Patterns of Instability Associated With Endotracheal Suctioning in Infants With Single-Ventricle Physiology

Lyvonne N Tume, Paul Baines, Rafael Guerrero, Robert Johnson, Paul Ritson, Elaine Scott, Philip Arnold, Laura Walsh

Research output: Contribution to journalArticle (journal)peer-review

8 Citations (Scopus)


BACKGROUND: In infants with single-ventricle physiology, endotracheal suctioning poses risks because of the instability between pulmonary and systemic blood flow.

OBJECTIVE: To examine processes and adverse events associated with endotracheal suctioning in the first 48 hours after 3 surgical procedures: the Norwood or Norwood-Sano procedure, pulmonary artery banding, and the modified Blalock-Taussig shunt.

METHODS: Prospective observational study in a pediatric intensive care unit.

RESULTS: Bedside nurses collected data from 211 episodes of endotracheal suctioning in 24 infants. Most (62%,130/211) suction episodes were unplanned; 38% (81/211) were planned. The most common reason for unplanned suctioning was arterial desaturation (48%, 62/130 episodes). The infants' oxygen saturation levels before suctioning ranged from 27% to 86%. Serious adverse events occurred in 9% (19/211) of suction episodes. In 8 (42%) of the episodes involving a serious adverse event, the patient received no additional intravenous bolus of analgesic or muscle relaxant before suctioning; in 8 episodes (42%), the patient received both an analgesic and a relaxant; in 3 episodes (16%), the patient received either an analgesic or a relaxant but not both. More adverse events occurred with open suctioning (68%, 13/19) than with closed suctioning (32%, 6/19). Most adverse events (68%, 13/19) occurred during the night shift.

CONCLUSIONS: Significant hemodynamic instability and adverse events occur during routine suctioning in infants with single-ventricle physiology after surgical palliation.

Original languageEnglish
Pages (from-to)388-394
Number of pages7
JournalAmerican Journal of Critical Care
Issue number5
Publication statusPublished - 30 Sept 2017


  • Blalock-Taussig Procedure
  • Critical Care Nursing/methods
  • Female
  • Heart Ventricles/abnormalities
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Pediatric
  • Intubation, Intratracheal/methods
  • Male
  • Norwood Procedures
  • Postoperative Care/methods
  • Postoperative Complications/prevention & control
  • Prospective Studies
  • Pulmonary Artery/surgery
  • Suction


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