Patterns of instability associated with endotracheal suctioning in infants with single ventricle physiology

Abstract

Background
In infants with single ventricle physiology endotracheal suctioning poses greater risks due to the instability between pulmonary and systemic blood flow.

Objective
To examine processes and adverse events associated with endotracheal suctioning in the first 48 hours post-operatively after three specific surgical procedures: Norwood or Norwood Sano, Pulmonary Artery banding and Modified Blalock-Taussig Shunt.

Methods
A prospective observational study in a single Pediatric Intensive Care Unit.

Results
Two hundred and eleven (211) episodes of bedside nurse endotracheal suctioning data were collected in 24 infants. Sixty-two per cent (130/211) of these suction episodes were classed (by the nurse) as unplanned and 38% (81/211) planned. Reasons cited for the unplanned suctions were most commonly (48% 62/130) acute arterial desaturation. However, the level of oxygen saturation prior to suctioning (for ‘desaturation’) ranged from 27% - 86%. A serious adverse event (SAE) occurred in 9% (19/211) of suction episodes. In the 19 suction episodes where a SAE occurred, 42% [8/19] did NOT have an additional intravenous bolus of analgesic or relaxant pre-suction and three of these were planned suctions. However, 42% [8/19] had both drugs pre-suction, 3/19 (16%) had either a relaxant but not an analgesic or vice versa. 74% [14/19] of adverse events occurred with open suction, 26% (5/19) with closed suction and 68% (13/19) occurred on the night shift 7pm – 7am.

Conclusions
Data collected by bedside nurses during their routine endotracheal suctioning, demonstrates significant hemodynamic instability and adverse events. It was notable that unit clinical guidelines were not always adhered to by bedside nurses.