| Learning Objective #1: the endotracheal suctioning with normal saline instillation has a decrease of oxygen saturation, increase of end-tidal CO2, increase of heart rate and blood pressure. | |||
| Learning Objective #2: instillation of normal saline should not be routine and that each pediatric patient should be individually assessed to determine normal saline instillation in required. |
The quasi-experimental research examined a comparison of the effects of endotracheal suctioning with and without normal saline instillation on physiologic changes in pediatric patients with mechanical ventilator. The conceptual framework was based on biomedical knowledge about pathophysiology of oxygenation and ventilation during endotracheal suctioning. Fifty-eight pediatric patients, who were admitted to the PICU in Ramathibodi Hospital during July 2005 to January 2006, were selected by purposive sampling. Among the sample in this study, 7 subjects were collected twice on separate occasion through a 7-day interval from the previous one. The crossover experimental design was to compare the mean changes in oxygen saturation, end-tidal CO2, heart rate, and mean blood pressure between the subjects after endotracheal suctioning. Each subject was exposed to both methods: the endotracheal suctioning with and without normal saline instillation. The sequence of experimental method of eligible subjects was assigned by drawing lots (number 1 to 65) without replacement. The duration between each suctioning method was 3 hours before starting the other method. Data were analyzed using with SPSS/FW program in descriptive statistics, paired t-test, and wilcoxon signed ranks test. The results revealed that oxygen saturation after endotracheal suctioning with normal saline instillation was decreased more than after the endotracheal suctioning without normal saline instillation over time with statistical significant difference (p<.05). End-tidal CO2, heart rate, and mean blood pressure after endotracheal suctioning with normal saline instillation was increased more than after the endotracheal suctioning without normal saline instillation over time with statistical significant difference (p<.05).
This study suggests that the instillation of normal saline before endotracheal suctioning has result in danger to the pediatric patients such as hypoxia, increase of end-tidal CO2, heart rate and blood pressure. Thus, the nurse should have knowledge in suctioning correctly for reduce hazard.