Beyin Cerrahisi Hemşirelerinin Endotrakeal Aspirasyon Uygulamasının Değerlendirilmesi: Kanıta Dayalı Uygulama Önerilerine Ne Kadar Uyuyoruz?
Öz
Amaç:Bu araştırmada beyin cerrahi yoğun bakım hemşirelerinin uyguladığı endotrakeal aspirasyon işleminin kanıta dayalı uygulama önerilerikapsamında değerlendirilmesi amaçlanmıştır.
Çalışma Planı:Tanımlayıcı olarak gerçekleştirilen araştırma,iki Tıp Fakültesi Hastanesi’nin Beyin Cerrahi Yoğun Bakım ünitesinde çalışan 37 hemşire ile Aralık 2017-Ocak 2018 tarihleri arasında gerçekleştirilmiştir. Veri toplama formu iki bölümden oluşmaktadır. İlk bölümde hemşirelerin bazı sosyodemografik özelliklerine ilişkin sorular yer almaktadır. İkinci bölümde, American Association of Respiratory Care tarafından 2010 yılında yayınlanan kılavuz ve konu ile ilgili yapılan araştırmalarda yer alan kanıt düzeyli bilgilerden oluşturulan form kullanılmıştır. Form,hastanın aspirasyon ihtiyacının belirlenmesi, aspirasyon öncesi-sırası ve sonrası işlemler, enfeksiyon kontrolü olmak üzere bölümlenmiştir.
Bulgular: Hemşirelerin yaş ortalaması 34.11±7.23’dür, %56.8’i lisans mezunu olup %32.4’ünün yoğun bakım sertifikası bulunmaktadır. Hemşirelerin çoğunluğunun aspirasyon öncesi ve sonrası işlemleri kanıta dayalı uygulamalara uygun olarak yaptığı tespit edilmiştir. Ancak aspirasyon sayısının birden fazla olmaması, aspirasyonu sık aralıklarla ve devamlı teknikte yapmama, havayolunaizotonik sodyum klorür vermeme, aspirasyon öncesi ve sonrası hiperoksijenasyonu sağlama gibi aspirasyon sırası ve sonrası uygulamalarile enfeksiyon kontrolünü sağlamada koruyucu ekipman kullanımında kanıtlara uyan hemşire sayısının düşük olduğu belirlenmiştir.
Sonuç:Araştırmanın sonunda hemşirelerin, aspirasyon öncesi ve sonrası uygulamalarda kanıtlara uyma oranının yüksek olduğu görülmüştür. Ancak aspirasyon ihtiyacını doğru tanımlama, aspirasyon işlemi sırası uygulamalar ve enfeksiyona yönelik bazı önerilere uyma oranının yetersiz olduğu saptanmıştır.
Anahtar Kelimeler
Kaynakça
- 1. Ayhan H, Tastan S, Iyigun E, Akamca Y, Arikan E, Sevim Z. Normal Saline İnstillation Before Endotracheal Suctioning: “What Does The Evidence Say? What Do The Nurses Think?”: Multimethod Study. J Crit Care 2015; 30(4); 762-7. doi: 10.1016/j.jcrc.2015.02.019.
- 2. Bülbül Maraş G, Kocaçal Güler E, Eşer İ, Köse Ş. Knowledge and Practice of Intensive Care Nurses for Endotracheal Suctioning in a Teaching Hospital in Western Turkey. Intensive Crit Care Nurs 2017; 39:45-54. doi: 10.1016/j.iccn.2016.08.006.
- 3. Galbiati G, Paola C. Effects of Open and Closed Endotracheal Suctioning on Intracranial Pressure and Cerebral Perfusion Pressure in Adult Patients with Severe Brain Injury: A Literature Review. J NeurosciNurs 2015; 47(4): 239-46.
- 4. Kalender N, Tosun N. A Controversial Practice Before Endotracheal Suctioning: Is Instillation of Isotonic Sodium Chloride Solution Necessary?JOHUFON 2015; 2(2): 82-9.
