Endotrakeal Aspirasyon Öncesinde Tartışmalı Bir Uygulama: Serum Fizyolojik Kullanımı Gerekli mi?

Yıl 2015, Cilt: 2 Sayı: 2, 82 - 89, 02.12.2015

Nurten Kalender Nuran Tosun

Öz

Mekanik ventilatör tedavisi uygulanan entübe hastalarda bakımın birincil amacı yeterli ventilasyonun sağlanması ve hava yolu açıklığının devam ettirilmesidir. Bu amaçla yapılan endotrakeal aspirasyon hastalarda solunum yolundaki sekresyonların temizlenmesi, oksijenasyonun artırılmasına katkıda bulunan ve sık uygulanan invaziv yöntemlerden biridir. Endotrakeal aspirasyon işlemi, öncesinde serum fizyolojik kullanımı sekresyonları dilüe etmek, mobilizasyonunu sağlamak ve aspirasyon için kullanılan kateterin kayganlığının sağlanması amacıyla da kullanılmaktadır. Ancak endotrakeal aspirasyon öncesinde kullanılan serum fizyolojik uygulamasına ilişkin yeterli kanıt bulunmamaktadır ve tartışmalı bir konudur. Bu derlemede endotrakeal aspirasyon işlemi öncesinde serum fizyolojik kullanımının oksijen satürasyonu, kalp hızı ve kan basıncı, enfeksiyon gelişimi ve hasta konforu üzerine olan etkilerinin değerlendirildiği çalışma sonuçlarına ve kanıta dayalı uygulama önerilerine yer verilmiştir. Anahtar Kelimeler: Endotrakeal aspirasyon, kanıt, serum fizyolojik

