Patterns of instability associated with endotracheal suctioning
in infants with single-ventricle physiology

Tume, LN; Baines, P; Guerrero, R; Johnson, R; Ritson, P; Scott, E; Arnold, P; Walsh, L

Abstract

Background In infants with single-ventricle physiology,
endotracheal suctioning poses risks because of the
instability between pulmonary and systemic blood flow.
Objective To examine processes and adverse events
associated with endotracheal suctioning in the first 48
hours after 3 surgical procedures: the Norwood or Norwood-
Sano procedure, pulmonary artery banding, and
the modified Blalock-Taussig shunt.
Methods Prospective observational study in a pediatric
intensive care unit.
Results Bedside nurses collected data from 211 episodes
of endotracheal suctioning in 24 infants. Most (62%,130/211)
suction episodes were unplanned; 38% (81/211) were
planned. The most common reason for unplanned suctioning
was arterial desaturation (48%, 62/130 episodes).
The infants’ oxygen saturation levels before suctioning
ranged from 27% to 86%. Serious adverse events occurred
in 9% (19/211) of suction episodes. In 8 (42%) of the episodes
involving a serious adverse event, the patient
received no additional intravenous bolus of analgesic or
muscle relaxant before suctioning; in 8 episodes (42%),
the patient received both an analgesic and a relaxant;
in 3 episodes (16%), the patient received either an analgesic
or a relaxant but not both. More adverse events
occurred with open suctioning (68%, 13/19) than with
closed suctioning (32%, 6/19). Most adverse events (68%,
13/19) occurred during the night shift.
Conclusions Significant hemodynamic instability and
adverse events occur during routine suctioning in infants
with single-ventricle physiology after surgical palliation.

Citation

in infants with single-ventricle physiology. American Journal of Critical Care, 26(5), 288-394

• Journal Article Type: Article
• Publication Date: Sep 1, 2017
• Deposit Date: Sep 4, 2019
• Journal: American Journal of Critical care
• Print ISSN: 1062-3264
• Publisher: American Association of Critical Care Nurses
• Volume: 26
• Issue: 5
• Pages: 288-394
• Publisher URL: http://dx.doi.org/10.4037/ajcc2017844
• Related Public URLs: http://ajcc.aacnjournals.org/
• Additional Information: Funders : Alder hey Children's Hospital Charity; Projects : CHRIS Study: Cardiac High Risk Infant Suction Study