TABLE OF CONTENTS
Page
Title page i
Approval page ii
Certification iii
Dedication iv
Acknowledgement v
Table of contents                                                                                            vi
List of Tables ix
List of Figures x
Abstract xi
CHAPTER ONE: INTRODUCTION
Background to the Study 1
Statement of Problem                                                                                        4
Purpose of theStudy 4
Specific Objectives 5
Hypotheses 5
Significance of the Study 6
Scope of the Study 6
Operational Definition of Terms                                                              7
CHAPTER TWO: LITERATURE REVIEW
Conceptual Review 9
Current Guidelines                                                                             10
Types of Endotracheal Suctioning                                                       11
Preparation for Endotracheal Suctioning Procedure                           13
Equipments/Devices Used During Suctioning                                         14
Hyper-oxygenation                                                                         14
Suction Catheter Size 15
Depth of Catheter Insertion                                                               15
Frequency of Suctioning                                                                          16
Documentation                                                                                     17
Complications Associated with Endotracheal Suctioning                  17
Theoretical Review                                                                              18
Application of the Model to the Study                                                              20
Empirical Review                                                                                 24
Summary of Literature Review                                                                 34
CHAPTRE THREE: RESEARCH METHOD
Research Design                                                                                    36
Area of Study 36
Target Population                                                                             38
Sample and Sampling Technique                                                          38
Inclusion Criteria                                                                               39
Instrument for Data Collection                                                            39
Validity of Instrument                                                                   39
Reliability of Instrument                                                                         40
Ethical Consideration                                                                          40
Procedure for Data Collection                                                                41
Method of Data Analysis                                                                      41
CHAPTER FOUR: PRESENTATION OF RESULTS
Presentation of Results                                                                    43
Summary of Major Findings                                                                    58
CHAPTER FIVE: DISCUSSION OF FINDINGS
Discussion of Major Findings                                                             60
Conclusion                                                                63                     Â
Implication of the Study                                                                          63
Limitation of the Study                                       64                                                  Suggestion for further Studies                                   64
Summary of the Study                                                          64
Recommendations                                                                               65
References                                                                                                 66
APPENDICES
Appendix I:   Questionnaire                                                          71                                                                          Â
Appendix II: Observational Checklist                                                77
Appendix III: Ethical Clearance                                                         78            Â
LIST OF TABLES
Table 1: Showing Socio-Demographic Data of Participants              38
Table 2: Respondents’ knowledge of Endotracheal Suctioning knowledge Procedure                                                                                                    45
Table 3: Knowledge of Endotracheal Suctioning Procedure 49   Â
Table 4: Overall Knowledge of Endotracheal Procedure           52
Table 5: Relationship between Demographic Data and Knowledge of Endotracheal Suctioning Procedure                                                          52
Table 6:  Observational checklist on adherence to practice and competence  in endotracheal suctioning                      55
Table 7:  Showing Level of Competence in Endotracheal  Suctioning Procedure                                                                                  57
 Table 8: Showing Relationship between Profession and Level of Adherence (Practice)                                                                                  57
LIST OF FIGURES
Figure 1: Application of Orem’s Self Care Deficit Theory to the Study 23
ABSTRACT
This study was carried out to determine endotracheal suctioning knowledge and practice among critical care practitioners in intensive care units of University of Calabar Teaching Hospital. The objectives of the study were to identify critical care practitioners’ knowledge of endotracheal suctioning, evaluate adherence to procedure in endotracheal suctioning, assess their competence in performing endotracheal suctioning, determine if there is an association between knowledge and competence in performing endotracheal suctioning and determine if there are differences in knowledge and practice between the critical care practitioners. A descriptive survey and observational designs were adopted for the study .A total population study of 96 respondents was used for the study. The instrument for data collection was a structured questionnaire and observational checklist. The face and content validity were determined by the supervisor, and two consultant Anaesthetists in UCTH. The results were presented in tables as percentages. Pearson Chi-square test was used to determine the association between the knowledge distribution for doctors and nurses, a Chi-Square Test of Association revealed no significant difference between them, p = .803 at 0.05 level of significance. Majority of practitioners Age between 31-35 years (85.2%) had low knowledge while few (14.8%) had high knowledge. Likewise, practitioners between 36-40 years, (85.2%) had low knowledge while few (14.8%) had high knowledge and those above 40 years, (48.8%), had low knowledge while (51.2%) had high knowledge. However, findings from the study revealed that few physicians, (21.7%) had inadequate adherence to practice of endotracheal suctioning procedure while majority (78.3%) had moderately adequate adherence. Likewise, nurses, (40.7%) had inadequate adherence while (59.3%) had moderately adequate adherence. Out of the 50 critical care practitioners that were assessed using the check-list, all had poor competence in endotracheal suctioning procedure. In conclusion, the overall knowledge of practitioner was low and there was no difference between knowledge and practice among practitioners. However, knowledge did not significantly influence practice of critical care practitioners. It was recommended that a fully equipped modern laboratory be put in place for continuous practice and simulation.
