Calidad de los cuidados del drenaje de tórax y habilidades autopercibidas en la atención de enfermería / Quality of thoracic drain care and self-special skills in nursing care

Objetivo principal: Conocer la percepción de los profesionales sobre la calidad de los cuidados en pacientes con drenaje de tórax respecto a la protocolización, capacitación, conocimientos y habilidades auto-percibidas en la atención de enfermería en servicios de internación. Metodología: Estudio transversal en 424 sujetos de hospitales de 3 regiones de Uruguay. Se analizaron 18 variables agrupadas en categorías referidas al personal, protocolización, capacitación y conocimientos, autopercepción de habilidades. Resultados principales: 41% no había recibido capacitación sobre el tema, 79% conocía el protocolo, 46% había presenciado un evento adverso relacionado a este cuidado. El 7% del personal responde correctamente el 100% de las variables sobre conocimiento, el 47% responde correctamente el 80% de ellas, el 43% dijo sentirse capacitado y con destrezas para orientar a otros, el 28% contaba con habilidades pero no se sentía seguro, el resto no se siente con habilidades suficientes. Conclusión principal: La percepción sobe la calidad de los cuidados difiere según el área estudiada. La capacitación y la implementación de programas de educación continua, que brinden conocimientos y se desarrollen con metodologías innovadoras para mejorar habilidades y seguridad de los cuidados, se muestran necesarios para desarrollar en los servicios

Objective: To know the perception of the professionals about quality of care in patients with chest drainage regarding protocolization, training, knowledge and self-perceived skills in nursing care in inpatient services. Methods: A cross-sectional study of 424 subjects from hospitals in three departments (provinces) of Uruguay. We analyzed 18 variables grouped in categories related to personnel, protocolization, training and knowledge, self-perception of skills. Results: 41% had not received training on the subject, 79% knew the protocol, and 46% said they had witnessed an adverse event related to this care. Only 7% of the staff correctly responds to 100% of the knowledge variables, 47% correctly responds 80% of them. Regarding self-perceived skills, 43% said they felt empowered and with skills to guide others, 28% had skills but did not feel safe to orient, the rest did not feel enough skills. Conclusions: The main aspects related to quality that must be improved are related to the implementation of continuous training programs that provide knowledge to the staff and are developed with innovative methodologies that achieve specific skills to improve their skills and safety of care

Effect of minimally invasive endotracheal tube suctioning on physiological indices in adult intubated patients: An open-labelled randomised controlled trial.

BACKGROUND: Endotracheal tube suctioning (ETS) is one of the most frequent procedures performed by nurses in intensive care units. Nevertheless, some suctioning practices are still being performed that do not provide any benefit for patients. OBJECTIVES: To investigate the effects of minimally invasive ETS (MIETS) versus routine ETS (RETS) on physiological indices in adult intubated patients. METHODS: In this single centre parallel randomised controlled, open label trial, 64 adult intubated patients in the four intensive care units of Alzahra University hospital, Isfahan, Iran, were randomly allocated to a MIETS or a RETS group. Physiological indices including systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and peripheral oxygen saturation were assessed immediately before, immediately after, and 10 min after ETS in both groups. The chi-square test, independent t-test, and repeated measures analysis of variance were used to analyse the data. RESULTS: Sixty-four patients were randomised and analysed. There were no significant differences in mean heart rate between the both groups across the three time points. However, there was a significant drop in peripheral oxygen saturation across the three time points in the RETS group compared to the MIETS group. Furthermore, there was a significant increase in systolic blood pressure, diastolic blood pressure, and mean arterial pressure across the three time points in the RETS group compared to the MIETS group. CONCLUSION: The results of this study indicate that the use of MIETS has less effect on the alterations of physiological indices and consequently fewer adverse effects than RETS.

"When no-one's looking," the application of lung recruitment and normal saline instillation with paediatric endotracheal suction: An exploratory study of nursing practice.

