Closed suctioning reduces risk of exposure to bodily fluids and outside pathogens

Closed suctioning reduces risk of exposure to bodily fluids and outside pathogens

For ventilated patients, endotracheal suctioning is part of the essential regimen of care. This process keeps the airway clear of secretions from the bronchial tubes, which is to allow the patient to receive enough oxygen and rest comfortably. There are two kinds of suction systems that can be used to achieve endotracheal suctioning in ventilated patients: the conventional open system, and the closed suction system.

The traditional open suctioning system demands that the healthcare professional first open the respiratory circuit to work. This is typically done by placing a single-use sterile suctioning catheter into the endotracheal tube, and disconnecting the patient from the ventilator.

The closed suction system was developed in the 1980s as an alternative to the traditional open suctioning method [4]. The closed suctioning system makes use of multi-use suction catheters protected by plastic envelopes, eliminating the need for both barrier precautions and the separation of patient and respirator [4].

Compared to the conventional open suctioning system, the newer closed suctioning system offers several potential benefits:

  • Less loss of lung volume or positive end expiratory pressure (PEEP) [5,6];
  • Reduction in chance of exogenous contamination of the endotracheal tube [6];
  • Decreased opportunity to contaminate the healthcare provider’s hands or the immediate environment with the patient’s respiratory microorganisms [6]

Research in at least one neonatal intensive care unit has shown that closed suctioning can be performed with fewer personnel, less physiological disturbance to patients, and without increasing numbers of adverse events [1]. Researchers also have noted that open suctioning was demonstrably riskier for cardiac surgery patients and that closed suctioning may be preferred [2]. The Centers for Disease Control (CDC) also states that implementing closed suctioning systems along with other engineering controls designed to prevent infection may be important to reducing infection risks [3].

In some research trials, findings indicate little difference in environmental contamination between open and closed suction systems, but others conclude that closed systems result in significantly less environmental contamination. There is no research at all that suggests increased risk of environmental contamination from closed suction systems.

For these reasons, closed suctioning may be preferred for preventing exposure to bodily fluids and outside pathogens for patients and caregivers. The multi-use suction catheters which are protected by plastic envelopes can protect both patients and healthcare professionals from contamination, making it unnecessary to separate patients from respirators.

References

  1. Evans, J. (2014, March 11). Comparison of open and closed suction on safety, efficacy, and nursing time in a paediatric intensive care unit. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24636425
  2. Ozden, D. (2014, July 3). Effects of open and closed suction systems on the haemodynamic parameters in cardiac surgery patients. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24991700
  3. NCIRD. (2018, February 13). Prevention strategies for seasonal influenza in healthcare settings. Retrieved from https://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm
  4. Yazdannik, A.R. (2018 March). Comparing two levels of closed system suction pressure in ICU patients. Retrieved from https://europepmc.org/articles/PMC3748566
  5. Cereda, M. (2001, March 22). Closed system endotracheal suctioning maintains lung volume during volume-controlled mechanical ventilation. Retrieved from https://link.springer.com/article/10.1007%2Fs001340100897
  6. Haghighat, S. (2015, September-October). The practice of intensive care nurses using the closed suctioning system. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4598911/?tool=pmcentrez