Endotracheal Suctioning: Coronary Artery Patient Case Analysis

This case study evaluates the effects of normal saline application before endotracheal tube suctioning in a 75-year-old patient with a history of chronic obstructive pulmonary disease (COPD). It uses strategies from the American Association for Respiratory Care (AARC) and highlights potential adverse effects such as increased pain, anxiety, elevated arterial and intracranial pressure, worsened dyspnea, inadequate oxygen exchange, and impacts on heart rate and blood pressure. The analysis incorporates the PICO (Population, Intervention, Comparison, Outcome) framework to assess the clinical practice, concluding that the use of saline before suctioning may have harmful effects, warranting further evidence-based research to justify its benefits.

Endotracheal Suctioning: A case of a Coronary Artery Patient
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Author Note

Endotracheal Suctioning: A case of a Coronary Artery Patient
Introduction
Generally, suctioning is one of the main processes used in the Intensive Care Unit (ICU) to get rid of secretions in the respiratory track. This
procedure helps to maintain the patency of the tract and hence prevent the retention of the secretions (Ayhan et al., 2015). This presentation seeks to evaluate
whether the application of normal saline prior to the endotracheal tube suctioning leads to more adverse effects in a 75-year-old patient who had a history of
chronic obstructive pulmonary disease.

The case of a 75-year-old man who had a history of chronic obstructive pulmonary disease.

Strategies Used to Search for Evidence
I would use the national strategies stipulated by the American Association for Respiratory Care (AARC) when performing endotracheal tube suctioning for the 75-
year-old patient. They include:
• Pre-oxygenation
• Only suctioning when secretions are present
• Not disconnecting the patient from the mechanical ventilator during suctioning
• Use shallow suctioning rather than deep suctioning
• Applying closed suctioning in adults
• Avoiding use of normal saline instillation
• Limiting the suctioning duration to less than 15 seconds

Summary of the Effects
Escalated pain, dread and anxiety.
Escalates the arterial and intracranial pressure.
Increased effects of dyspnea.
Insufficient oxygen exchange.
Worsens sputum recovery.
Affects processes such as the heart rate, blood pressure, trapping of saline and other risks for infections.

Summary of Evidence

Escalated Pain, Dread and Anxiety

Increases the Arterial and Intracranial Pressure

Increased Effects of Dyspnea

Inadequate Oxygen Exchange
Affects Processes such as the Heart rate, Blood Pressure and pH

Discussion on Evidence

The PICO Question

Components of the PICO Question
A Case of the 75-year-old man

Application of PICO in the Clinical Practice

Foreground and Background Questions
In a normal clinical environment, it is necessary for the practitioner to identify both the foreground and background questions basing on the
experience of specific diseases and therapy.

The PICO Strategy

Population or Patient Characteristics
Intervention Approach
Comparison and Outcome

Conclusion
A lot of studies have indicated that the use of saline before endotracheal suctioning has harmful effects on the patient. Basing on the case study given, this
presentation has highlighted some which encompass increased dyspnea level, effects on gas exchange, blood pressure and heart rate. Therefore, if the use of normal
saline in loosening secretions is to be encouraged, one would anticipate a steady, study evidence on the importance of normal saline instillation. However, it is not
always that way.

References
Ayhan, H., Tastan, S., Iyigun, E., Akamca, Y., Arikan, E., & Sevim, Z. (2015). Normal saline instillation before endotracheal suctioning: “What does the evidence
say? What do the nurses think?”: Multimethod study. Journal of critical care, 30(4), 762-767.
Caparros, A. C. S., & Forbes, A. (2014). Mechanical ventilation and the role of saline instillation in suctioning adult intensive care unit patients: An evidence-based
practice review. Dimensions of Critical Care Nursing, 33(4), 246-253.