BACKGROUND: The complex nature of the Paediatric Intensive Care Unit (PICU) patient requires the bedside nurse to make rapid, complex decisions regarding endotracheal suction (ETS) interventions. It is not understood what influences nurses' decision making in the context of ETS, however, the actions of the clinician have a direct impact on the efficacy of the ETS event and patient outcomes. OBJECTIVES: To explore and describe the use of normal saline instillation and lung recruitment with paediatric ETS in a cohort of Australian nurses, and to identify factors that influence normal saline use with ETS. METHODS: A descriptive, exploratory study. An evidence-based practice model formed the conceptual basis for the study. Semi-structured interviews were conducted with 12 nurses from an Australian tertiary referral paediatric intensive care unit. Audiotaped interviews were transcribed. Inductive thematic analysis was used to code and analyse the interview data and identify themes. FINDINGS: Data analysis revealed three themes: patient's clinical presentation, clinician judgement and unit practice norms. CONCLUSIONS: Variability in nurses ETS practice was marked. In the absence of evidence based clinical guidelines, nurses relied on knowledge derived from clinical experience and the local setting to guide NSI and LR intervention decisions. Participants reported uncertainty regarding ETS best practice and perceived the lack of research evidence as a barrier to making informed clinical decisions at the bedside. Rigorous research evaluating the safety and efficacy of NSI and LR with ETS is urgently required for patient care; however PICU nurses rely on multiple sources of evidence to inform ETS practice decision.

Endotracheal suction in intensive care: A point prevalence study of current practice in New Zealand and Australia.

BACKGROUND: Despite the evidence and available guidelines about endotracheal suction (ETS), a discrepancy between published guidelines and clinical practice persists. To date, ETS practice in the adult intensive care unit (ICU) population across New Zealand and Australia has not been described. OBJECTIVE: To describe ICU nurses' ETS practice in New Zealand and Australia including the triggers for performing endotracheal suction. METHODS: A single day, prospective observational, binational, multicentre point prevalence study in New Zealand and Australian ICUs. All adult patients admitted at 10:00 on the study day were included. MAIN OUTCOME MEASURES: In addition to patient demographic data, we assessed triggers for ETS, suction canister pressures, use of preoxygenation, measures of oxygenation, and ETS at extubation. RESULTS: There were 682 patients in the ICUs on the study day, and 230 were included in the study. Three of 230 patients were excluded for missing data. A total of 1891 ETS events were performed on 227 patients during the study day, a mean of eight interventions per patient. The main triggers reported were audible (n = 385, 63%) and visible (n = 239, 39%) secretions. Less frequent triggers included following auscultation (n = 142, 23%), reduced oxygen saturations (n = 140, 22%), and ventilator waveforms (n = 53, 9%). Mean suction canister pressure was -337 mmHg (standard deviation = 189), 67% of patients received preoxygenation (n = 413), and ETS at extubation was performed by 84% of nurses. CONCLUSION: Some practices were inconsistent with international guidelines, in particular concerning patient assessment for ETS and suction canister pressure.

Long-Term Effects of Saline Instilled During Endotracheal Suction in Pediatric Intensive Care: A Randomized Trial.

BACKGROUND: Saline instillation is still used to assist in removal of secretions from endotracheal tubes in some pediatric intensive care units. OBJECTIVE: To compare the effect of using either no saline, quarter-normal (0.225%) saline, or normal (0.9%) saline during endotracheal suctioning of children receiving ventilatory support in a pediatric intensive care unit. METHOD: An unblinded, randomized trial with 3 treatment groups was conducted with 427 children who received ventilatory support for at least 12 hours. Children were randomly assigned to receive no saline, 0.225% saline, or 0.9% saline during routine endotracheal suctioning. RESULTS: The primary outcome was the number of hours of invasive mechanical ventilation; oxygen therapy and length of stay in the unit were secondary outcomes. There were 138 children randomly assigned to the no-saline group, 141 to the 0.225% saline group, and 148 to the 0.9% saline group. In Kaplan-Meier intention-to-treat analysis, the median (interquartile range) number of hours of invasive mechanical ventilation was 32 (20-68), 43 (21-86), and 40 (20-87) in the no-saline, 0.225% saline, and 0.9% saline groups, respectively. Although the no-saline group received fewer hours of invasive ventilation, oxygen therapy, and intensive care than the other groups combined, the differences were not statistically significant. CONCLUSION: Using no saline was at least as effective as using either 0.225% or 0.9% saline in endotracheal suctioning. The optimal policy may be to routinely use no saline with endotracheal suctioning in children but allow the occasional use of 0.9% saline when secretions are thick.

