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Nasal Continuous Positive Airway Pressure: A Multisite Study of Suctioning Practices Within NICUs

Mann, Brenda BSN, RN; Sweet, Michele MS, RN; Knupp, Amy M. MSN, RN, CNS; Buck, Jacalyn PhD, RN, NE-BC; Chipps, Esther PhD, RN

Section Editor(s): Dowling, Donna

doi: 10.1097/ANC.0b013e3182863eaf
Online Only: Original Research

PURPOSE: The purpose of this multisite study was to describe suctioning techniques of registered nurses (RNs) and respiratory therapists (RTs) caring for neonates requiring nasal continuous positive airway pressure (CPAP). The care practices investigated included suctioning frequency, assessment parameters, and techniques used to suction.

SUBJECTS: A convenience sample of neonatal intensive care unit (NICU) RNs and practicing RTs at 8 Midwestern hospitals in the United States caring for neonates on nasal CPAP in a level II or III NICU were included. Eighty-five percent of respondents were RNs of which almost 89% (88.6%) were staff RNs, 63% were bachelor prepared, and 33% of the RNs had greater than 20 years of neonatal nursing experience.

DESIGN: A cross-sectional descriptive comparative design was used for this study.

METHODS: An investigator-developed Web-based survey pertaining to current practice concerns was developed by the research team. The 31-item survey tool consisted of 4 sections. The first section addressed the frequency of suctioning. The second section addressed assessment parameters used to determine the need for suctioning. The third section addressed the technique used to suction, including gloving techniques, hyperoxygenation, and the use of catheters in nares and mouth and suctioning devices. Demographic data, including staff position, level of education, years of nursing, and NICU experience and certification, were collected in the fourth section. Descriptive statistics were used to characterize demographics and each item of the survey. Chi-square statistics (Pearson chi-square and Fisher Exact text) were used to compare RNs' and RTs' nasal CPAP suctioning practices.

PRINCIPAL RESULTS: The results of this study indicated that decision making related to the need to suction was variable. In addition, the frequency of suctioning and nasopharyngeal and oropharyngeal suctioning techniques were highly variable for neonates requiring nasal CPAP.

CONCLUSIONS: Despite the treatment of respiratory distress with nasal CPAP, there are no best practice guidelines for providing nasopharyngeal and oropharyngeal suctioning for maintenance of a patent airway. Future randomized controlled clinical trials are needed to develop best practices for nasal CPAP suctioning.

Neonatal Intensive Care Unit, Wexner Medical Center, the Ohio State University (Ms Mann and Ms Sweet); Department of Health System Nursing Quality, Research, Education, and Evidence-Based Practice, Wexner Medical Center, the Ohio State University (Ms Knupp and Drs Buck and Chipps), Health System Nursing Quality & Patient Safety (Ms Knupp), Wexner Medical Center, the Ohio State University, Columbus.

Correspondence: Amy M. Knupp, MSN, RN, CNS, Department of Health System Nursing Quality, Research, Education and Evidence-Based Practice at the Wexner Medical Center at the Ohio State University, PO Box 182495, Columbus, OH 43218 (

The authors thank the following individuals for serving as the study coordinators at their individual sites: Kim Firestone, Akron Children's Hospital; Barb Fleming, Children's Memorial Hospital; Erin L. Keels, Nationwide Children's Hospital; Phyllis Lawlor-Klean, Advocate Christ Medical Center; Christie Lawrence, Rush University Medical Center; Anne McPherson, Cadence Health–Central DuPage Hospital; and Martha Meyers, Nationwide Children's NICU at Mount Carmel St Ann's. The authors also thank Priscilla Koeplin, PhD, RN, FAAN, for assisting with editing and review.

The authors declare no conflict of interest.

© 2013 National Association of Neonatal Nurses