Determining The Effects Of Nasopharyngeal Suction
Condition: Aspiration, Respiratory; Pain; Mucosal Irritation; Infant
MeSH terms: Respiratory Aspiration
Study type: Interventional

Summary: 
      Objective: The aim of the study is to determine the effects of nasopharyngeal suction with
      negative and positive pressure on the pain level, respiratory parameters, and mucosal
      irritation in infants.

      Materials and Methods: This study was conducted as a posttest randomised controlled
      experimental research. The data were collected at XX Training and Research Hospital between
      January and November 2020. While the positive pressure suction method was applied to the
      experimental group, the negative pressure suction method was applied to the control group.
    

Detailed description: 
      Nurses are responsible for suction function to clear the airway from secretions for effective
      breathing. Suction is defined as the removal of secretions of the respiratory system with a
      negative pressure vacuum device. In patients who are unable to extract respiratory secretions
      independently, suction is essential to maintain the oxygen demand and ventilation at the
      desired level and remove these secretions.

      The infant's respiratory and circulatory systems may be adversely affected as a result of the
      suction procedure, and several complications such as trauma, haemorrhage, and pain may
      develop. Suction is therefore one of the procedures that should be applied with caution in
      infants. Suction procedures for the respiratory tract in infants include oro/nasopharyngeal
      and endotracheal suction and suction methods include open and closed system suction methods.

      Oro/nasopharyngeal suction is a method that requires the use of negative pressure to remove
      secretions from the oropharynx, nasopharynx, or both. When a foreign body penetrates the
      trachea from the pharynx, when respiratory secretions are too much, or when the secretion
      cannot be removed by normal cilia movement, coughing holds an important role. Inability to
      cough leads to atelectasis, pneumonia, and respiratory failure during infection of the
      respiratory tract. The cough reflex matures around the age of five in children. Adults are
      able to quickly remove existing airway secretions, but children with excessive airway
      secretions prior to this age are unable to do so easily. These secretions may be removed
      through either nasopharyngeal or oropharyngeal suction.

      There are several risks and complications associated with suction procedure. The most common
      are hypoxia, bradycardia, tachycardia, hypotension, hypertension, cardiac arrhythmia, cardiac
      arrest, atelectasis, bronchospasm, elevated intracranial pressure, nosocomial infection,
      tracheobronchial damage, and pain. Hypoxemia is the most prevalent and serious complication
      among them. To avoid the suction-induced hypoxemia, different suction methods are being
      developed and novel devices are being employed.Suction, a painful procedure, has been
      reported to negatively impact the physiological parameters, comfort, sleep, growth, and
      hospital stay of infants. The primary goal of pain management in infants is to minimise the
      pain experienced by infants due to various medical procedures and allow them to cope with the
      pain.

      When the literature was reviewed, it was observed that the respiratory rate, heart rate, SpO2
      and tidal volumes of the patients were assessed as respiratory parameters, while spirometry
      was utilized to assess respiratory function.

      Trauma is another complication of negative pressure suction. Suctioning of the tracheal,
      oral, and nasopharyngeal mucosa caused by negative pressure may result in haemorrhage and
      ulceration. As a result of the increased vacuum pressure generated during suction, the
      mucosal fragments are displaced from the catheter holes and absorbed.

      Objective This study aimed to determine the effects of nasopharyngeal suction with negative
      and positive pressure on the level of pain, respiratory parameters, and mucosal irritation in
      infants.

      Research Hypotheses H0: There is no difference between positive pressure nasopharyngeal
      aspiration procedure and negative pressure nasopharyngeal aspiration procedure.

      H1: The level of pain felt by infants during nasopharyngeal suction with positive pressure is
      lower than the level of pain they suffer during nasopharyngeal suction with negative
      pressure.

      H2: In infants, the SpO2 level after nasopharyngeal suction with positive pressure is higher
      than the SpO2 level following nasopharyngeal suction with negative pressure.

      H3: In infants, the respiratory rate after nasopharyngeal suction with positive pressure is
      less affected than the respiratory rate following nasopharyngeal suction with negative
      pressure.

      H4: In infants, the mucosal irritation caused by the nasopharyngeal suction with positive
      pressure is less than the mucosal irritation caused by the nasopharyngeal suction with
      negative pressure.
    

Intervention name(s): Experimental group; control group
Intervention type(s): Device; Device
Intervention description(s): THE EFFECTS OF NASOPHARYNGEAL SUCTION POSITIVE PRESSURE; THE EFFECTS OF NASOPHARYNGEAL SUCTION NEGATIVE PRESSURE
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: This study was designed as randomized, controlled, and experimental
Masking: None (Open Label)
Primary purpose: Health Services Research