Annals of Tropical Medicine and Public Health
Home About us Ahead Of Print Instructions Submission Subscribe Advertise Contact e-Alerts Editorial Board Login 
Users Online:1644
  Print this page  Email this page Small font sizeDefault font sizeIncrease font size

Table of Contents   
Year : 2017  |  Volume : 10  |  Issue : 5  |  Page : 1312-1317
Comparing the effect of endotracheal tube suction using open method with two different size catheters 12 and 14 on discharge secretion, pain, heart rate, blood pressure, and arterial oxygen saturation of patients in the intensive care unit: A randomized clinical trial

1 Research Center for Nursing and Midwifery, School of Midwifery, Shahid Sadoghi University of Medical Sciences, Yazd, Iran
2 Department of Anesthiology, Clinical Research Development Unit, Yasuj University of Medical Sciences, Yasuj, Iran
3 Department of Nursing, Yasuj University of Medical Sciences, Yasuj, Iran
4 Department of Pediatric Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
5 Department of Critical Care Nursing, Yazd University of Medical Sciences, Yazd, Iran

Click here for correspondence address and email

Date of Web Publication6-Nov-2017


Background and Purpose: Performing suction with complications such as tachycardia or bradycardia, increase or decrease blood pressure, pain, discharge, and decrease arterial oxygen saturation. The aim of this study was to compare the effect of endotracheal tube suctioning to open two different size catheters 12 and 14 on the discharge, pain, heart rate, blood pressure, and blood oxygen saturation in patients admitted to the Intensive Care Unit (ICU). Materials and Methods: This clinical trial compared two interventions of a pre- and post-test, and sampling was random. 36 patients admitted to the ICU in Yasuj martyr Beheshti Hospital iran, in a group of suctioning with catheter size 12 and 14. Changes in heart rate, blood pressure, pain, discharge, and arterial oxygen saturation before, during, 5 min and 20 min after the suction were recorded. Data analysis was performed by analysis of variance with repeated measures and paired t-test. Results: The Heart rate increased during suction catheter 14 than to 12, and the difference was statistically significant (P = 0.000). Suctioning with both catheters decreased oxygen saturation, but the reduction was not significant between both (P = 0.149). Systolic pressure increased after suction, and this increase was significantly in the higher catheter (P = 0.05). Diastolic pressure increased during suction with the highest increase of 5 min. There were no significant differences between the two catheters (P = 0.186). In the third episode, the highest rated pain during suctioning was observed and the difference was significant between large and small catheters (P = 0.000). Post-suction discharge was in the higher catheter was more and statistically significant (P = .000). Conclusion: The use of small size suction catheter To a lesser extent in heart rate, blood pressure, pain and suffering oxygen saturation changed.

Keywords: Blood pressure, discharge, heart rate, pain, suction

How to cite this article:
Javadi M, Hejr H, Zolad M, Khalili A, Paymard A. Comparing the effect of endotracheal tube suction using open method with two different size catheters 12 and 14 on discharge secretion, pain, heart rate, blood pressure, and arterial oxygen saturation of patients in the intensive care unit: A randomized clinical trial. Ann Trop Med Public Health 2017;10:1312-7

How to cite this URL:
Javadi M, Hejr H, Zolad M, Khalili A, Paymard A. Comparing the effect of endotracheal tube suction using open method with two different size catheters 12 and 14 on discharge secretion, pain, heart rate, blood pressure, and arterial oxygen saturation of patients in the intensive care unit: A randomized clinical trial. Ann Trop Med Public Health [serial online] 2017 [cited 2020 Jun 5];10:1312-7. Available from:

   Introduction Top

The endotracheal tube is used to treat respiratory dysfunction by improving gas exchange and creating an open airway when patients are at risk of aspiration, or maintaining airway mecha- nism, and when requiring mechanical ventilation.[1] Tube breathing is a process that is usually done in an Intensive Care Unit (ICU) with a high risk of complications (25%–35%) because of instability in respiratory status and associated hemodynamic ill patients.[2] Intubated Patient suction Under ventilator is a nursing process and is considered as an important intervention in the care of patients who are supported by a mechanical ventilation device [3] and the purpose of doing this is to clean the chip, bronchial tubes, and maintain openness. Tracheal tube [4] The primary objective of endotracheal suctioning is to remove secretions and prevent airway obstruction, prevent atelectasis, ventilation and oxygenation, and reduce the work of breathing which is optimal.[5] Today, liposuction is done in two ways: open and close procedures, in the open procedure, the patient is isolated from ventilator and suctioning is performed, while in closed procedure, the patient is connected to a mechanical ventilator and then suctioning will be carried out.[6] The most commonly used procedure for suctioning in the patient's trachea is an open suction that involves disconnecting the patient from the device during suction, which can lead to airway pressure loss and loss of lung volume. It should be noted that while the endotracheal tube suctioning device is used to remove secretions and when the airway is kept open, numerous side effects are caused.[7] Hence, it can be reported that endotracheal suction opening may cause major complications, including hypoxemia risks, tissue hypoxia, significant changes in heart rate or blood pressure, cardiac dysrhythmia, cardiac arrest or respiratory, tracheal and bronchial mucosal tissue damage, bronchospasm, infection, pulmonary hemorrhage, and severe pain associated with increased pressure inside the skull.[8]

