Preoxygenation practices prior to tracheal suctioning by nurses caring for individuals with spinal cord injury.

摘要

Hypoxemia and hypoxia-induced physiological changes are acknowledged complications of airway suctioning. Guidelines for tracheal suctioning are conflicting on the need for preoxygenation prior to suctioning of individuals with spinal cord injuries. The purpose of this exploratory study was to describe preoxygenation practices of nurses who perform tracheal suctioning with individuals with spinal cord injury and to identify decision making factors used when altering the frequency or method of preoxygenation. The Roy Adaptation Model (RAM) and ventilatory acclimatization are used to explain the decision making process over time. Members of the Association of Rehabilitation Nurses and American Association of Spinal Cord Injury Nurses participated in a Web-based survey on preoxygenation practices and factors that contribute to a decision to do more or do less in terms of preoxygenation. There were 232 useable surveys; 75% of the respondents (n = 174) reported that they did not routinely preoxygenate patients prior to tracheal suctioning. A majority (56.6%, n = 131) were active decision makers; that is, they chose to preoxygenate some or most of the time, based on patient, environmental, or time factors. Cluster analysis methods revealed that various factors are used when making the decision to do less or to do more in terms of preoxygenation. Results and differences in decision making patterns are reported in the context of rehabilitation nursing practice. The study suggests a population of acclimatized individuals for whom new practice guidelines for preoxygenation and tracheal suctioning may be warranted.