Pain and Comfort During Endotracheal Suction in Premature Neonates
Condition: Premature
MeSH terms: Premature Birth
Study type: Interventional

Summary: 
      Most of the preterm babies in neonatal units are followed up with invasive mechanical
      ventilation support. For this reason, endotracheal suction is needed repeatedly in preterm
      babies in order to open the airway obstruction caused by secretions and to maintain the
      airway patency. Endotracheal aspiration, which is one of the invasive procedures in which
      pain is felt most in newborns, is performed by nurses.

      Endotracheal suction, which causes pain and discomfort in intensive care units, negatively
      affects the comfort of patients. Studies emphasize that comfort is an indicator of pain and
      stress, and the comfort scale is also used in pain and distress assessments.

      Effective pain management and the development of pain-related care standards to reduce pain
      in preterm newborn infants improve clinical and neurodevelopmental outcomes. For this reason,
      it is necessary to reduce the pain that has an effect on the development of preterm babies.

      In pediatric nursing, studies on non-pharmacological methods have increased in recent years
      in order to increase the comfort of infants and reduce pain and stress, especially during
      painful and stressful procedures in infants followed in neonatal intensive care units. When
      the literature is examined, there are few studies measuring the effectiveness of
      non-pharmacological methods used in reducing pain due to endotracheal suction. There are
      differences in the effectiveness of the methods applied in the existing studies. Therefore,
      more observation, research and scientific studies by neonatal nurses are needed to reduce the
      pain associated with endotracheal suction in preterm newborns.

      In this study, swaddling and oropharyngeal colostrum, which are two non-pharmacological
      methods, will be applied during endotracheal suction to preterm newborns receiving invasive
      mechanical ventilation support. This experimental study was planned to determine the effect
      of these two non-pharmacological methods on procedural pain and comfort and to contribute to
      evidence-based nursing practices.
    

Detailed description: 
      The study was conducted experimentally in randomized controlled trials to determine the
      effect of two non-pharmacological methods, swaddling and oropharyngeal colostrum on
      procedural pain and comfort during endotracheal suction (ES) in premature neonates. The
      population of the study was intubated premature neonates hospitalized in NICU in two
      foundation university hospitals between July 2019 and October 2020. The study sample
      consisted of 48 babies who met the sample selection criteria. Descriptive Characteristics
      Form, Premature Infant Intervention Follow-up Form, Premature Infant Pain Profile-Revised
      (PIPP-R) and Newborn Comfort Behavior Scale (COMFORTneo) were used in data collection.

      Two minutes before the ES procedure, babies were swaddled or 0.4 ml of oropharyngeal
      colostrum was given, depending on the group in which they were involved. Physiological
      parameters (heart rate, respiration, saturation) of the babies were recorded before, during
      and after the procedure, and PIPP-R and COMFORTneo scores were given by two observers by
      video recording.
    

Intervention name(s): Swaddling; Oropharyngeal colostrum
Intervention type(s): Other; Other
Intervention description(s): Babies in this group were wrapped with a white cheesecloth 2 minutes before ES in addition to incubator cover and nesting.
Common procedure steps:
Legal representatives of the infants will sign an informed consent form.
İncubator cover and nesting
Endotracheal suction(ES) was performed in the supine position.
ES was done at the time of care the baby needed.
No painful procedure was applied until 2 hours before ES and 15 minutes after ES.
Aspiration was performed sterile at 80 mmHg pressure.
A second nurse assisted in the suction process and the procedure took no more than 15 seconds.
The amount of oxygen taken by the baby was increased by 10% 30 seconds before the suction procedure and returned to its original value 60 seconds after the procedure.
Beginning 3 minutes before the ES procedure, during the procedure and until 15 minutes after the procedure, the infants' behaviors and bedside monitor indicators were video recorded.; Common procedure steps
In addition to incubator cover and nesting, babies in this group were given 0.4 ml of colostrum with an insulin injector on the inside of the cheeks and on the tongue.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Supportive Care
Keywords: endotracheal suction; pain; comfort; swaddling; colostrum