Airway suctioning is an important health care intervention that can be associated with serious adverse effects. Given the risks involved with suctioning, it is important to ensure the clinical competence of health care professionals who perform it. A scoping review was conducted to identify the nature and extent of research related to the assessment of airway-suctioning competence for health care professionals working with adults. This included an examination of the assessment context, the type of suctioning and health care professionals being assessed, and the methods used to assess competence. Four scientific electronic databases (MEDLINE, EMBASE, CINAHL, and the Cochrane Library) were searched from inception to March 9, 2018. A gray literature search was also performed. Two reviewers independently screened articles and resources for inclusion, and data were extracted using a form created by the authors. Seventy full text articles and resources were screened for eligibility, with 36 included in the review. Endotracheal suctioning was the most common type, and intensive or critical care units were the primary setting of interest (28 of 36, 78%). Competence or a component of competence for nurses, nursing students, nursing assistants, or nurse technicians was specifically addressed in 97% (35 of 36) of the included articles and resources; 4 of 36 (11%) also included physical therapists, 1 of 36 (3%) included respiratory therapists, and 1 of 36 (3%) was aimed toward all clinicians who perform suctioning. Nine (25%) used questionnaire-based assessments, 11 (31%) used checklists, audit forms, or other observational tools, and 16 (44%) used both. Directed content analysis revealed 3 major themes: consistency across overarching evaluation frameworks, inconsistency across detailed components, and inconsistency in the evaluation or reporting of assessment tool measurement properties. Additional gaps in the literature included limited consideration of health care professionals beyond nursing, limited consideration of settings beyond intensive and critical care, a lack of tools to assess nasotracheal and orotracheal suctioning, and limited detail regarding assessment tool development.
AbbasiniaM, IrajpourA, BabaiiA, ShamaliM, VahdatnezhadJ. Comparison the effects of shallow and deep endotracheal tube suctioning on respiratory rate, arterial blood oxygen saturation and number of suctioning in patients hospitalized in the intensive care unit: a randomized controlled trial. J Caring Sci, 2014; 3(3):157–164.
7.
JohnsonKL, KearneyPA, JohnsonSB, NiblettJB, MacMillanNL, McClainRE. Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med, 1994; 22(4):658–666.
8.
KakN, BurkhalterB, CooperM. Measuring the competence of healthcare providers. Bethesda, MD: Operations Research Issue Paper; 2001.
9.
EpsteinRM, HundertEM. Defining and assessing professional competence. JAMA, 2002; 287(2):226–235.
BrooksD, SolwayS, GrahamI, DownesL, CarterM. A survey of suctioning practices among physical therapists, respiratory therapists and nurses. Can Respir J, 1999; 6(6):513–520.
12.
LeddyR, WilkinsonJM. Endotracheal suctioning practices of nurses and respiratory therapists: how well do they align with clinical practice guidelines?. Can J Respir Ther, 2015; 51(3):60–64.
13.
CrossJ. A survey of physiotherapists' current practice with closed suction systems in adult patients. Adv Physiother, 2001; 3(2):67–75.
14.
SoleML, BennettM. Comparison of airway management practices between registered nurses and respiratory care practitioners. Am J Crit Care, 2014; 23:191–200.
15.
TanCS, HarroldM, HillK. Approaches and adjuncts used by physiotherapists when suctioning adult patients who are intubated and ventilated in intensive care units in Australia and New Zealand: a cross-sectional survey. Aust Crit Care, 2017; 30(6):307–313.
16.
PetersMD, GodfreyCM, KhalilH, McInerneyP, ParkerD, Baldini SoaresC. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc, 2015; 13(3):141–146.
17.
ArkseyH, O'MalleyL. Scoping studies: towards a methodological framework. Int J Social Res Methodol, 2005; 8(1):19–32.
Almeida SilvaL, Sampaio TelesLC, do Carmo Cruz RobazziML, Elias SilveiraS, Souza TerraF. Knowledge of tracheobronchial aspiration of health professionals from the intensive care unit. J Nurs UFPE, 2012; 6(11):2625–2632.
23.
