• Journal of Korean Academy of Nursing
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• v.33 no.1
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• pp.42-50
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• 2003

Purpose: This study was conducted to investigate the effects of the suction-induced hypoxemia interventions. Method: 30 suction-induced hypoxemia interventions were reviewed for the purpose of meta-analysis. Result: The study showed that both preoxygenation and insufflation were the most frequently examined oxygenation time periods, and hyperoxygenation combined with hyperinflation was the most commonly applied oxygenation method in order to prevent suction-induced hypoxemia. The greatest effect was obtained by providing oxygenation before and after suctioning, whereas negative effect(the contrary results from the study hypotheses) was frequently obtained by applying insufflation only. Applying hyperoxygenation combined with hyperinflation had the greatest effect over that of applying hyperoxygenation only, even though the difference between effect sizes of both methods were statistically significant. Conclusion: The results of meta-analysis showed that the occurrence rate of hypoxemia after suctioning was significantly reduced with the overall interventions for hypoxemia (decreasing 40% of occurrence rate), independent with time periods or methods for providing oxygenation.

• Journal of Korean Academy of Nursing
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• v.41 no.2
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• pp.175-181
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• 2011

Purpose: This study was conducted to identify endotracheal colonization and the incidence of ventilator-associated pneumonia related to the type of endotracheal suction system. Methods: The participants in this study were ICU patients hospitalized between October 2009 to March 2010 who used ventilators for over 48 hr with closed (CSS, n=30) or open (OSS, n=32) suction systems. To standardize the pre-intervention suction system, a suctioning protocol was taught to the ICU nurses. Collected data were analyzed using ${\chi}^2$-test, Fisher's exact test, Wilcoxon rank sums test, Wilcoxon test, Log-rank test and Poisson regression. Results: Endotracheal colonization was higher in OSS than CSS from day 1 to day 8 while using a ventilator and there was a significant difference between the two groups. The CSS reached 50% of endotracheal colonization by the 4th day, whereas for the OSS, it was the 2nd day (p=.04). The incidence of ventilator-associated pneumonia showed no significant difference. Conclusion: For patients with a high risk of pneumonia, CSS must be used to lower endotracheal colonization.

• Journal of Korean Academy of Nursing
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• v.34 no.7
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• pp.1315-1325
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• 2004

Purpose: The purpose of this study was to examine the effects of a closed endotracheal suction system(CES) on oxygen saturation, ventilator associated pneumonia(VAP), and nursing efficacy in mechanically ventilated patients. Method: This study was conducted in the intensive care unit of a University Hospital in Gwangju City. Data was collected from July to October, 2003. Seventy mechanically ventilated patients were randomly divided into two groups; 32 for CES and 38 for open endotracheal suction system(OES) protocol. Twenty one nurses were also involved to examine the nurses' attitude of usefulness about CES. Result: $SaO_2$ was significantly different between CES and OES. The incidence of VAP in CES was lower than that of OES. Nursing efficacy was related to time, cost, and usefulness of the suction system. Time of suctioning in CES was shorter than that of OES. CES also contributed significantly to lower the cost of treatment than OES. The usefulness score of CES increased after 6 months of use. Conclusion: CES prevented VAP, was cost effective, and a safe suctioning system. CES can be used with patients with sensitivity to hypoxygenation and with a high risk of VAP.

• Journal of Korean Academy of Nursing
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• v.28 no.3
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• pp.591-601
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• 1998

미숙아에 있어 주로 표면활성제의 부족으로 인한 호흡곤란증은 미숙아 사망의 주원인이 된다. 호흡곤란증의 치료목적은 적절한 환기를 통해 체내 산소화를 유지시키는 것이다. 인공호흡기 치료를 받는 미숙아에게 필수적인 간호중재인 기관지 흡인술은 그 효과를 극대화하기 위해 흉곽진동법과 같이 사용될 수도 있다. 그러나 미숙아를 대상으로 하는 흉곽진동법은 그 중재의 안전성이나 효과에 대한 과학적 검증 없이 시행되고 있는 실정이다. 이에 본 연구는 호흡곤란증 미숙아에 있어 기관지 흡인술 이전에 행하여지는 흉곽진동법이 산소화와 기관지 분비물에 미치는 영향을 연구하기 위해 실시되었다. 이를 위해 20명의 호흡곤란증 미숙아를 대상으로 대상자내 반복실험연구가 설계되었다. 독립변수는 기관지흡인술이전에 흉곽진동이고 종속 변수는 산소 포화도, 심박동수, 그리고 기관지 분비물의 양이었다. 각 대상자는 무작위 순서에 따라 한번은 흉곽진동없이 흡인을, 나머지 한번은 흉곽진동과 흡인의 두 가지 형태의 흡인을 경험 하였다. 연구 결과, 기관지 흡인술이전에 흉곽진동을 실시하든, 안하든 산소포화도와 심박동수의 변화양상에는 차이가 없었다. 그러나, 융곽진동법을 실시한 경우가 실시안한 경우에 비해 더 많은 양의 기관지 분비물을 흡인하였다. 이는 기관지 흡인술 이전에 실시하는 흉곽진동법이 미숙아의 체내에 부가적 산소소모를 초래하지 않는 반면, 기도로부터 더 많은 분비물을 흡인하는데 효과적임을 시사한다.

