Abstract
Background
Endotracheal aspiration is a painful nociceptive procedure. There is still a gap in
the literature on studies to determine the pain level and nursing interventions for
aspiration.
Objectives
This study evaluated pain during endotracheal aspiration and examined the factors
affecting pain.
Methods
This prospective observational study was conducted with 105 inpatients meeting the
inclusion criteria in the internal intensive care unit of a public hospital. Two hundred
ten aspiration procedures were monitored for pain and other variables. ASPMN 2019
Position Statement recommendations were followed in designing the study and determining
the procedure. The pain score range obtained from The Critical Care Pain Observation
Tool was 0–8. A score of 2 or more is considered to indicate the presence of pain.
The primary outcome measures were pain associated with endotracheal aspiration and
affecting factors in this study. The generalised linear mixed model established for
aspiration procedure-associated pain and affecting factors was analysed.
Results
Patients' mean pain score was 1.24 ± 2.05 before, 3.07 ± 2.17 during, and 2.35 ± 1.94
after aspiration and 0.89 ± 1.40 at 15 min after aspiration. The pain rate was 26.1%
before, 71% during, and 60.9% after the aspiration procedure and 18.8% after 15 min.
There was a statistically significant difference between all pain scores evaluated.
The difference in aspiration-related pain scores by age, respiratory diseases, sedation
status, aspiration pressure, and tube diameter was statistically significant.
Conclusions
The pain score due to aspiration procedure increased significantly in intensive care
unit inpatients and is an important risk factor for patient safety. More focus is
needed on the causes and measures of aspiration-related pain.
Keywords
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References
- Pandharipande, P.P., et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU.Crit Care Med. 2018; 46: 825-873https://doi.org/10.1097/CCM.0000000000003299
- Pain assessment in the critically ill adult: recent evidence and new trends.Intensive Crit Care Nurs. 2016; 34: 1-11https://doi.org/10.1016/j.iccn.2016.03.001
- Pain assessment in the patient unable to self-report: clinical practice recommendations in support of the ASPMN 2019 Position Statement.Pain Manag Nurs. 2019; 20: 404-417https://doi.org/10.1016/j.pmn.2019.07.005
- Vital signs fluctuations and their relationship with pain in the brain-injured adult critically ill- a repeated-measures descriptive-correlational study.Intensive Crit Care Nurs. 2019; 55102743https://doi.org/10.1016/j.iccn.2019.07.002
- Current perspectives on the assessment and management of pain in the intensive care unit.J Pain Res. 2021; 14: 1733-1744https://doi.org/10.2147/JPR.S256406
- ASPMN 2019 Position Statement: pain assessment in the patient unable to self-report.Pain Manag Nurs. 2019; 20: 402-403https://doi.org/10.1016/j.pmn.2019.07.007
- Pain among non-verbal critically ill mechanically ventilated patients: prevalence, correlates and predictors.J Crit Care. 2019; 49: 14-20https://doi.org/10.1016/j.jcrc.2018.10.002
- Determinants of procedural pain intensity in the intensive care unit. The Europain® study.Am J Respir Crit Care Med. 2014; 189: 39-47https://doi.org/10.1164/rccm.201306-1174OC
- Evaluation of pain severity in critically ill patients on mechanical ventilation.Intensive Crit Care Nurs. 2022; 68 (ISSN 0964-3397)103118https://doi.org/10.1016/j.iccn.2021.103118
- Patient's experiences of endotracheal tubes and suction following cardiac surgery.Nurs Crit Care. 2021; : 1-8https://doi.org/10.1111/nicc.12604
- Pain distress: the negative emotion associated with procedures in ICU patients.Intensive Care Med. 2018; 44 (Epub 2018 Aug 21. PMID: 30128592): 1493-1501https://doi.org/10.1007/s00134-018-5344-0
- Pain during tracheal aspiration in patients with traumatic brain injury undergoing mechanical ventilation.Rev Dor São Paulo. 2017; 18: 332-337
- Assessment of procedural pain in patients with Covid-19 in the intensive care unit.Pain Manag Nurs. 2022; (ISSN 1524-9042)https://doi.org/10.1016/j.pmn.2022.03.002
- Pain behaviours of intubated and sedated intensive care patients during positioning and aspiration.Acıbadem Üniv Sağlık Bilim Derg. 2010; 2: 89-93
- Evaluation of behavioral and physiological pain indicators during invasive procedures on the intensive care patients.Hemşir Araşt Gelişt Derg. 2016; 18: 13-21
- Evaluation of pain during mobilization and endotracheal aspiration in critical patients.Med Intensiva. 2016; 40: 96-104https://doi.org/10.1016/j.medin.2015.03.004