AnsariA, Masoudi AlaviN, Adib-HajbagheriM, AfazelM. The gap between knowledge and practice in standard endo-tracheal suctioning of ICU nurses, Shahid Beheshti Hospital. Iran J Crit Care Nurs, 2012; 5(2):71–76.
24.
BellS, TaggartJ, KarlJ, LindM, PetermanP, StoneK. Implementing a research-based protocol: an interactive approach. AACN Clin Issues Criti Care Nurs, 1994; 5(2):147–151.
25.
Bhanu ParamjyothiB, DanielLE, IndiraS. A study to assess the knowledge regarding ET suctioning among staff nurses and student nurses in NMCH, Nellore. Int J Appl Res, 2016; 2(6):150–152.
26.
Bülbül MaraşG, Kocaçal GülerE, Eşerİ, KöseŞ. Knowledge and practice of intensive care nurses for endotracheal suctioning in a teaching hospital in western Turkey. Intensive Crit Care Nurs, 2017; 39:45–54.
ChaselingW, BaylissS-L, RoseK, ArmstrongL, BoyleM, CaldwelJ, et al. Suctioning an Adult ICU patient with an artificial airway. Agency for Clinical Innovation NSW Government Version 2 Chatswood, NSW, Australia. 2014; 33.
29.
ChauJ, ThompsonDR, ChanD, ChungL, Wai-LinA, TamS, et al. An evaluation of the implementation of a best practice guideline on tracheal suctioning in intensive care units. Int J Evid Based Healthc, 2007; 5(3):354–359.
30.
DayT, WainwrightS, Wilson-BarnettJ. An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units. J Clin Nurs, 2001; 10:682–696.
31.
DayT, FarnellS, HaynesS, WainwrightS, Wilson-BarnettJ. Tracheal suctioning: an exploration of nurses' knowledge and competence in acute and high dependency ward areas. J Adv Nurs, 2002; 39(1):35–45.
32.
DayT, IlesN, GriffithsP. Effect of performance feedback on tracheal suctioning knowledge and skills: randomized controlled trial. J Adv Nurs, 2009; 65(7):1423–1431.
33.
de LimaED, FleckCS, BorgesJJ, CondessaRL, VieiraSR. Effects of educational intervention on adherence to the technical recommendations for tracheobronchial aspiration in patients admitted to an intensive care unit. Rev Bras Ter Intensiva, 2013; 25(2):115–122.
34.
ElbokharyR, OsamaA, AL-kharderM. Knowledge and practice of ICU nurses regarding endotracheal suctioning for mechanically ventilated patients in Khartoum Teaching Hospital. Am J Cli Neurol Neurosurg, 2015; 1(2):92–98.
35.
Grossbach-LandisI, McLaneAM. Tracheal suctioning: a tool for evaluation and learning needs assessment. Nurs Res, 1979; 28(4):237–242.
36.
HaghighatS, YazdannikA. The practice of intensive care nurses using the closed suctioning system: an observational study. Iranian J Nurs Midwifery Res, 2015; 20(5):619–625.
37.
HarjotK, Hemant KumarS, KrishanGK. Effectiveness of teaching intervention on knowledge and practices regarding endotracheal tube suctioning among staff nurses. Int J Nurs Educ, 2016; 8(2):8–11.
38.
HeidariM, ShahbaziS. Nurses' awareness about principles of airway suctioning. J Clin Diagn Res, 2017; 11(8):LC17–LC19.
39.
KelleherS, AndrewsT. An observational study on the open-system endotracheal suctioning practices of critical care nurses. J Clin Nurs, 2008; 17(3):360–369.
40.
MajeedHM. Assessment of knowledge and practices of intensive care unit nurses about endotracheal suctioning for adult patients in Baghdad teaching hospitals, Iraq. Int J Res Med Sci, 2017; 5:4.
41.
BalbinoCM, Ribeiro BrazM, de Castro MedeirosJ, Simões RodriguesLM, SilvinoZR. Evaluation of aspiration technique on the patient with mechanical ventilation performed by nursing. J Nurs UFPE, 2016; 10:4797–4803.
42.