- 5. Silva LA, Pacheco JA, Silva LL, Mantelli FF, Silveira SE.,Oliveira LP. Endotracheal Aspiration: İntensivist Professional Knowledge. Journal of Nursing UFPE on line Recife 2014; 8(8):2678-85.
- 6. Frota OP, Loureiro MD, Ferreira AM. Knowledge About Endotracheal Suctioning on The Part of Intensive Care Nursing Professionals: A Descriptive Study. Online Brazilian Journal of Nursing 2013; 12 (2): 546-54.
- 7. AARC Clinical Practice Guidelines, Endotracheal Suctioning of Mechanically Ventilated Patients with Artificial Airways 2010. Respir Care 2010; 55(6): 758-64.
- 8. Negro A, Ranzanic R, Villa M, Manara D. Survey of Italian Intensive Care Unit Nurses’ Knowledge About Endotracheal Suctioning Guidelines. Intensive Crit Care Nurs 2014; 30: 339-45.
- 9. Haghighat S, Yazdannik AR. The Practice of Intensive Care Nurses Using The Closed Suctioning System: An Observational Study. Iran J Nurs Midwifery Res 2015; 20(5): 619-25.
- 10. Jongerden IP, Kesecioglu J, Speelberg B, Buiting AG, Hall MA, Bonten MJ. Changes in Heart Rate, Mean Arterial Pressure, and OxygenSaturation After Open and Closed Endotracheal Suctioning:A Prospective Observational Study. J Crit Care 2012; 27, 647-54.
- 11. Uğraş GA, Aksoy G. The Effects of Open and Closed Endotracheal Suctioning on Intracranial Pressure And Cerebral Perfusion Pressure: A Crossover, Single-Blind Clinical Trial. J Neurosci Nurs 2012; 44(6): E1-E8. doi: 10.1097/JNN.0b013e3182682f69.
- 12. Favretto DO, Silveira RC, Canini SR, Garbin LM, Martins FT,Dalri MC. Endotracheal Suction in Intubated Critically Ill Adult Patients Undergoing Mechanical Ventilation: A Systematic Review.Revista latino-americana de enfermagem2012; 20(5): 997-1007.
- 13. Day T, Farnell S, Hayes S, Wainwright S, Wilson-Bannett J. Tracheal Suctioning: An Exploration of Nurses’ Knowledge and Compotence in Acute and High Dependency Ward Areas. J Adv Nurs 2002; 39(1), 35-45.
- 14. Ansari A, Alavi NM, Adib-Hajbagheri M, Afazel M. The Gap Between Knowledge and Practice in Standard Endo-Tracheal Suctioning of ICU Nurses, Shahid Beheshti Hospital.Crit Care Nurs 2012; 5(3): 71-6
- 15. Kelleher S, Andrews T. An Observational Study on The Open-System Endotracheal Suctioning Practices of Critical Care Nurses. JClin Nurs2008; 17(3): 360-9. doi: 10.1111/j.1365-2702.2007.01990.x.
- 16. Özden D, Görgülü S. Development of Standard Practice Guidelines for Open and Closed System Suctioning. J Clin Nurs 2012; 21(9-10):1327-38. doi: 10.1111/j.1365-2702.2011.03997.x.
- 17. Sole ML, Byers JF, Ludy JE, Zhang CM, Banta JE, Brummel K. A Multisite Survey of Suctioning Techniques and Airway Management Practices. AmJCritical Care 2003; 12(3):220-30;
- 18. Sole ML, Bennet M, Ashworth S. Clinical Indicators for Endotracheal Suctioning in Adult Patients Receiving Mechanical Ventilation. AJCrit Care2015; 24(4):318-24; doi: 10.4037/ajcc2015794.
- 19. Wang CH, Tsai JC, Chen SF, Su CL, Chen L, Lin CC, Tam KW. Normal Saline Instillation Before Suctioning: A Meta-Analysis of Randomized Controlled Trials. Aust Crit Care 2017; 30(5): 260-65. doi: 10.1016/j.aucc.2016.11.001.
