J Caring Sci. 2022;11(1): 21-27.
doi: 10.34172/jcs.2022.09
  Abstract View: 93
  PDF Download: 141

Original Article

The Effect of Endotracheal Suctioning Using the Four-handed Care on Physiological Criteria and Behavioral Responses of the Preterm Infants: Randomized Crossover Clinical Trial

Somayeh Sadeghi Niaraki 1 ORCID logo, Batool Pouraboli 1* ORCID logo, Aida Safaiee Fakhr 2 ORCID logo, Jila Mirlashari 1,3 ORCID logo, Hadi Ranjbar 4 ORCID logo

1 Department of Pediatric and Neonatal Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Public Health and Paraclinics, Qazvin University of Medical Sciences, Qazvin, Iran
3 Department of OBGYN, Women’s Health Research Institute, University of British Columbia, Vancouver, BC, Canada
4 Research Center for Mental Health, Iran University of Medical Sciences, Tehran, Iran
*Corresponding Author: Batool Pouraboli, Email: b-pouraboli@sina.tums. ac.ir


Introduction: Endotracheal suctioning is one of the procedures that can cause pain and stress for infants admitted to neonatal intensive care units (NICUs). Pain and stress can be manifested with physiological and behavioral responses. This study is a crossover randomized clinical trial design that aimed to investigate the effect of endotracheal suctioning, using four-handed care on the physiological criteria and behavioral responses of preterm infants.

Methods: In this study, 40 infants were randomly divided into two groups of 20, one group was first suctioned by the routine method (two hands) and then with the four-handed method. The other group was first suctioned by the four-handed method and then with the routine one. The ALPS-Neo (Astrid Lindgren Children’s Hospital Pain Scale Neonates) was used to evaluate pain and stress in infants. One camera recorded facial expressions and body movements, and physiological data were recorded from the monitor simultaneously.

Results: Repeated measures analysis of variance (ANOVA) showed no statistically significant difference in changes in arterial saturation, heart rate and behavioral response scores between the two methods, but there was a significant difference in the mean heart rate of infants during and two minutes after suctioning in four-handed method using independent t test. Data were analyzed using SPSS version 13.

Conclusion: Four-handed suctioning method can prevent an increase in the heart rate during and two minutes after suctioning, but it does not seem to affect behavioral responses and oxygen saturation of the infants. Since one of the symptoms of pain and stress in infants is the change of vital signs, especially the heart rate, we recommend four-handed method for suctioning of endotracheal tube.

Keywords: Suction, Preterm infant, Neonatal intensive care unit, Pain, Stress

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Submitted: 15 Mar 2021
Revision: 22 Aug 2021
Accepted: 22 Aug 2021
ePublished: 25 Jan 2022
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