Anahtar Kelimeler

Endotrakeal aspirasyon, kanıt, serum fizyolojik

Kaynakça

• McKelvie S. Endotracheal suctioning. Nurs Crit Care 1998; 3: 244–248.
• Bourgault AM, Brown CA, Hains SM, Parlow JL. Effects of endotracheal tube suctioning on arterial oxygen tension and heart rate variability. Biol Res Nurs 2006; 7: 268-278.
• O’Neal PV, Grap MJ, Thompson C, Dudley W. Level of dyspnoea experienced in mechanically ventilated adults with and without saline instillation prior to endotracheal suctioning. Intensive Crit Care Nurs 2001; 17: 356-363.
• Maggiore SM, Iacobone E, Zito G, Conti C, Antonelli M, Proietti R. Closed versus open suctioning techniques. Minerva Anestesiol 2002; 68: 360–364.
• Ridling DA, Martin LD, Bratton SL. Endotracheal suctioning with or without instillation of isotonic sodium chloride solution in critically ill children. Am J Crit Care 2003; 12: 212-219.
• AARC Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respir Care 2010; 55: 758-764.
• Lorente L, Blot S, Rello J. New issues and controversies in the prevention of  ventilator-associated pneumonia. Am J Respir Crit Care Med  2010; 182: 870-876.
• Christensen RD, Henry E, Baer VL, Hoang N, Snow GL, Rigby G, Burnett J, Wiedmeier SE, Faix RG, Eggert LD. A low-sodium solution for airway care: results of a multicenter trial. Respir Care 2010; 55: 1680-1685.
• Halm MA, Krisko-Hagel K. Instilling normal saline with suctioning: beneficial technique or potentially harmful sacred cow? Am J Crit Care. 2008; 17: 469-472.
• Demers RR, Saklad M. Minimizing the harmful effects of mechanical aspiration. Hearth Lung 1973; 2: 542-545.
• Schwenker D, Ferrin M, Gift AG. A survey of endotracheal suctioning with instillation of normal saline. Am J Crit Care. 1998; 7: 255-260.
• Sole ML, Byers JF, Ludy JE, Zhang Y, Banta CM, Brummel K. A multisite survey of suctioning techniques and airway management practices. Am J Crit Care 2003; 12: 220-230, quiz 231–232.
• Blackwood B. Normal saline instillation with endotracheal suctioning: primum non nocere (first do no harm). J Adv Nurs 1999; 29: 928-934.
• Ji YR, Kim HS, Park JH. Installition of normal saline before suctioning in patients with pneumonia. Yonsei Med J 2002; 43: 607-612.
• Celik SA, Kanan N. A current conflict: use of isotonic sodium cloride solution on endotracheal suctioning in critically ill patients. Dimens Crit Care Nurs 2006; 25: 11-14.
• Paratz JD, Stockton KA. Efficacy and safety of normal saline instillation: a systematic review. Physiotherapy 2009; 95: 241-250.
• Briening E. The effects of saline instillation prior to endotracheal suctioning. Online J Knowl Synth Nurs 1996; 3: 1.
• Swartz K, Noonan DM, Edwards-Beckett J. A national survey of endotracheal suctioning techniques in the pediatric population. Heart Lung. 1996; 25: 52-60.
• Sole ML, Byers JF, Ludy JE, Osttrow CL. Suctioning techniques and airway management practices: pilot study and instrument evaluation. Am J Crit Care 2002; 11: 363-368.
• Özden D, Taş Z, Yıldız M. Hemşirelerin Açık ve Kapalı Sistem Aspirasyon Yönteminde Serum Fizyolojik Uygulama Durumlarının ve Nedenlerinin Belirlenmesi. HEMAR-G 2009; 3: 18-29.
• Akgül S, Öztekin D, Akyolcu N. Hemşirelerin, endotrakeal aspirasyonda serum fizyolojik uygulamasına ilişkin bilgi durumları. İstanbul Üniversitesi Florence Nightingale Hemşirelik Yüksekokulu Dergisi 2001; 12: 45-55.
• Rauen C, Chulay M, Bridges E, Vollman KM, Arbour R. Seven evidence-based practice habits: putting some sacred cows out to pasture. Crit Care Nurse. 2008; 28: 98-124.
• Bostick J, Wendelgass ST. Normal saline instillation as part of the suctioning procedure: effects of PaO2 and amount of secretions. Heart Lung 1987; 16: 532-537.
• Hagler DA, Traver GA. Endotracheal saline and suction catheters: sources of lower airway contamination. Am J Crit Care 1994; 3: 444–447.
• Kinloch D. Instillation of normal saline during endotracheal suctioning: effects on mixed venous oxygen saturation. Am J Crit Care. 1999; 8: 231-240, quiz 241-242.
• Ackerman MH, Mick DJ. Instillation of normal saline before suctioning in patients with pulmonary infections: a prospective randomized controlled trial. Am J Crit Care 1998; 7: 261-266.
• Akgul S, Akyolcu N. Effects of normal saline on endotracheal suctioning. J Clin Nurs 2002; 11: 826-830.
• Iranmanesh S, Rafiei H. Normal saline instillation with suctioning and its effect on oxygen saturation, heart rate, and cardiac rhythm. Int J Nurs Educ 2011; 3: 42-44.
• Day T, Wainwrihgt SP, Wilson-Barnett J. An evalution of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units. J Clin Nurs 2001; 10: 682-689.
• Gray JE, Maclntyre NR, Kronenberger WG. The effects of bolus normal-saline instillation in conjunction with endotracheal suctioning. Respir Care 1990; 35: 785-790.
• Reynolds P, Hoffman LA, Schlichtig R, Davies PA, Zullo TG. Effects of normal saline instillation on secretion volume, dynamic compliance and oxygen saturation. Am Rev Respir Dis 1990; 141: A574.
• Ackerman MH. The effect of saline lavage prior to suctioning. Am J Crit Care 1993; 2: 326-330.
• Maggiore SM, Lellouche F, Pignataro C, Girou E, Maitre B, Richard JC, Lemaire F, Brun-Buisson C, Brochard L. Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice. Respir Care 2013; 58: 1588-1597.
• Branson RD. Secretion management in the mechanically ventilated patient. Respir Care 2007; 52: 1328- 1342, discussion 1342-1347.
• Caruso P, Denari S, Ruiz SA, Demarzo SE, Deheinzelin D. Saline instillation before tracheal suctioning decreases the incidence of ventilator- associated pneumonia. Crit Care Med 2009; 37: 32-38.
• Yosunkaya A. Ventilatör İlişkili Pnömoniden Korunma. Selçuk Ünv. Tıp Derg 2010; 26: 160-166.
• Reeve JC, Davies N, Freeman J, O’Donovan B. The use of normal saline instillation in the intensive care unit by physiotherapists: a survey of practice in New Zealand. NZ Journal of Physiotherapy 2007; 35: 119-125.
• Mei-Yu L, Shu-Hua C, Yi-Hui S. Reducing ventilator-associated pneumonia (VAP) by not using instillation saline before suctioning [abstract]. Journal of Nursing and Healthcare Research 2012; 8: 325-331.
• Favretto DO,  Silveira RC,  Canini SR,  Garbin LM,  Martins FT,  Dalri MC. Endotracheal  suction  in  intubated  critically ill adults patients endergoing mechanical ventilation: a systematic review. Rev Lat Am Enfermagem 2012; 20: 997-1007.
• Jablonski RS. The experience of being mechanically ventilated. Oualitative Health Research 1994; 4: 186-207.
• Schreuder FM, Jones UF. The effect of saline instillation on sputum yield and oxygen saturation measurement in adult intubated patients: single subject design [abstract]. Physiotherapy 2004; 90: 108- 109.
• Pedersen CM,  Rosendahl-Nielsen M,  Hjermind J,  Egerod I. Endotracheal suctioning of the adult intubated patient--what is the evidence? Intensive Crit Care Nurs 2009; 25: 21-30.
• Caparros AC. Mechanical ventilation and the role of saline instillation in suctioning adult intensive care unit patients: an evidence-based practice review. Dimens Crit Care Nurs 2014; 33: 246-253.
• Thompson L. Suctioning Adults with an Artificial Airway; A Systematic Review. The JBI Database of Systematic Reviews and Implementation Reports 2000; 3: 88-175.
• Agency for Healthcare Research and Quality. Guideline title: endotracheal suctioning of mechanically ventilated patients with artificial airways. 2010. URL: http://www.guideline.gov/content.aspx?id=23992. March 27, 2014.