- 20. Pedersen CM, Rosendahl-Nielsen M, Hjermind J, Egerod I. Endotracheal Suctioning of The Adult Intubated Patient-What Is The Evidence? Intensive Crit Care Nurs2009; 25(1):21-30. doi: 10.1016/j.iccn.2008.05.004.
- 21. Gilder E, Parke RL, Jull A, Australian and New Zealand Intensive Care Society Clinical Trials Group and The George Institute for Global Health.Endotracheal Suction in Intensive Care: A Point Prevalence Study of Current Practice in New Zealand and Australia. Aust Crit Care 2019; 32(2):112-5. doi: 10.1016/j.aucc.2018.03.001.
- 22. Caramez MP, Schettino G, Suchodolski K, Nishida T, Harris RS, Malhotra A. Kacmarek RM. The Impact of Endotracheal Suctioning on Gas Exchange and Hemodynamics During Lung-Protective Ventilation in Acute Respiratory Distress Syndrome. Respir Care 2006; 51(5): 497-502.
- 23. Beuret P, Roux C, Constan A, Mercat A, Brochard L. Discrepancy Between Guidelines and Practice of Tracheal Suctioning in Mechanically Ventilated Patients: A French Multicenter Observational Study. Intensive Care Med 2013; 39(7):1335-6. https://doi.org/10.1007/s00134-013-2936-6.
- 24. Özden D(a). Bir Devlet Hastanesinde Açık ve Kapalı Sistem Aspirasyon Yöntemleri İçin Standart Geliştirilmesi ve Bu Yöntemlerin Hastaların Hemodinamik Durumuna Etkisinin Belirlenmesi. Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü Hemşirelikte Doktora Tezi, (Danışman: Selma Görgülü), Ankara: 2007.
- 25. Özden D, Taş Z, Yıldız M. Hemşirelerin Açık ve Kapalı Sistem Aspirasyon Yönteminde Serum Fizyolojik Uygulama Durumlarının ve Nedenlerinin Belirlenmesi. Hemşirelikte Araştırma Geliştirme Dergisi 2009; 3: 18-29
- 26. Leddy R, Wilkinson JM. Endotracheal Suctioning Practices of Nurses and Respiratory Therapists: How Well Do They Align with Clinical Practice Guidelines? Can J Respir Ther 2015;51(3):60-4.
Evaluation of Endotracheal Aspiration for NeurosurgeryNurses: Do We Comply with the Evidence-Based Practice Guideliness
Öz
Objective:The aim of this study is the evaluation of endotracheal aspiration procedureapplied by the neurosurgery intensive care nurses within the context of evidence-based practices recommendations.
Study Design:The descriptive study was conducted between December 2017 and January 2018 with 37 nurses working in the Neurosurgery Intensive Care Unit of two Medical FacultyHospitals.Data collection form consists of two parts. In the first part, there are questions about some socio-demographic characteristics of nurses. In the second part, there are questions based on the guide published by the American Association of Respiratory Care in 2010 and evidence-basedrecommendations in the literature. The questionnaire was divided in to determine the patient's need for aspiration, preaspiration, during the aspiration and post-aspiration procedures, and infection control.
Results:The mean age of the nurses was 34.11 ± 7.23, 56.8% have undergraduate degree and 32.4% have intensive care certificate. It was found that the majority of nurses performed before and after aspiration procedures in accordance with evidence-based practices. However, it was determined that nurses were inadequate to accord with the evidence during and after aspiration applications such as not having more than one aspiration, not performing continuous aspiration techniques, not giving saline solutionto the airway, providing hypoxigenation before and after aspirationand in the use of protective equipment to maintain infection control.
Conclusion:As a result of the study, it was observed that the rate of compliance of the nurses with the evidence-based recommendations was high before and after the aspiration. However, it has been found that the rate of compliance with the evidence-based recommendations was insufficient to correctly identify the need for aspiration, during aspiration procedures and in some procedures for infection control.
