The Effects of a Clinical Pathway for Endotracheal Tube Suctioning Pain Management on Pain Presence and Agitation in Surgical Intensive Care Unit Chinese Adults

Abstract

Even though endotracheal tube suctioning (ETS) is a necessary and frequently used procedure among intubated patients to maintain a patent airway, the pain associated with it seriously impacts patients. ETS pain can be minimized with a quality pain management program. This quasi-experimental study explored the effects of the implementation of a clinical pathway for endotracheal tube suctioning (CPETS) pain management on the level of pain presence and agitation in critically ill adult patients. Fifty-two critically ill adults admitted to the surgical intensive unit (SICU) of the second affiliated hospital of Kunming Medical university, Yunnan, China were recruited from January through March 2018. The first 26 and the next 26 patients were consecutively allocated into the usual ETS care group and the CPETS pain management group. The CPETS started before ETS with the preparation of the patient. Pain assessment and management continued during ETS through the completion of the ETS procedure. The level of pain presence was evaluated by using the Chinese-version Critical Care Pain Observation Tool (CPOT). Moreover, the Chinese-version Richmond Agitation-Sedation Scale (RASS) was used to evaluate the level of agitation. The outcomes in intervention and control groups were measured before, during, immediately after, 5 minutes after, and 15 minutes after ETS by the research assistant (RA). A clinical characteristics questionnaire was used to collect the demographic and clinical data (S-CVI= .92). The documentation form for the ETS pain management outcomes was used to document the outcomes (S-CVI 1.00). The percentage of inter-rater reliability testing between the researcher and the RA was 100%. Descriptive and Mann-Whitney U were used to analyse the data and test the research hypothesis. The statistical analysis of the results indicated that all of the participants experienced pain and agitation during ETS. As compare to the control group, the Mann-Whitney U test analysis revealed a statistically significant decrease in level of pain presence at during (z = -5.97, p < .05), immediately after (z = -5.94, p < .05), and 5 minutes after (z = -2.06, p < .05) the ETS procedure in the intervention group. A significantly lower level of agitation at during (z = -3.05, p < .05) and immediately after (z = -3.91, p < .05) the ETS procedure was also found in the CPETS group. No significant differences were observed between the groups in relation to the CPOT scores before and 15 minutes after the ETS (p > .05). The same results was true for as the RASS scores before, 5 minutes after, and 15 minutes after the ETS (p > .05). The findings demonstrated that the implementation of the CPETS pain management into practice could help to reduce ETS-related pain. The adoption and application of the clinical pathway (CP) across the nation as well as the establishment of in-service training programs to enhance the nurses' competence in ETS pain management are recommended.