• Journal of East-West Nursing Research
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• v.23 no.1
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• pp.53-62
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• 2017

Purpose: This study aimed to evaluate the adherence to the clinical guideline for endotracheal suction in nurses working at intensive care units (ICU) and to identify the characteristics of nurses with good adherence. Methods: This study was a descriptive study to evaluate the pattern of adherence and its related factors to endotracheal suction. One hundred fifty five nurses working at ICU participated in this study. We used a questionnaire developed based on American Association for Respiratory Care (AARC) guidelines and other associated factors from previous studies. Results: Around half of the participants reported that their adherence to the clinical guideline was poor. Items deviated from the recommended guideline were reasons for initiating a suctioning, applied suction pressure ranged from 20 to 200mmHg, and applied catheter size from 6 to 17 french. Other factors deviated were the depth of inserted catheter, and inappropriate use of normal saline instillation. The most significant factor was related to hospital; the misused or misled clinical protocol. Conclusions: The adherence to the clinical guidelines of the endotracheal suction in ICU nurses was not appropriate, which might contribute to the patient health outcomes. More enhanced continuing education as well as hospital regulation is warranted.

• Journal of Korean Clinical Nursing Research
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• v.14 no.3
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• pp.73-85
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• 2008

Purpose: To examine effects of application of bronchodilators after endotracheal suction on peak air way pressure (PAP), lung compliance (Cdyn), oxygen saturation ($SpO_2$), heart rate (HR), blood pressure (BP), and respiration rate (RR) in cardiac surgery patients. Method: Data were collected from October 2007 to March 2008. Participants were patients who were treated with bronchodilators through mechanical ventilators in the SICU. At each suctioning, bronchodilators were applied immediately, and at 5, 10, and 15 minutes after suctioning. Besides PAP, Cdyn, $SpO_2$, HR, BP, RR, data on the frequency of side effects were also collected at 15, 30, 60 minutes after nebulization. Data were analyzed using the SAS program. Results: For application of bronchodilator right after suctioning and after, 5, 10 and 15 minutes, PAP and Cdyn did not show any significant differences although PAP was persistently decreased for 15 to 30 minutes and Cdyn increased at 15 minutes and decreased gradually after nebulization. Besides $SpO_2$, HR, BP, and RR, frequency of side effects did not show any significant difference. Conclusion: Bronchodilators can be applied at any time. However, the positive effects of bronchodilation right after suctioning on PAP and Cdyn, as also shown in previous reports, indicate it is a more efficient clinical process to maintain an adequate airway.

• Journal of Korean Clinical Nursing Research
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• v.18 no.1
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• pp.136-148
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• 2012

Purpose: The purpose of this study was to develop a reliable and valid pain assessment tool suitable for critically ill patients with communication problem in Korean intensive care unit. Methods: This pain assessment tool, Critical Care Non-verbal Pain Scale (CNPS), was developed based on review of national and international researches. Data were collected from ten intensive care units at five major general hospitals in Seoul. Reliability and validity were tested during performance of position change and endotracheal suctioning. Pain was measured before, during, and 20 minutes after the two procedures. Results: Interrater reliability of the CNPS was analyzed by ICC (Intraclass correlation coefficients). ICC values were significant from .833 to .883. Significant correlation between the FPS (Face Pain Scale) scores and the CNPS scores verified concurrent validity of the CNPS. For position change, CNPS scores increased significantly between before and during (t=-23.399, p<.001) and decreased significantly between during and 20 minutes after (t=22.760, p<.001). For endotracheal suctioning, CNPS scores increased significantly between before and during (t=-29.064, p<.001) and significantly decreased between during and 20 minutes after (t=28.194, p<.001), verifying construct validity of the CNPS. Conclusion: Results indicate that the CNPS can be used to assess pain of critically ill patients who have communication problem.