Carga de trabajo y cumplimiento por parte de las enfermeras de las medidas no farmacológicas para la prevención de la neumonía asociada a la ventilación mecánica. Estudio piloto / Nursing workload and adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia. A pilot study

Objetivo: Analizar si el cumplimiento de las medidas no farmacológicas para la prevención de la neumonía asociada a la ventilación mecánica (NAV) se asocia a la carga de trabajo de las enfermeras. Método: Estudio observacional prospectivo llevado a cabo en una UCI médico-quirúrgica. Se evaluó a las enfermeras a cargo de pacientes con soporte ventilatorio. Variables: cuestionario de conocimiento, aplicación de las medidas no farmacológicas de prevención de la NAV, carga de trabajo medida mediante el Nine Equivalents of Nursing Manpower Use Score. Fases: 1) las enfermeras realizaron un programa educativo, basado en conferencias de 60 min sobre medidas no farmacológicas para la prevención de NAV, completando al finalizar un cuestionario de conocimiento; 2) periodo de observaciones; 3) cuestionario de conocimiento. Resultados: De un total de 67 enfermeras de UCI, 54 completaron el programa formativo y fueron incluidos en el estudio. Se llevaron a cabo un total de 160 observaciones de 49 enfermeros/as. El correcto conocimiento de las medidas de prevención se confirmó tanto en el cuestionario inicial como final. La aplicación de las medidas de prevención varió desde el 11% para el lavado de manos preaspiración hasta el 97% para el uso de sonda de aspiración estéril. La puntuación del Nine Equivalents of Nursing Manpower Use Score fue de 50±13. No se observaron asociaciones significativas entre el grado de conocimiento y la aplicación de medidas de prevención, ni entre la carga de trabajo y la aplicación de dichas medidas. Conclusiones: El conocimiento de las enfermeras de las medidas de prevención de la NAV no se traslada necesariamente a la práctica diaria. En la población estudiada, la falta de aplicación de estas medidas no está sujeta a la falta de conocimiento ni a la carga de trabajo, sino probablemente a los factores contextuales (AU)

Objective: To analyse whether adherence to non-pharmacological measures in the prevention of ventilator-associated pneumonia (VAP) is associated with nursing workload. Methods: A prospective observational study performed in a single medical-surgical ICU. Nurses in charge of patients under ventilator support were assessed. Variables: knowledge questionnaire, application of non-pharmacological VAP prevention measures, and workload (Nine Equivalents of Nursing Manpower Use Score). Phases: 1) the nurses carried out a educational programme, consisting of 60-minute lectures on non-pharmacological measures for VAP prevention, and at the end completed a questionnaire knowledge; 2) observation period; 3) knowledge questionnaire. Results: Among 67 ICU-staff nurses, 54 completed the educational programme and were observed. A total of 160 observations of 49 nurses were made. Adequate knowledge was confirmed in both the initial and final questionnaires. Application of preventive measures ranged from 11% for hand washing pre-aspiration to 97% for the use of a sterile aspiration probe. The Nine Equivalents of Nursing Manpower Use Score was 50±13. No significant differences were observed between the association of the nurses' knowledge and the application of preventive measures or between workload and the application of preventive measures. Conclusions: Nurses' knowledge of VAP prevention measures is not necessarily applied in daily practice. Failure to follow these measures is not subject to lack of knowledge or to increased workload, but presumably to contextual factors (AU)

Normal saline instillation before suctioning: A meta-analysis of randomized controlled trials.