It is recommended that the outer diameter of the suction catheter should not be more than half the diameter of the endotracheal tube,[9] but there is no consensus on the size of the suction catheter and the suction catheter should be small to prevent hypoxia and other complications or it should be large enough to facilitate the discharge. When the catheter is small, the air enters the lung from the vicinity of the catheter during suction, which prevents sudden loss of remaining capacity and also reduces the risk of atelectasis.[10].

Other studies showed that the insertion of a catheter with a larger size will increase large negative pressure in the lungs and the discharge is more effective.[5] In other words, to select the appropriate-sized suction catheter, there are still a difference of opinion.[11] Therefore, due to these contradictions, and that there is no complete study of changes in systolic and diastolic blood pressure, heart rate, arterial oxygen saturation, pain and discharge before, during and after suction with different catheters, or clearly this the present study aimed to compare the effect of suctioning in the open end of the trachea with two different catheters of 12 and 14 french on discharge of discharge, pain, heart rate, blood pressure and arterial oxygen saturation in patients admitted to the intensive care unit.

   Materials and Methods Top

This study is a clinical trial of a pre- and post-test comparison of two interventions performed in the Martyr Beheshti Hospital in Yasouj. The study population included patients admitted to the intensive care unit with endotracheal tubes and respiratory support by a volume-controlled ventilator. In these cases, within-repeated measures study design was used. All patients received both interventions. According to Etemadi Far and colleagues Study,[12] with a significant level of α = 0.05 and test power of 90%, and considering the standard deviation of the mean oxygen saturation in their study, it was 25.5%, and also with regard to the prediction of the saturation of oxygen At 2.4% and the test power of 90%, the sample size was calculated to be 34 in each group. were selected as sample. Inclusion criteria were lack of diseases and thrombocytopenia, coagulation disorder, not using narcotic drugs and muscle relaxants, lack of underlying respiratory disease, lack of positive inotrope drugs such as dopamine, and paralysis of upper and lower limbs. Exclusion criteria included usage of endotracheal tube and exit from any cause during the study, need to change the mode of fashion volumetric pressure ventilator suction requiring [13]

In order to measure the discharge mass, a container called a wing is used, the net weight of the containers is the same. After the suction and drainage of the discharge in the container, Japan's digital scale, with a sensitivity of 0/01gr MH, is weighed out of the net weight of the container The weight of the discharge is obtained. Regarding the normal distribution of data, parametric tests were used. To compare changes in mean oxygen saturation, heart rate, systolic and diastolic blood pressure and pain in different stages of suction, ANOVA with repeated measures was used. At a time when changes were statistically significant, least significant difference post hoc test was used to compare the two variables. Paired t-test was used to compare the mean discharge. All codes of ethics required by the Code of Ethics Committee, confidentiality and use of information for research purposes, informed consent to participate in research, freedom of entry and exit from the study, and other codes of ethics should be respected.

   Results Top

The study included 38 patients who were in coma, were admitted in ICU, and two patients were excluded due to the withdrawal of the endotracheal tube, and eventually the study was performed on 36 patients. Patients were in the age range of 18 to 60 years, with an average age of 39.11 years. Twenty-one percent (58.3) of the patients were male and the rest were female. The tracheal tube used for all patients was 7.5 and their level of consciousness varied from 4 to 8 on the basis of Glasgow's coma standard. The mean total in the patients was 5.89 ± 1.16 [Table 1], [Table 2], [Table 3], [Table 4], [Table 5].
Table 1: Comparison of oxygen saturation in both small and large suction catheters during various stages of suction

Click here to view
Table 2: Comparison of average heart rate in both groups large and small suction catheters during various stages of suction