Anahtar Kelimeler
Kaynakça
- 1. Ayhan H, Tastan S, Iyigun E, Akamca Y, Arikan E, Sevim Z. Normal Saline İnstillation Before Endotracheal Suctioning: “What Does The Evidence Say? What Do The Nurses Think?”: Multimethod Study. J Crit Care 2015; 30(4); 762-7. doi: 10.1016/j.jcrc.2015.02.019.
- 2. Bülbül Maraş G, Kocaçal Güler E, Eşer İ, Köse Ş. Knowledge and Practice of Intensive Care Nurses for Endotracheal Suctioning in a Teaching Hospital in Western Turkey. Intensive Crit Care Nurs 2017; 39:45-54. doi: 10.1016/j.iccn.2016.08.006.
- 3. Galbiati G, Paola C. Effects of Open and Closed Endotracheal Suctioning on Intracranial Pressure and Cerebral Perfusion Pressure in Adult Patients with Severe Brain Injury: A Literature Review. J NeurosciNurs 2015; 47(4): 239-46.
- 4. Kalender N, Tosun N. A Controversial Practice Before Endotracheal Suctioning: Is Instillation of Isotonic Sodium Chloride Solution Necessary?JOHUFON 2015; 2(2): 82-9.
- 5. Silva LA, Pacheco JA, Silva LL, Mantelli FF, Silveira SE.,Oliveira LP. Endotracheal Aspiration: İntensivist Professional Knowledge. Journal of Nursing UFPE on line Recife 2014; 8(8):2678-85.
- 6. Frota OP, Loureiro MD, Ferreira AM. Knowledge About Endotracheal Suctioning on The Part of Intensive Care Nursing Professionals: A Descriptive Study. Online Brazilian Journal of Nursing 2013; 12 (2): 546-54.
- 7. AARC Clinical Practice Guidelines, Endotracheal Suctioning of Mechanically Ventilated Patients with Artificial Airways 2010. Respir Care 2010; 55(6): 758-64.
- 8. Negro A, Ranzanic R, Villa M, Manara D. Survey of Italian Intensive Care Unit Nurses’ Knowledge About Endotracheal Suctioning Guidelines. Intensive Crit Care Nurs 2014; 30: 339-45.
- 9. Haghighat S, Yazdannik AR. The Practice of Intensive Care Nurses Using The Closed Suctioning System: An Observational Study. Iran J Nurs Midwifery Res 2015; 20(5): 619-25.
- 10. Jongerden IP, Kesecioglu J, Speelberg B, Buiting AG, Hall MA, Bonten MJ. Changes in Heart Rate, Mean Arterial Pressure, and OxygenSaturation After Open and Closed Endotracheal Suctioning:A Prospective Observational Study. J Crit Care 2012; 27, 647-54.
- 11. Uğraş GA, Aksoy G. The Effects of Open and Closed Endotracheal Suctioning on Intracranial Pressure And Cerebral Perfusion Pressure: A Crossover, Single-Blind Clinical Trial. J Neurosci Nurs 2012; 44(6): E1-E8. doi: 10.1097/JNN.0b013e3182682f69.
- 12. Favretto DO, Silveira RC, Canini SR, Garbin LM, Martins FT,Dalri MC. Endotracheal Suction in Intubated Critically Ill Adult Patients Undergoing Mechanical Ventilation: A Systematic Review.Revista latino-americana de enfermagem2012; 20(5): 997-1007.
- 13. Day T, Farnell S, Hayes S, Wainwright S, Wilson-Bannett J. Tracheal Suctioning: An Exploration of Nurses’ Knowledge and Compotence in Acute and High Dependency Ward Areas. J Adv Nurs 2002; 39(1), 35-45.