BACKGROUND: For airway management of intensive care unit (ICU) patients who are intubated, a 5-10-mL bolus of sterile normal saline (NS) solution is commonly instilled into an endotracheal or tracheostomy tube before suctioning. However, NS instillation has been associated with adverse events such as dyspnea, increasing heart rate, decreasing of oxygenation, blood pressure, and other vital parameters. OBJECTIVE: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the necessity of NS instillation before suctioning in ICU patients. DATA SOURCES: The PubMed, Embase, Cochrane Library, and Scopus databases and the ClinicalTrials.gov registry were searched for studies published before May 2016. REVIEW METHODS: RCTs evaluating the outcome of NS instillation before suctioning in ICU patients undergoing endotracheal intubation or tracheostomy were included. Individual effect sizes were standardised, and a meta-analysis was conducted to calculate the pooled effect size by using a random-effect model. The primary outcome was the oxygen saturation immediately and 2 and 5min after suctioning. The secondary outcomes were the heart rate and blood pressure after suctioning. RESULTS: We reviewed 5 RCTs including 337 patients. Oxygen saturation was significantly higher in the non-NS group than in the NS group 5min after suctioning. The pooled mean difference in oxygen saturation was -1.14 (95% confidence interval: -2.25 to -0.03). The heart rate and blood pressure did not differ significantly between the non-NS and NS groups. CONCLUSION: NS instillation before suctioning does not benefit patients undergoing endotracheal intubation or tracheostomy. Moreover, it reduces oxygen saturation 5min after suction. However, our reviewed studies had a low methodological quality. Thus, additional studies involving large-scale RCTs are warranted.

Amamentação na primeira hora de vida em uma instituição com iniciativa hospital amigo da criança / Lactancia en la primera hora de vida en una institución con iniciativa hospital amigo delniño / Breastfeeding in the first hour of life at an institution with the baby-friendly hospital initiative

RESUMO Objetivou-se, neste estudo, identificar a prevalência da amamentação na primeira hora de vida e seus resultados para a manutenção do aleitamento materno. Trata-se de uma pesquisa descritiva desenvolvida em uma instituição hospitalar com Iniciativa Hospital Amigo da Criança da Tríplice Fronteira, realizada no segundo e terceiro trimestres de 2015. A coleta dos dados envolveu observação da primeira mamada e após 18 horas de nascimento; e contato telefônico após 90 dias. Os dados foram analisados pela estatística simples. Observaramse 88 binômios, dos quais 79,5% mamaram na primeira hora de vida. O parto normal foi um fator protetor para a amamentação na primeira hora e boa sucção. No alojamento conjunto, os binômios que iniciaram a mamada na primeira hora demonstraram melhor adaptação da sucção, porém não melhor resposta do recém-nascido. Após 90 dias do nascimento, a maioria das crianças estava sendo amamentada, mas também recebiam leite artificial. Aponta-se para a necessidade de sensibilizar gestores e profissionais de saúde para promover a prática do aleitamento materno na primeira hora de vida como uma prioridade de cuidado.

RESUMEN El objetivo de este estudio fue identificar la prevalencia de la lactancia en la primera hora de vida y sus resultados para el mantenimiento de la lactancia materna. Investigación descriptiva desarrollada en una institución hospitalaria con Iniciativa Hospital Amigo del Niño de la triple frontera, en el segundo y tercer trimestre de 2015. La recolección de los datos involucró observación de la primera mamada y tras 18 horas de nacimiento; y contacto telefónico tras 90 días. Los datos fueron analizados por la estadística simple. Se observaron 88 binomios, siendo que, 79,5% mamaron en la primera hora de vida. El parto normal fue un factor protector para la lactancia en la primera hora y buena succión. En el alojamiento conjunto, los binomios que iniciaron la mamada en la primera hora demostraron mejor adaptación de la succión, pero sin una mejor respuesta del recién nacido. Después de 90 días del nacimiento, la mayoría de los niños estaba siendo amamantada, aunque, también recibía leche artificial. Se apunta a la necesidad de sensibilizar a gestores y profesionales de salud para promover la práctica de la lactancia materna en la primera hora de vida como una prioridad de cuidado.