Click here to view
Table 3: Mean change in systolic and diastolic blood pressure in small and large suction catheters at different stages

Click here to view
Table 4: Mean change in pain intensity at different stages of large and small suction catheters

Click here to view
Table 5: Comparison of weights outside the discharge of large and small suction catheters

Click here to view

   Discussion Top

The findings of this study showed that the average heart rate in people under suction catheter is larger, and at 5 and 20 minutes after suction, the mean heart rate returned to the basal state in patients with large catheter suction with a large catheter consistent with the study by Mohammad Pour et al. He stated in his study that heart rate was measured before, during, immediately after suction and one minute and 5 minutes after suction, which, although not open and closed in both methods, but the rate of heart rate changes before and after There was significant difference during suctioning. The process was like a horseshoe pattern.[14] Hashemi et al. also reported that the heart rate after the suction was increased when compared before suction, the highest increase was recorded in 2 min after suctioning, and the above results confirm the results of this study.[15]

The increase in heart rate seems to have been caused by large suction catheters due to the blockage of the tracheal tube space.

Another study was carried out by Etemadi Far and colleagues. The results of this study showed that heart rate during suctioning increased compared with baseline, and this level was statistically significant. The heart rate is statistically significant for one minute after suction as compared to pre-suctioning, and is slightly higher than baseline. The heart rate 3 min after suctioning resulted in no significant difference in comparison before suction. However, the heart rate was significant at 3 minutes after suction with a minute after suctioning, and it decreased significantly more than one minute after suctioning. The results of this study are consistent with suction lining which was confirmed in another study.[12] In general, it is expected that with passing time, more suction rate would slowly return to normal. The comparison of the blood pressure before, during, and after the suction showed that systolic blood pressure and diastolic suction before and after differences were statistically significant. Therefore, the large increase in suction catheter is required. In a study by AliPor et al., they reported no statistically significant difference between groups in mean systolic blood pressure, although the increase in systolic blood pressure was higher than the suction opening in closed suction method. The differences could be due to differences between open and closed suction methods. The difference in diastolic blood pressure during and immediately 2 min and 5 min after the suction has statistically significant difference revealing a greater increase in diastolic blood pressure in open suction method, which is consistent with the results of the present study.[16] Etemadi et al. showed that systolic blood pressure and diastolic suctioning increased compared to the base case and the rate is statistically significant. Also, the systolic blood pressure level was statistically significant in one minute after suction as compared to pre-suctioning, and the diastolic blood pressure level was not statistically significant after one minute after suction as compared to pre-suctioning, all of which confirmed the present study.[10]

The study conducted by Mohammad et al. showed that the mean arterial blood pressure before and immediately after the suction and each minute to 5 minutes after suction, which was detected in both open and close procedures, was not meaningful but the mean arterial blood pressure before and during suction and in each sucrose stage in each group was open suction and the pack had a significant difference that increased systolic blood pressure in open suction.[14]

The causes can be related to the duration of suction and also the pressure of the suction device, because such factors can affect the amount of blood pressure during suction, which is recommended in a separate study with a pressure and duration Determine the changes in blood pressure at different stages of suction.

The results of Hashemi and his colleagues showed that the blood pressure increased in comparison with pre-suctioning, and the highest change in blood pressure was in the 5th minute after the start of suction, which is not consistent with the results of the present study.

The difference in diastolic blood pressure compared to baseline and statistically significant differences were negligible before suctioning. This finding is also not consistent with the results of the present study and it should be noted that the duration of suction due to stimulation of the vagus and brady nerve and the high pressure of suction due to the high negative pressure have the greatest effect on diastolic blood pressure.[15]

The results of the study by Etemadi Far and colleagues showed that the saturation level of arterial blood oxygenation decreased in the stage during suction as compared to pre-suction (P = 0.05), as well as the highest changes in arterial blood oxygenation in the 3-minute stage after Suction has occurred during suctioning (P < 0.05), which is consistent with the results of the present study and confirms the findings of this study. It is recommended that you should take hypoproteinase or oxygen at 100% before being soaked for about two minutes.[12] Regarding the decrease in saturation of oxygen during the suctioning period, the results of the study of coral Seyyed Mozhars confirm the results of this study in terms of significant differences and decrease in this rate during open suction. The results of their study indicated that there was a significant difference in arterial oxygen saturation decrease during suctioning (P = 0/000). Offsetting the drop in blood oxygen at 2 min after suctioning and 5 min after suctioning has a significant difference. Also, their results indicate that blood oxygen saturation is reversible to the base (P = 0.021). These findings confirmed the results and reduced the time to remind suction.[17] Alipor et al. showed that changes in blood oxygen saturation at different times during the open and closed suction methods do not have a significant difference. These findings are inconsistent with the findings of this study. Due to the fact that only free open suction was used in the present study, it can not be said about its significant difference with closed suction, but it is advisable to examine this difference in a separate study. Also, their study did not show a significant decrease in oxygen saturation in open suctioning times (P = 0.021), which the study of Copenille et al. In 2009 did not confirm their findings and that it seems this is a dispute concerning the use of catheter size 12 as well as the duration of suction in each stage can have an impact on the results.[16]