• Child Health Nursing Research
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• v.4 no.2
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• pp.245-254
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• 1998

Prematurity is the main cause for respiratory disorders in neonates. The goal in respiratory management is to maintain respiration with adequate oxygenation. Chest vibration(CV) prior to on dotracheal suctioning(ETS) has been arbitrarily applied to ventilated premature infants without the scientific evaluation of its safety and efficacy. A repeated measure within subjects experimental study was conducted to investigate the effects of CV prior to 875 on oxygenation and lung secretions in twenty-one ventilated premature infants. The independent variable was the type of research protocol, the control type (275 without C.V) and t he intervention(ETS with CV). The dependent variables were oxygen saturation(SpO₂), heart rate (HR), measured by pulse oximeter, and the amount of lung secretions measured in gram. The results showed there was no difference in SpO₂ responses regardless CV employed before ETS. But there was a significant difference in HR responses between the control and the intervention, even without clinical significance. There was a significant difference in the amount of lung secretions retrieved during ETS with CV, compared to ETS without CV. This study suggested the safety of CV by demonstrating no clinically significant changes in SpO₂ and HR in premature infants. The efficacy of CV could be supported by the increases in the amount of sputum during ETS with CV compared to ETS without CV in premature infants.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.21 no.3
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• pp.226-234
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• 2014

Purpose: This study was done to present guidelines for deciding appropriate times for measuring blood pressure (BP) in patients with neurological disorders who had surgery due to brain damage. Method: It was a repeated measures-experimental research on time variants in BP after nursing care. SBP (Systolic BP) and DBP (Diastolic) were measured every 2 minutes up to 5 times using an EKG patient monitor. Measured data were analyzed using repeated measures ANOVA and paired t-test. Results: For suctioning, there were significantly higher differences for SBP averages after 2 min. (138mmHg, p<0.01) and 4 min. (133mmHg, p<0.01) compared to before suctioning (120mmHg). For position change, there were significant differences in SBP averages after 2 min. (136mmHg, p<0.01) and 4 min. (130mmHg, p=0.01) compared to before changing position (121mmHg). For position change followed by suctioning there were significant differences in SBP averages after 2 min. (136mmHg, p<0.01), 4 min. (136mmHg, p<0.01) and 6 min. (125mmHg, p=0.003) compared to before the interventions (121mmHg). Conclusions: Results indicate that there are significant differences in SBP and DBP over time during nursing interventions, suggesting clinical measurement of BP after 6 min. or 8 min. be done for patients with neurological disorders in neurosurgery clinics.

• Clinical and Experimental Pediatrics
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• v.50 no.10
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• pp.959-964
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• 2007

Purpose : The purpose was to investigate the clinical considerations of patients affected by meconium aspiration syndrome (MAS) and the effect of suctioning through endotracheal intubation immediately after delivery on the prognosis of MAS. Methods : A total of 44 inpatients diagnosed as MAS in the Neonatal Intensive Care Unit (NICU) at Cheil Hospital were selected from January 2004 to June 2006. They were divided into two groups. In the early aspiration group (12 patients), suctioning through endotracheal intubation was performed according to the neonatal resuscitation program of the American Academy of Pediatrics and the American Heart Association because infants born through meconium-stained amniotic fluid (MSAF) were not vigorous after birth. In the early non-aspiration group (32 patients), endotracheal intubation was not performed because the infants born through MSAF were vigorous after birth. These two groups were analyzed retrospectively by medical records in the fields of clinical features, obstetric risk factors, complications, treatment, and duration of hospitalization. Results : There was no significant difference in mean gestational age, mean birth weight, sex, and delivery mode between the early aspiration group and the early non-aspiration group. Mean Apgar score of the early aspiration group both in 1 and 5 minute score was significantly lower than in the early non-aspiration group. Lengths of hospitalization and duration of mechanical ventilator care were longer in the early non-aspiration group, but there was no significant difference. Total duration of oxygen therapy was significantly longer in the early non-aspiration group than in the early aspiration group. Conclusion : In this study, the early non-aspiration group used surfactant more and had a longer duration of mechanical ventilator and hospitalization, but there was no significant difference. Total duration of oxygen therapy was significantly longer in the early non-aspiration group. Therefore, more detailed guidelines for vigorous infants born through MSAF are needed and we should study and follow up the long term prognosis of neurological complications of MAS.