ABSTRACT The objective of this study was to identify the prevalence of breastfeeding in the first hour of life and its outcomes to breastfeeding continuation. This is a descriptive research developed at a hospital institution with the Child-Friendly Hospital Initiativein the triple frontier, during the second and third quarter of 2015. Data collection involved observation of the first breastfeeding and breastfeeding 18 hours after birth, and a phone call after 90 days. Data were analyzed through simple statistics. A total of 88 binomials were assessed, with 79.5% being breastfed in the first hour of life. Normal delivery was a protective factor to breastfeeding in the first hour of life and to good suction. As for rooming-in, those binomials that started being breastfed in the first hour showed better suction adaptation, but not better response from the newborn. After 90 days of birth, most children were being breastfed but were receiving artificial milk too. It is worth highlighting the need to make health managers and professionals sensitive to promoting breastfeeding practice in the first hour of life as a healthcare priority.

How to perform open tracheal suction via an endotracheal tube.

Rationale and key points Tracheal suction involves the removal of pulmonary secretions from the respiratory tract using negative pressure under sterile conditions. Practitioners should be aware of the indications for, and risks associated with, open tracheal suction via an endotracheal tube. ▶ Respiratory assessment of the patient should be carried out to identify when tracheal suction is required. ▶ A suction pressure of 80-120mmHg is recommended, and suction should last no longer than 15 seconds. ▶ Reassurance and support should be given to the patient to minimise any discomfort and distress that might result from tracheal suction. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: 1. How you think this article will change your practice when performing open tracheal suction via an endotracheal tube. 2. How you could use this resource to educate your colleagues. Subscribers can upload their reflective accounts at: rcni.com/portfolio .

Effects of Open and Closed Endotracheal Suctioning on Intracranial Pressure and Cerebral Perfusion Pressure in Adult Patients With Severe Brain Injury: A Literature Review.

In neurologically impaired adult patients, endotracheal suctioning is a potentially dangerous nursing procedure because it can increase intracranial pressure (ICP) and decrease cerebral perfusion pressure (CPP). This article presents an overview of the literature relating to the appropriate techniques (open system suctioning and closed system suctioning) for minimizing variability in ICP and CPP. The research used databases such as Medline, CINAHL, Embase, Scopus, Cochrane Library, and TripDataBase. Literature published from January 1, 2002, to August 31, 2013, that involved adult patients was reviewed. The main search strings were obtained using the following keyword combinations: "suction AND intracranial pressure AND cerebrovascular circulation," "brain injuries OR craniocerebral trauma AND suction," and "brain injuries OR craniocerebral trauma AND suction AND intracranial pressure." Fourteen articles were included: two systematic reviews, two prospective nonrandomized studies, two prospective double-blind clinical trials, a crossover single-blind clinical trial, three prospective interventionist case studies, a case-control study, and three observational studies. Although most of the articles show an increased ICP above 20 mm Hg when using open system suctioning (as opposed to closed system suctioning), it is still not clear which technique is best for maintaining CPP. Therefore, further studies are needed to determine the best technique for nursing practice.

Normal saline instillation before endotracheal suctioning: "What does the evidence say? What do the nurses think?": Multimethod study.

PURPOSE: This study aimed to systematically review studies that investigated the effects of normal saline instillation before endotracheal suctioning and to determine the views of nurses concerning this procedure. METHODS: This study was carried out in 2 stages as a systematic review and a descriptive study. In the first stage, the Medline and CINAHL databases were searched. The second stage of the study consisted of a survey of 65 intensive care nurses. RESULTS: The systematic review identified 7 studies. Nearly all of the studies had a self-controlled clinical trial design. Normal saline instillation before endotracheal suctioning was demonstrated to decrease patient oxygenation in most studies (P < .05). However, the impact of normal saline on hemodynamics and the incidence of ventilator-associated pneumonia remain unclear. Most nurses (87.7%) apply normal saline instillation. CONCLUSION: Although the effects of normal saline instillation on hemodynamics and pneumonia incidence remain controversial, this procedure significantly decreases the oxygenation. Therefore, the use of this procedure is not recommended. However, normal saline instillation is used frequently by nurses to manage thick and tenacious secretions in clinical practice. Additional studies are needed to determine the effectiveness of applications that may be alternatives to normal saline instillation in the management of these secretions.

Nursing care of patients with a temporary tracheostomy.