- 14. Ansari A, Alavi NM, Adib-Hajbagheri M, Afazel M. The Gap Between Knowledge and Practice in Standard Endo-Tracheal Suctioning of ICU Nurses, Shahid Beheshti Hospital.Crit Care Nurs 2012; 5(3): 71-6
- 15. Kelleher S, Andrews T. An Observational Study on The Open-System Endotracheal Suctioning Practices of Critical Care Nurses. JClin Nurs2008; 17(3): 360-9. doi: 10.1111/j.1365-2702.2007.01990.x.
- 16. Özden D, Görgülü S. Development of Standard Practice Guidelines for Open and Closed System Suctioning. J Clin Nurs 2012; 21(9-10):1327-38. doi: 10.1111/j.1365-2702.2011.03997.x.
- 17. Sole ML, Byers JF, Ludy JE, Zhang CM, Banta JE, Brummel K. A Multisite Survey of Suctioning Techniques and Airway Management Practices. AmJCritical Care 2003; 12(3):220-30;
- 18. Sole ML, Bennet M, Ashworth S. Clinical Indicators for Endotracheal Suctioning in Adult Patients Receiving Mechanical Ventilation. AJCrit Care2015; 24(4):318-24; doi: 10.4037/ajcc2015794.
- 19. Wang CH, Tsai JC, Chen SF, Su CL, Chen L, Lin CC, Tam KW. Normal Saline Instillation Before Suctioning: A Meta-Analysis of Randomized Controlled Trials. Aust Crit Care 2017; 30(5): 260-65. doi: 10.1016/j.aucc.2016.11.001.
- 20. Pedersen CM, Rosendahl-Nielsen M, Hjermind J, Egerod I. Endotracheal Suctioning of The Adult Intubated Patient-What Is The Evidence? Intensive Crit Care Nurs2009; 25(1):21-30. doi: 10.1016/j.iccn.2008.05.004.
- 21. Gilder E, Parke RL, Jull A, Australian and New Zealand Intensive Care Society Clinical Trials Group and The George Institute for Global Health.Endotracheal Suction in Intensive Care: A Point Prevalence Study of Current Practice in New Zealand and Australia. Aust Crit Care 2019; 32(2):112-5. doi: 10.1016/j.aucc.2018.03.001.
- 22. Caramez MP, Schettino G, Suchodolski K, Nishida T, Harris RS, Malhotra A. Kacmarek RM. The Impact of Endotracheal Suctioning on Gas Exchange and Hemodynamics During Lung-Protective Ventilation in Acute Respiratory Distress Syndrome. Respir Care 2006; 51(5): 497-502.
- 23. Beuret P, Roux C, Constan A, Mercat A, Brochard L. Discrepancy Between Guidelines and Practice of Tracheal Suctioning in Mechanically Ventilated Patients: A French Multicenter Observational Study. Intensive Care Med 2013; 39(7):1335-6. https://doi.org/10.1007/s00134-013-2936-6.
- 24. Özden D(a). Bir Devlet Hastanesinde Açık ve Kapalı Sistem Aspirasyon Yöntemleri İçin Standart Geliştirilmesi ve Bu Yöntemlerin Hastaların Hemodinamik Durumuna Etkisinin Belirlenmesi. Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü Hemşirelikte Doktora Tezi, (Danışman: Selma Görgülü), Ankara: 2007.
- 25. Özden D, Taş Z, Yıldız M. Hemşirelerin Açık ve Kapalı Sistem Aspirasyon Yönteminde Serum Fizyolojik Uygulama Durumlarının ve Nedenlerinin Belirlenmesi. Hemşirelikte Araştırma Geliştirme Dergisi 2009; 3: 18-29
- 26. Leddy R, Wilkinson JM. Endotracheal Suctioning Practices of Nurses and Respiratory Therapists: How Well Do They Align with Clinical Practice Guidelines? Can J Respir Ther 2015;51(3):60-4.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Hemşirelik |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Nisan 2021 |
| Gönderilme Tarihi | 28 Kasım 2019 |
| Yayımlandığı Sayı | Yıl 2021Cilt: 12 Sayı: 2 |
