, infant, neonate, single ventricle physiology, nursing, heart surgery
Public URL https://uwe-repository.worktribe.com/output/881861
Publisher URL http://dx.doi.org/10.4037/ajcc2017844

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