CHAPTER ONE
INTRODUCTION
Background to the Study
Endotracheal suctioning is a clinical procedure that helps to clear airways in the respiratory system by mechanically removing accumulated pulmonary secretions  in patients with artificial airways (Sharma, Sarin & Bala, 2014). Critically ill patients with artificial airways require endotracheal suctioning to remove secretions and prevent airway obstruction, without which the patient may experience inadequate oxygenation and ventilation. Endotracheal intubation is an artificial airway that inhibits cough reflex and interferes with normal muco-ciliary function, therefore increasing airway secretion production and decreasing the ability to clear such secretions (The Royal Children’s Hospital Melbourne, 2012). Although  endotracheal suctioning is an essential way of maintaining ventilation and oxygenation  in patients with such artificial airways, it can result in adverse effects and serious complications when performed inappropriately or incorrectly (Kelleher & Andrews, 2008).
Patients on mechanical ventilation are vulnerable to disease complications such as alveolar hypoventilation, alveolar hyperventilation, fluid and electrolyte imbalance, pneumothorax and ventilator associated pneumonia, a most common infectious complication accounting for about 47% of all infections among critical care patients (Sharma, Sarin & Bala, 2014). In spite of the fact that most of the technical aspects of managing mechanical ventilator is the responsibility of respiratory care practitioners (physiotherapist who specialized in respiratory care), nurses provide holistic care to patients, including the management of clinical symptoms and responses to mechanical ventilator support (Chlan, 2011).
Critical care practitioners (anesthetists and nurses) are professionals that provide evidence-based assistance in critical care units of healthcare facilities in order to proÂmote quality healthcare services to clients. Such practitioners monitor client’s responses to ventilation intervene to maintain oxygenation and ventilation and ensure that the complex needs of critically ill patients are met. It is very important that critical care practitioners are aware of endotracheal suctioning procedure and are able to practice according to current evidence based recommendations. Knowledge and experience can determine a critical care practitioner’s ability to adequately perform endotracheal tube suctioning. However, some researchers have documented that some critical care practitioners do not have sufficient knowledge about the current recommendations for endotracheal suctioning and, their practice is often based on rituals and traditions (Frota, Loureiro & Ferreira, 2013). Others observed that the critical care practitioners do not often adhere to the recommended procedures by the World Health Organisation and their level of competence in endotracheal suctioning practices is below expectation (Akram, Negin, Mohsen & Mohammadreza, 2012; Bighamian, Zarkeshan & Rafieeano, 2010; George & Sequiera, 2010).
Also, it was reported in a multisite survey of suctioning techniques and airway management practices by Sole, Byers and Ludy (2009) that the management practices were inadequate; compliance with hand washing guidelines was 82%, wearing gloves was 75%, elevating head of bed was 50%, and proper oral care protocol was 50%. Day, Farrell and Hayes (2012) observed that the mean score for knowledge was 11.1 and 10.3 for practice among critical care practitioner; and majority of the subjects failed to perform suctioning as accurately as they had claimed.
Similarly, in Cairo, a study by Nahla (2013), revealed that less than half of the nurses recognized closed system suctioning as recommended, while the rest were unfamiliar with closed system suctioning. Heyland, Cook and Dodek (2012) also reported on prevention of ventilator associated pneumonia practice in Canadian critical care units that nurses were familiar with closed suctioning practices because such practices were common in 88% of the ICUs. Sierra (2010) reported that in Spain open tracheal suctioning was reported in 96% of the ICUs and added that closed suction systems are not commonly used, and thus nurses were unfamiliar with those systems. More than half of the nurses in the study knew that frequent change in suction systems, and kinetic beds decrease the risk and occurrence of pneumonia. While only 48% of nurses knew that semi-recumbent positioning help in prevention of pneumonia.
Despite the recognition that endotracheal suctioning is an effective technique that clears the airways by mechanically removing accumulated pulmonary secretions  in critically ill patients with artificial airways, the adherence to established guidelines on endotracheal suctioning by critical care practitioners is not impressive. Studies by Day, Farnell, Haynes, Wainwright and Wilson-Barnett (2012); Negro, Ranzani  and Manara (2014) have shown that critical care practitioners’ lack of adequate knowledge about endotracheal suctioning may be a barrier to adhere to evidenced based guidelines. Â
The researcher is unaware of any empirical evidence of endotracheal suctioning knowledge and practices of critical care practitioners and has not come across any study on endotracheal tube suctioning in Nigeria. Hence, this research was undertaken to evaluate the effectiveness of endotracheal suctioning in terms of knowledge and practices of critical care practitioners in University of Calabar Teaching Hospital, Calabar.
Statement of the Problem
