To suction the ETT, or not?

[CactusFlower]

I am increasingly irritated in my current position regarding the management of ventilator patients. I am working in a small rual hospital, 6 bed ICU and have been told repeatedly by the respiratory personnel here it is no longer accepted practice to suction the ETT, much less to break the circuit to do so. The nursing staff here do not suction, they call respiratory for any respiratory issues.

I have kept current since leaving the city and the large ICU's. I worked over 20 years trauma and burn ICU, and feel I have adequate assessment skills to make the judgement if my patient needs suctioning or not. This I do not simply do on a wim! I know the indications and the risks of ETT suctioning, but I do not think it is appropriate to simply leave all those wonderful secretions, mucous plugs, pulmonary edema, ect in there.

I am big on turning, repostioning, mouth care, HOB elevation ect. Once in a blue moon we have a patient deteriorate into full blown ARDS. (Don't want to go into what that becomes here). I have done an extensive literary search, see nothing that states ETT suctioning is not done--I have concluded if there are secretions, they get suctioned being carefull to assess patient, ect. Also stated if needed it is "okay" to break the circuit. What is your experience lately?

[ghillbert, MSN, NP]

Check the thread about giving ice to a ventilated pt - think someone posted research about lavaging showing it is ineffective and potentially harmful.

[organichombre, ADN, BSN, MSN, LPN, RN]

Dontcha just hate it when someone outside of direct pt care throws out a blanket statement like that? Obviously this is a pt by pt management decision and all the previous posts are correct. Inline ballard sxing is great however there are times especially post traumatic intubations where the circuit must be broken for not only sxing but lavage. And not all facilities have gone to the inline mdi's vs nebulizers. I say suction but discriminately as does most research,.. after all like someone said, we nurses are there every minute of the day!