The results of a study by John Walsh et al. Stated that the amount of arterial oxygen saturation decreases during suctioning than before suction, but this level is not statistically significant (P = 0.005). Because of not mentioning the size of the catheter and the duration of suction, it is not possible to judge appropriately about the relationship between the results of their study and the results of the present study.[18]

The findings showed that the pain level increased with the increase of suction episodes, which suggests the need to reduce the duration of suction, by studying Takashi Yunki et al. With the aim of the effect of extubation chest massage on the status of oxygenation and removal of pulmonary secretions in patients under ventilation Mechanical studies in Tokyo, Japan. In both studies, it was found that suction did not have much effect on the discharge of discharge, and only the patient's pain was increased.[19] This finding was also found by studying Pedersen et al. About the lack of suction in unnecessary cases, a section with a catheter measuring half the size of the trachea, using the minimum pressure for chip suction and lowering the catheter-sized catheter to reduce pain and not changing the physiological parameters Patients need suctioning.[20] Harada in his study stated that compared with the large and small catheters, it can not be conclusively stated that pain, mortality and changes in physiological parameters increase, which is not consistent with the findings of the present study. Harada noted the causality of this incongruity by a small sample of them in the study.[21]

   Conclusion Top

It is recommended to use a smaller catheter to suction the small catheter that increases the heart rate to a large catheter. It is also better to use a small catheter to lower blood pressure during suction. During suction, the diameter of the catheter should be carefully selected so that the negative pressure caused by the catheter diameter does not result in prolonged loss of arterial oxygen saturation. It is advisable to use a small catheter with less negative pressure to reduce the pain intensity during suctioning. To remove pulmonary secretions, the use of a large catheter causes more discharge of the discharge, but on the other hand, it causes more pain to reduce the amount of suction pressure and instead use a smaller catheter to be used more often than not. Patient hemodynamics can not be changed, and patients will not suffer too much.

Research limitations

Constraints include simultaneous recording of arterial oxygen, blood pressure, and heart rate at predetermined, before and after suction times. To solve this problem, we tried to collaborate with a researcher-nurse familiar with the method of work, which enabled Trend to activate The device and video recorder were solved by another fellow.

Suggestions for further study

The authors' suggestions for future studies include the study of the effect of suctioning with different negative pressures on discharge volume and hemodynamic variables, the effect of small and large suction with a catheter on the intracranial pressure of patients, and finally, the effect of two levels of pressure Negative suction with catheters 12 and 14 on the amount of lung left ventricular in patients under ventilation.


