You are a staff nurse working in an intensive care unit and assigned to care for a 75-year-old man who had coronary artery bypass graft surgery 4 days ago. The patient has a history of chronic obstructive pulmonary disease exacerbated by heavy smoking. His postoperative course has been difficult, and he has had a number of setbacks. The staff, despite their diligent efforts, have not been able to wean him off the ventilator since the surgery. He has required frequent suctioning throughout the shift, and he is being evaluated for the development of ventilator-associated pneumonia. Today, when returning from lunch, you observed that an experienced nurse was suctioning your patient. His secretions were thick, and you observed that the nurse was instilling saline into the patient’s endotracheal tube as she was suctioning him. The patient turned red and began coughing, and it was obvious he was in distress. You asked the nurse why she was instilling saline into his endotracheal tube. She replied that this was being done to loosen the secretions. You told her this was no longer an acceptable practice. She stated that she had lots of critical care experience, and she didn’t care what anyone said, that the only way you could loosen the patient’s secretions would be to instill saline. She also said that would be the last time she would do something for one of your patients while you were at lunch.
Develop a PICO (patient population, intervention, comparison, outcome) question for the instillation of saline during endotracheal suctioning.
Ans) PICO for installation of saline during endotracheal suctioning:
Population: All age Ranges
Male/Female,North American, Turkey, UK,
Presence of an Endotracheal Tube
Intervention: To not use NS in endotracheal suctioning
Comparison: Endotracheal suctioning should be done without the use of NS as opposed to with NS.
Outcome: Provide an evidence-based
practice of suctioning technique that eliminates adverse effects and risks to
the patient's well-being.
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