Evidence-based practice is essential for nurses to enhance patient outcomes and provide high-quality evidence. Although clinical experience is an essential part of nursing, it is vital not to ignore recent developments in guidelines and research that offer modern, practical solutions for patients. In the chosen scenario, the nurse was instilling saline into the patient’s endotracheal tube, although it was no longer an acceptable practice. When confronted about this, she referred to her clinical experience and ignored later clinical guidelines entirely. To understand the scenario and develop strategies for improving suctioning practice in the hospital, it is essential to perform a literature search to identify modern evidence-based practices for this procedure. In addition, a PICO question relevant to the case will be developed, and the application of the PICO format to the student’s practice will also be considered.
Search Strategies
To collect high-quality evidence, I would start with Google Scholar, since it is the largest aggregate of scholarly research online. The search phrases that I would use are “suctioning guidelines,” “endotracheal suctioning,” and “saline installation.” These search criteria will produce two types of results: clinical guidelines and research studies evaluating the effectiveness and safety of saline instillations. To narrow down the results further, I would restrict publication dates to the last five years. I would also apply sorting by relevance and select the top sources published by reputable, peer-reviewed journals or by professional associations. This search strategy will produce the best results given the goals of the research.
Search Results
The research revealed about 50,000 results for all the three search phrases combined, and with the publication, date filters were applied. However, many of the articles considered the application of guidelines and best practices by nurses instead of commenting on the procedure itself. The most relevant sources were chosen that apply to the selected case and can provide valuable information to support clinical practice in suctioning. Firstly, a study by Ayhan et al. (2015), which followed the methodology of a systematic review, found saline instillations to decrease oxygenation. The researchers also noted that the effect of saline installations on hemodynamics and ventilator-associated pneumonia is unclear. Thus, the use of saline during suctioning is not recommended. A meta-analysis of randomized controlled trials by Wang et al. (2017) confirmed these findings, also stating that saline should not be used during suctioning. Finally, the search was also expanded to include the most recent guidelines, which were published in 2010. According to these guidelines, saline should not be used since its benefits are unclear, and it may cause harm to patients based on the latest evidence (American Association for Respiratory Care, 2010). Hence, both research studies and the most recent edition of clinical guidelines on endotracheal suctioning warn against saline.
Collecting information on a particular practice and its benefits is easier when a structured approach is used, and the PICO format can thus benefit information search and research studies. For the present case, the population of interest are mechanically ventilated adult patients. The intervention that should be evaluated is normal saline instillation, and the control is regular suctioning without the use of normal saline. Finally, the outcomes of interest are oxygenation and the incidence of ventilator-associated pneumonia. Thus, the suggested PICO question for the research is as follows: In mechanically ventilated adult patients, does the use of normal saline instillations during suctioning, compared with regular suctioning without saline instillations, improve oxygenation and reduce the incidence of ventilator-associated pneumonia?
Application to Practice
The PICO format can be applied to a range of practice settings, and it can provide essential benefits for data collection and assessment. First of all, it could help to narrow down the research process by focusing on specific populations, interventions, and outcomes. Secondly, the format allows comparing evidence for two or more interventions, which is essential to updating practice guidelines in accordance with the principles of evidence-based practices. Finally, the PICO format can serve as a framework for research studies, thus helping researchers to structure their work and present conclusions that would be relevant to clinical practice. An example of how the PICO format could be applied in my practice is studying various approaches to surgical site infection prevention. For instance, it would be beneficial to examine the benefits of negative pressure wound therapy in the prevention of surgical site infections. The PICO question for this study would be “In patients after surgery, does the use of negative pressure wound therapy, compared to standard wound care, decrease the incidence of surgical site infections?”. Answering this question using research findings could contribute to surgical site infection prevention, thus improving patient outcomes.
Conclusion
On the whole, the case highlights the importance of applying the principles of evidence-based practice in critical care. Although the nurse insisted on using saline instillations, research findings show that it can harm patients by decreasing oxygenation. Clinical guidelines that advise against using saline were published ten years ago, indicating that the nurse’s approach was very outdated. The application of the PICO format to practice issues can be useful since it allows narrowing down the focus of the research and offers findings that can be utilized in practice.
References
American Association for Respiratory Care. (2010). AARC Clinical Practice Guidelines: Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respiratory Care, 55(6), 758-764.
Ayhan, H., Tastan, S., Iyigun, E., Akamca, Y., Arikan, E., & Sevim, Z. (2015). Normal saline instillation before endotracheal suctioning: “What does the evidence say? What do the nurses think?”: Multimethod study. Journal of Critical Care, 30(4), 762-767.
Wang, C. H., Tsai, J. C., Chen, S. F., Su, C. L., Chen, L., Lin, C. C., & Tam, K. W. (2017). Normal saline instillation before suctioning: A meta-analysis of randomized controlled trials. Australian Critical Care, 30(5), 260-265.