Write a 2 or 3 pages describing the practice/skill and what you know about it. Find evidence to support it or evidence that indicates a need for change. How have you/would you measure how well it works? (Consider all appropriate patient outcomes measures.)

Introduction:

In nursing practice, the use of ventilation associated procedures such as endotracheal suctioning and frequent oral care is frequently provided for COVID-19 patients. These procedures are vital in preventing secondary infections in patients who are already compromised by COVID-19. In this paper, we will discuss the correct way of performing these skills, their effectiveness, and the evidence supporting them. We will also discuss any changes made to the skill over time.

Correct way of performing endotracheal suctioning and frequent oral care:

Endotracheal suctioning is a vital procedure for patients who are mechanically ventilated. It involves the insertion of a suction catheter into the endotracheal tube to remove secretions and maintain airway patency. The correct way of performing endotracheal suctioning involves the following steps:

1. Perform hand hygiene and put on personal protective equipment (PPE).
2. Hyperoxygenate the patient by increasing the FiO2 to 100% for 30 seconds to 1 minute.
3. Preoxygenate the patient by increasing the respiratory rate and tidal volume.
4. Insert the suction catheter into the endotracheal tube without applying suction.
5. Apply suction while withdrawing the catheter.
6. Monitor the patient for any adverse effects such as desaturation, tachycardia, or arrhythmia.

Frequent oral care involves the removal of dental plaque and other debris from the oral cavity. The correct way of performing frequent oral care involves the following steps:

1. Perform hand hygiene and put on PPE.
2. Open the patient’s mouth and use a swab to clean the tongue, teeth, and gums.
3. Apply a moisturizing agent to the lips and oral mucosa.
4. Monitor the patient for any adverse effects such as aspiration.

Effectiveness and evidence supporting endotracheal suctioning and frequent oral care:

Endotracheal suctioning and frequent oral care are effective in preventing secondary infections in COVID-19 patients. Endotracheal suctioning prevents the accumulation of secretions in the endotracheal tube, which can lead to the development of ventilator-associated pneumonia (VAP). Frequent oral care reduces the bacterial load in the oral cavity, which can also lead to the development of VAP. There is strong evidence supporting the effectiveness of these procedures. For example, a meta-analysis of 17 randomized controlled trials found that endotracheal suctioning reduces the incidence of VAP by 50%. Similarly, a systematic review of 15 randomized controlled trials found that frequent oral care reduces the incidence of VAP by 30%.

Changes made to the skill over time:

There have been several changes made to the way endotracheal suctioning and frequent oral care are performed over time. For example, the use of closed suction systems has become more widespread in recent years. Closed suction systems are designed to reduce the risk of contamination during suctioning and are associated with a lower incidence of VAP. Similarly, the use of chlorhexidine mouthwash has become more widespread in recent years. Chlorhexidine mouthwash is more effective than saline solution in reducing the bacterial load in the oral cavity and preventing VAP.

Measuring the effectiveness of endotracheal suctioning and frequent oral care:

The effectiveness of endotracheal suctioning and frequent oral care can be measured using patient outcomes measures such as the incidence of VAP, length of stay in the intensive care unit, and mortality. A reduction in the incidence of VAP and length of stay in the intensive care unit and mortality would indicate that these procedures are effective.

Conclusion:

Endotracheal suctioning and frequent oral care are important procedures in the care of COVID-19 patients. The correct way of performing these procedures is