BACKGROUND: The limited literature on closed-system suctioning suggests a need for further research in this area. Information is lacking about the frequency of use of the closed versus the open system of suctioning and about the current patterns of practice of closed-system suctioning among nurses. OBJECTIVES: To determine the frequency of use of closed- versus open-system suctioning by critical care nurses and to describe the endotracheal suctioning practices of nurses who use closed-system suctioning, in particular the current practice of hyperoxygenation and hyperinflation. METHODS: A survey developed by the investigators was mailed to a stratified proportional sample of 241 critical care nurses who are members of the American Association of Critical-Care Nurses in a tristate area in the mid-Atlantic region of the United States. The 19-item questionnaire included both open and forced-choice items. The response rate was 50%. RESULTS: Closed-system suctioning is common in the critical care setting, and current nursing practices of closed-system suctioning vary. Use of hyperoxygenation is more common than use of hyperinflation with closed-system suctioning. Nurses had knowledge deficits about the proper performance of hyperoxygenation and hyperinflation. CONCLUSIONS: Further research on closed-system suctioning is warranted, especially on the practices of hyperoxygenation and hyperinflation and the effect of these interventions on the prevention of suctioning-induced hypoxemia.

BACKGROUND: Little evidence indicates that changing a patient's body position to the Trendelenburg (head lower than feet) or the modified Trendelenburg (only the legs elevated) position significantly improves blood pressure or low cardiac output. This intervention is still used and is often the first measure implemented for treatment of hypotension. OBJECTIVES: The purpose of this research was to assess the degree of use of Trendelenburg positions by critical care nurses, the clinical uses of these positions, and the sources of knowledge and beliefs of nurses about the efficacy of the positions. METHOD: A survey was mailed to 1000 nurses whose names were randomly selected from the membership list of the American Association of Critical-Care Nurses. RESULTS: The return rate was 49.4%. Ninety-nine percent of the respondents had used the Trendelenburg position, and 80% had used the modified Trendelenburg position, mostly for treatment of hypotension. Most used this intervention as an independent nursing action, and most learned about these positions from their nursing education, nurse colleagues, supervisors, and physicians. The Trendelenburg position was used for many nonemergent reasons; the most frequent use was for insertion of central IV catheters. Although 80% of the respondents believed that use of the Trendelenburg position improves hypotension almost always or sometimes, many respondents recognized several adverse effects associated with use of this position. DISCUSSION AND CONCLUSIONS: The results provide evidence that tradition-based therapy still underlies some interventions used in the care of critically ill patients and that some nurses may be relying on an outdated knowledge base that is not supported by the current literature.

BACKGROUND: Although we have insufficient knowledge about the effects of Trendelenburg positions on various hemodynamic parameters, these positions are frequently used to influence cardiac output and blood pressure in critically ill patients. OBJECTIVES: To determine the effect of Trendelenburg and modified Trendelenburg positions on five dependent variables: cardiac output, cardiac index, mean arterial pressure, systemic vascular resistance, and oxygenation in critically ill patients. METHODS: In this preliminary study subjects were 23 cardiac surgery patients (mean age, 55; SD, 8.09) who had a pulmonary artery catheter for cardiac output determination and who were clinically stable, normovolemic and normotensive. Baseline measurements of the dependent variables were taken in the supine position. Patients were then placed in 10 degrees Trendelenburg or 30 degrees modified Trendelenburg position. The dependent variables were measured after 10 minutes in each position. A 2-period, 2-treatment crossover design with a preliminary baseline measurement was used. RESULTS: Five subjects were unable to tolerate Trendelenburg position because of nausea or pain in the sternal incision. In the 18 who were able to tolerate both position changes, no statistically significant changes were found in the five dependent variables. Changes in systemic vascular resistance over time approached statistical significance and warrant further study. CONCLUSIONS: This preliminary study does not provide support for Trendelenburg positions as a means to influence hemodynamic parameters such as cardiac output and blood pressure in normovolemic and normotensive patients.