Review: several techniques optimise oxygenation during suctioning of patients.

Suctioning intubated patients aids in removing secretions and maintaining a patent airway, while promoting optimal ventilation and oxygenation. The development of guidelines by Brooks et al supports clinical decision making by taking into consideration both the benefits and complications associated with the procedure. Recommendations for preoxygenation, hyperoxygenation, hyperinflation plus method of delivery, swivel adaptor use, and others were reported. The authors noted that insufficient evidence exists regarding several aspects of suctioning. For example, instillation of normal saline is thought to thin and loosen secretions, lubricate the suction catheter, and stimulate coughing. However, normal saline instillation may also cause a decrease in oxygen saturation and dislodge more bacteria in endotracheal tubes than use of suction catheters alone. Brooks et al highlight the paucity of scientific evidence to support saline instillation. Subsequent guidelines need to address the evidence for the heated humidification of the inspired gas, monitoring of patient hydration status, and use of mucolytic agents or nebulisers. Patients receiving 100% humidity heated to core temperature (37°C) are reported to be at the optimal level for mucosal function, maximising mucous clearance. Brooks et al provide recommendations useful to healthcare providers engaged in the care of ventilated and intubated patients. These guidelines for suctioning can be applied to all ventilated patients, including those who are on volume control, synchronised intermittent mandatory ventilation, or pressure support. However, guidelines do not pre-empt sound clinical decision making. Clinicians still need to pay close attention to patient oxygenation levels, haemodynamic status, and responses to suctioning, especially if patients are unstable or have thick and tenacious secretions. Ruth Taylor-Piliae, RN, CNS, MN Doctoral Student, School of Nursing University of California, San Francisco San Francisco, California, USA