This research is based on the approved dissertation of Yazd University of Medical Sciences with ethics code ir.ssu.rec.1394.86 and IRCT2015100724410N1 code. I am grateful to you from the deputy research associate of Yazd University of Medical Sciences and all those who are willing to cooperate and participate in the study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Bigatello LM, Alam H, Allain RM. Critical Care Handbook of the Massachusetts General Hospital. 6th Ed: Lippincott Williams & Wilkins; 2009.  Back to cited text no. 1
Jaber S, Jung B, Corne P, Sebbane M, Muller L, Chanques G, et al. An intervention to decrease complications related to endotracheal intubation in the Intensive Care Unit: A prospective, multiple-center study. Intensive Care Med 2010;36:248-55.  Back to cited text no. 2
Mohammadi N, Parviz S, Peyravi H, Hosseini AF. Effect of endotracheal suctioning education for nurses on patients' hemodynamic parameters. Hayat 2012;18:38-46.  Back to cited text no. 3
Kaiser JR, Gauss CH, Williams DK. The effects of closed tracheal suctioning plus volume guarantee on cerebral hemodynamics. J Perinatol 2011;31:671-6.  Back to cited text no. 4
Pedersen CM, Rosendahl-Nielsen M, Hjermind J, Egerod I. Endotracheal suctioning of the adult intubated patient – What is the evidence? Intensive Crit Care Nurs 2009;25:21-30.  Back to cited text no. 5
Lorente L, Lecuona M, Jiménez A, Mora ML, Sierra A. Tracheal suction by closed system without daily change versus open system. Intensive Care Med 2006;32:538-44.  Back to cited text no. 6
Evans J, Syddall S, Butt W, Kinney S. Comparison of open and closed suction on safety, efficacy and nursing time in a paediatric Intensive Care Unit. Aust Crit Care 2014;27:70-4.  Back to cited text no. 7
Jeong JH, S-JN, Cho YJ, Lee YJ, Kim SJ, Song IA. A closed-suction catheter with a pressure valve can reduce tracheal mucosal injury in intubated patients. Korean J Crit Care Med 2014;29:7-12.  Back to cited text no. 8
Lindgren S. Open and Closed Endotracheal Suctioning. Experimental and Human Studies.:Doctoral thesis, Institute of Clinical Sciences, Department of Anesthesiology & Intensive Care Medicine; 2007.  Back to cited text no. 9
Glass CA, Grap MJ. Ten tips for safer suctioning. Am J Nurs 1995;95:51-3.  Back to cited text no. 10
Russian CJ, Gonzales JF, Henry NR. Suction catheter size: An assessment and comparison of 3 different calculation methods. Respir Care 2014;59:32-8.  Back to cited text no. 11
Etemadi Sh NS, Aslani Y, Mehralian H. The effect of endotracheal suction on hemodynamic and arterial oxigen saturated. Iran J Nurs 2008;54:31-9.  Back to cited text no. 12
Asadi Noghabi AA, Gholizadeh Gerdrodbari M, Zolfaghari M, Mehran A. Effect of Application of Critical-Care Pain Observation Tool in Patients with Decreased Level of Consciousness on Performance of Nurses in Documentation and Reassessment of Pain. Hayat 2012; 18:54-65.  Back to cited text no. 13
Mohammad Pour A, Amini SH, Shakeri MT, Mirzaei S. Comparing the effect of open and closed endotracheal suctioning on patients' hemodynamic factors after coronary artery bypass grafting under mechanical ventilation. 2014:20:87-92.  Back to cited text no. 14
Hashemi SJ, Jabalameli M, Soltani HA, Heydari M. Frequency of cardiac dysrhythmia, blood pressure changes and level of arterial oxygen saturation during endotracheal suctioning in Intensive Care Unit patients. J Guilan Univ Med Sci 2006;14:48-53.  Back to cited text no. 15
Paymard A, Khalili A, Zoladl M, Zarei Z, Javadi M. Comparison of the Effect of Open Endotracheal Tube Suction with Two Different Sizes of Suction Catheter on Heart Rate and Blood Pressure in Patients Hospitalized in Intensive Care Unit: A Randomized Clinical Trial. Qom Univ Med Sci J 2017;11:1-9.  Back to cited text no. 16
Mazhari SM, Zam HH. Effect of open and closed endotracheal suction systems on heart rhythm and artery blood oxygen level in intensive care patients. Int Jt Conf Neural Netw 2010;2:1-2.  Back to cited text no. 17
Walsh JM, Vanderwarf C, Hoscheit D, Fahey PJ. Unsuspected hemodynamic alterations during endotracheal suctioning. Chest 1989;95:162-5.  Back to cited text no. 18
Unoki T, Kawasaki Y, Mizutani T, Fujino Y, Yanagisawa Y, Ishimatsu S, et al. Effects of expiratory rib-cage compression on oxygenation, ventilation, and airway-secretion removal in patients receiving mechanical ventilation. Respir Care 2005;50:1430-7.  Back to cited text no. 19
Pedersen CM R-NM, Hjermind J, Egerod I. Endotracheal suctioning of the adult intubated patient—What is the evidence? Intensive and Critical Care Nursing 2009;25:9.  Back to cited text no. 20
Harada N. Closed suctioning system: Critical analysis for its use. Jpn J Nurs Sci 2010;7:19-28.  Back to cited text no. 21

Correspondence Address:
Akvan Paymard
Department of Critical Care Nursing, Yazd University of Medical Sciences, Yazd
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ATMPH.ATMPH_181_17

Rights and Permissions


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *

    Materials and Me...
    Article Tables

 Article Access Statistics
    PDF Downloaded19    
    Comments [Add]    

Recommend this journal