McKillopA. Evaluation of the implementation of a best practice information sheet: tracheal suctioning of adults with an artificial airway. Int J Evid Based Healthc, 2004; 2(9):293–308.
43.
NegroA, RanzaniR, VillaM, ManaraD. Survey of Italian intensive care unit nurses' knowledge about endotracheal suctioning guidelines. Intensive Crit Care Nurs, 2014; 30(6):339–345.
ÖzdenD, GörgülüRS. Development of standard practice guidelines for open and closed system suctioning. J Clin Nurs, 2012; 21(9/10):1327–1338.
46.
PariharR. Effectiveness of planned teaching programme on the knowledge of endotracheal suctioning among staff nurses working in ICU. Baba Farid University Nurs J, 2015; 8(1):63–67.
47.
Pereira FrotaO, Dias Rolan LoureiroM, Menis FerreiraA. Knowledge about endotracheal suctioning on the part of intensive care nursing professionals: a descriptive study. Online Braz J Nurs, 2013; 12(3):546–554.
48.
RoghiehN, FatemeH, HamidS, HamidH. The effect of formative evaluation using “direct observation of procedural skills” (DOPS) method on the extent of learning practical skills among nursing students in the ICU. Iran J Nursing Midwifery Res, 2013; 16(4):290–293.
SeemaS, PityK, KiranB. Effectiveness of suction protocol on nurse's and patient's outcome in ICU. Asian J Nurs Educ Res, 2017; 7(4):589–595.
51.
Shamna Majeed AbdulM, Shambhavi. Effectiveness of planned teaching programme on knowledge and practice of endotracheal suctioning among staff nurses in selected hospitals of Mangalore. Asian J Nurs Educ Res, 2013; 3(4):243–247.
52.
SmithAM, OrtigueraSA, LaskowskiER, HartmanAD, MullenbachDM, GainesKA, et al. A preliminary analysis of psychophysiological variables and nursing performance in situations of increasing criticality. Mayo Clin Proc, 2001; 76(3):275–284.
53.
VargheseS, MolyK. Exploratory study on the knowledge and skill of critical care nurses on endotracheal suctioning. J Nat Accred Board Hosp Healthc Providers, 2016; 3(1):13–19.
54.
WoodCJ. Can nurses safely assess the need for endotracheal suction in short-term ventilated patients, instead of using routine techniques?. Intensive Crit Care Nurs, 1998; 14(4):170–178.
55.
ZebA, Shams-ul-Haq, AliF, HussainN, Haidar Ali ShahS, FaisalS. Knowledge and practice of ICU nurses regarding endotracheal suctioning in tertiary care hospitals, Peshawar. JOJ Nurse Health Care, 2017; 2(4):555–595.
56.
American Association for Respiratory Care. AARC clinical practice guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respir Care, 2010; 55(6):758–764.
57.
ThompsonL. Suctioning adults with an artificial airway: a systematic review. The Joanna Briggs Institute for Evidence Based Nursing and Midwifery. Adelaide, S. Australia, Australia: 2000; 9.
58.
OverendTJ, AndersonCM, BrooksD, CicuttoL, KeimM, McAuslanD, NonoyamaM. Updating the evidence-base for suctioning adult patients: a systematic review. Can Respir J, 2009; 16(3):e6–e17.
59.
SoleML, ByersJF, LudyJE, ZhangY, BantaCM, BrummelK. A multisite survey of suctioning techniques and airway management practices. Am J Crit Care, 2003; 12(3):220–230.
60.
KarrasJD. Statistical methodology. II. Reliability and validity assessment in study design, part A. Acad Emerg Med, 1997; 4(1):64–71.
61.
SullivanGM. A primer on the validity of assessment instruments. J Grad Med Educ, 2011; 3(2):119–120.
62.
KimberlinCL, WintersteinA. Validity and reliability of measurement instruments used in research. Am J Health-Syst Pharm, 2009; 65:2276–2284.
63.
American Association for Respiratory Care. AARC clinical practice guideline. Nasotracheal suctioning—2004 revision & update. Respir Care, 2004; 49(9):758–764.