- An association between pain and American Association of Respiratory Care 2010 guidelines during tracheal suctioning.Dimens Crit Care Nurs. 2016; 35: 283-290https://doi.org/10.1097/DCC.0000000000000200
- Setting a regulated suction pressure for endotracheal suctioning; a systematic review.JBI Libr Syst Rev. 2011; 9: 295-311
- Mechanical ventilation and the role of saline ınstillation in suctioning adult ıntensive care unit patients: an evidence-based practice review.Dimens Crit Care Nurs. 2014; 33: 246-253https://doi.org/10.1097/DCC.0000000000000049
- AARC Clinical practice guideline: endotracheal suctioning.Respir Care. 2010; 55: 758-764
- Endotracheal suctioning of the adult intubated patient: what is the evidence.Intensive Crit Care Nurs. 2009; 25: 21-30https://doi.org/10.1016/j.iccn.2008.05.00422
- Puntillo KA. Pain related to tracheal suctioning in awake acutely and critically ill adults: a descriptive study.Intensive Crit Care Nurs. 2008; 24: 20-27https://doi.org/10.1016/j.iccn.2007.05.002
- Psychometric analysis of behavioral pain scale Brazilian version in sedated and mechanically ventilated adult patients: a preliminary study.Pain Pract. 2016; 16: 451-458https://doi.org/10.1111/papr.12287
- The Richmond Agitation – Sedation Scale: validity and reliability in adult intensive care unit patients.Am J Respir Crit Care Med. 2002; 166: 1338-1344https://doi.org/10.1164/rccm.2107138
- Adaptation of two measurement tools used to assess sedation agitation and pain among patients in intensive care units in to Turkish: a reliability and validity study.Yoğun Bakım Hemşire Derg. 2018; 22: 50-65
- Validating a pain assessment tool in heterogeneous ICU patients: is it possible?.Nurs Crit Care. 2020; 25: 8-15https://doi.org/10.1111/nicc.12469
- Validation of the critical-care pain observation tool in adult patients.Am J Crit Care. 2006; 15: 420-427
- Pain assessment in critically ill adult patients: validity and reliability research of the Turkish version of the critical-care pain observation tool.Türk Yoğun Bakım Dern Derg. 2006; 14: 93-99https://doi.org/10.4274/tybdd.95967
- Methods of pain assessment in adult intensive care unit patients- Polish version of the CPOT (Critical Care Pain Observation Tool) and BPS (Behavioral Pain Scale).Anaesthesiol Intensive Ther. 2017; 49 (PMID: 28362033): 66-72https://doi.org/10.5603/AIT.2017.0010
- Comparison of two pain scales: behavioral pain scale and critical-care pain observation tool during invasive and noninvasive procedures in intensive care unit-admitted patients.Iran J Nurs Midwifery Res. 2019; 24: 151-155https://doi.org/10.4103/ijnmr.IJNMR_47_18
- Evaluation of pain in intubated and sedated adult intensive care patients.(Master thesis) Trakya University Institute of Health Sciences Nursing Master's Program, 2019 (Supervisor: Serap Ünsar)
- Increasing suction pressure during endotracheal suctioning increases the volume of suctioned secretions, but not procedure-related complications: a comparative study in open system endotracheal suctioning.Intensive Crit Care Nurs. 2020; 61102928https://doi.org/10.1016/j.iccn.2020.102928
- Pain management principles in the critically ill.Chest. 2009; 135: 1075-1086https://doi.org/10.1378/chest.08-2264
- Efficacy of the use of evidence-based algorithmic guidelines in the acute care setting for pain assessment and management in older people: a critical review of the literature.Int J Older People Nurs. 2012; 7: 127-140https://doi.org/10.1111/j.1748-3743.2010.00261.x
- Tracheal pressures during open suctioning.Anaesthesia. 2008; 63: 313-315https://doi.org/10.1111/j.1365-2044.2007.05348.x
- The thorax and lungs. Bates' guide to physical examination and history taking.11th ed. Lippincott Williams & Wilkins, 2013: 293-319
- Assessment of pain in sedated and mechanically ventilated patients: an observational study.Acta Anaesthesiol Scand. 2012; 56: 645-654https://doi.org/10.1111/j.1399-6576.2012.02660.x
- Midazolam: an essential palliative care drug.Palliat Care Soc Pract. 2020; 14https://doi.org/10.1177/2632352419895527
- Comparison of the effect of open and closed endotracheal suctioning methods on pain and agitation in medical ICU patients: a Clinical Trial.Anesth Pain Med. 2016;31; 6 (PMID: 27847697; PMCID: PMC5101537)e38337https://doi.org/10.5812/aapm.38337
- Comparing the effect of endotracheal tube suction using open method with two different size catheters 12 and 14 on discharge secretion, pain, heart rate, blood pressure, and arterial oxygen saturation of patients in the intensive care unit: a randomized clinical trial.Ann Trop Med Public Health. 2017; 10: 1312-1317
Article info
Publication history
Published online: January 03, 2023
Accepted:
November 23,
2022
Received in revised form:
October 27,
2022
Received:
July 24,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
