Best Practice in Tracheostomy Suctioning Among Pediatric Patients: A Poster Presentation

Sunday, November 1, 2009

Katherine Anne Abbott, RN, BS, CPN1
Dolores Ann Puthoff, RN, MSN1
Jessica Young, RRT, AAS2
Kimberly Kombrinck, APN1
Erin Michelle Laws, RRT, AAS1
1Transitional Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
2Transitional Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati Cincinnati, OH

Learning Objective 1: to identify current standards for tracheostomy suctioning techniques.

Learning Objective 2: to identify the need for further research regarding proper tracheostomy suctioning techniques.

Compromised children with complex respiratory needs may not be able to clear their airway of troublesome secretions. The issue of airway clearance and airway patency becomes even more critical in the narrow passages of pediatric patients. Pediatric patients with artificial airways, such as tracheostomies, may require suctioning to rid their airway of secretions.

As nurses and respiratory therapists, excellence in clinical practice requires determining the most effective, efficient, and safe suctioning technique.  Published current international suctioning standards recommend the use of negative pressure only during withdrawal of the suction catheter from the tracheostomy.  Experts, articles, textbooks, and policies recommend suction techniques without research to support the practice. A literature search was conducted to seek a comparison between suctioning on catheter insertion and withdrawal as opposed to only suctioning during catheter withdrawal.  Critical appraisal of the literature revealed that a majority of the currently published work is expert opinion or level five.   The majority of the evidence consisted of descriptive and longitudinal studies.  The overall grade of the evidence is low. There are no high quality research studies to support a determination of best suctioning practice. 

Healthcare continues to expand its limits to give children life through artificial airways.  The increasing numbers of children with tracheostomies worldwide require a precedence to be set for best practice.  Given that current standards are based on low level evidence, it is recommended that research be conducted.   Embarking on a study may allow healthcare providers to develop guidelines based on high level evidence that then provides the best care for pediatric patients.