BACKGROUND: Peritoneal catheters may be used routinely in children undergoing cardiac surgery. Removal of the catheter is often complicated by omental herniation, which can cause intraperitoneal bleeding, peritonitis, and bowel obstruction. Instillation of saline into the catheter before removal is used in some institutions as a preventive measure, but the practice has never been investigated. OBJECTIVE: To determine the effectiveness of instilling saline into peritoneal catheters before their removal in reducing the occurrence of omental herniation and to determine risk factors for omental herniation. METHODS: A total of 404 patients with peritoneal catheters in place were randomized to either the control or the study group. The study group (n = 204) had saline (1 mL/kg; maximum, 10 mL) instilled into the catheter before the catheter was removed; the control group (n = 200) did not. Extrusion or no extrusion of omentum was recorded. Other data collected included the child's weight, the length of time the catheter was in place, whether peritoneal dialysis was performed, and whether the child was pharmacologically paralyzed when the catheter was removed. RESULTS: Extrusion of omentum occurred in 39% of the study group and in 33% of the controls. Results of logistic regression analysis suggested that omental herniation was more common in smaller children, children whose catheters remained in place longer, and children who were not pharmacologically paralyzed when the catheter was removed. CONCLUSIONS: Instillation of saline does not appear to reduce the occurrence of omental herniation. Further research into strategies to reduce this complication is recommended.
BACKGROUND: Although many investigators have assessed the technique of endotracheal tube suctioning, the tissue of how frequently it should be performed remains controversial. No objective data is available to determine the answer. OBJECTIVE: To determine the criteria nurses use to make decisions regarding endotracheal suctioning. METHOD: Twenty-four registered nurses of varying levels of experience were asked a series of open-ended questions related to their theoretical knowledge, their ability to apply this knowledge, their suctioning practice, and how they made decisions regarding suctioning. RESULTS: All participants believed their patients required suctioning every 1 to 3 hours, with 17 performing it every 2 to 3 hours. Twenty criteria of which nine related to frequency were used in determining suctioning requirements. Eleven related to recognizing the need for immediate suctioning and were concerned with changes in the patient's condition. Common significant changes included desaturation, hemodynamic changes, loss of color, and blood gas changes. No single criterion was identified by all nurses. No differences were apparent between experienced and less experienced nurses. CONCLUSIONS: The large number of criteria identified suggests that the decision to suction is a complex one. It is a concern that many nurses rely on a deterioration in the patient's condition to indicate when suctioning is required. A policy of suctioning as necessary is provision of clear guidelines and education of all staff.