Safety considerations are important when caring for a patient with a temporary tracheostomy. Early detection and resolution of problems in tracheostomy management are important to prevent serious incidents arising. Nurses working outside critical care areas need to be competent and confident in the management or detection of potential problems with tracheostomies. This article summarises the essential care of a patient with a temporary tracheostomy with reference to best practice guidelines, emphasising the importance of prompt intervention and response, if a potential problem is identified.

Drenaje del seroma posquirúrgico en la cirugía de la mama con SeromaSet® / Drainage of postoperative seroma in breast surgery with SeromaSet®

El cáncer de mama es la neoplasia maligna más frecuente en la mujer. El abordaje quirúrgico constituye uno de los pilares fundamentales en el tratamiento de esta enfermedad. Una de las complicaciones de la cirugía es el seroma posquirúrgico. A pesar de no ser una complicación grave, para la mujer sí lo es e implica incomodidad, más visitas hospitalarias y, en ocasiones, retraso de los tratamientos coadyuvantes (AU)

Breast cancer is the most common malignancy in women. The surgical approach is one of the cornerstones in the treatment of this disease. One of the complications of surgery is postoperative seroma. Despite not being a serious complication, for women it is, and involves discomfort, more hospital visits and sometimes delay of adjuvants treatments (AU)

Clinical indicators for the initiation of endotracheal suction in children: An integrative review.

BACKGROUND: Critical decisions and interpretation of observations by the nurse caring for the paediatric intensive care (PIC) patient can have dramatic and potential adverse impact on the clinical stability of the patient. A common PIC procedure is endotracheal tube (ETT) suction, however there is inconsistent evidence regarding the clinical indicators to guide and support nursing action. Justification for performing this procedure is not clearly defined within the literature. Further, a review of the literature has failed to establish clear standards for determining if the procedure is warranted, especially for paediatric patients. OBJECTIVE: The objective of the review is to identify current clinical indicators used in practice to determine why ETT suction should be performed. METHOD: An integrative review using a systematic approach to summarise the empirical and theoretical evidence within the literature as it relates to clinical practice was used. RESULTS: Consensus of opinion indicates that ETT suctioning should only be performed when clinically indicated. There is no general consensus regarding which clinical indicators should be measured and used to guide the decision to perform ETT suctioning. CONCLUSION: Research is required to identify the clinical indicators that could be used to design a valid and clinically appropriate tool to use to assist in the decision making process to perform ETT suction.

Conocimientos y prácticas que realizan los enfermeros en la aspiración de secreciones en pacientes intubados en el Servicio de Emergencia de Adultos HNERM. 2014 / Knowledge and practices realized by nurses in the aspiration of secretions in intubated patients in the Adult Emergency Services at the HNERM. 2014

El objetivo del estudio fue determinar los conocimientos y prácticas que realizan los Enfermeros en la aspiración de secreciones en pacientes intubados en el servicio de Emergencia de Adultos HNERM 2014. Material y Método: El estudio es de nivel aplicativo, tipo cuantitativo, método descriptivo de corte transversal. La muestra fue obtenida por muestreo probabilístico de proporciones para población finita y aleatoria simple conformada por 38. La técnica fue la encuesta y la observación, y los instrumentos fueron un formulario tipo cuestionario y la lista de chequeo, aplicado previo consentimiento informado. Resultados: Del 100 por ciento (38), 63 por ciento (24) conoce y 37 por ciento (14) no conoce. En cuanto a la práctica 68 por ciento (26) son inadecuadas y 32 por ciento (12) adecuada. Acerca de las practicas antes 39 por ciento (15) inadecuada y 61 por ciento (23) adecuadas; durante 34 por ciento (13) son inadecuadas y 66 por ciento (25) adecuadas, y después del procedimiento 34 por ciento (13) es inadecuada y 66 por ciento (25) adecuada. Conclusiones: El mayor porcentaje conoce que es necesario lubricar la punta de la sonda con agua destilada y una de las contraindicaciones es la obstrucción de la vía aérea por cuerpo extraño; y un porcentaje considerable no conocen que el primer paso que se realiza es valorar los signos vitales y estados de oxigenación del paciente; la práctica es adecuada ya que se lava las manos, repite el procedimiento hasta dejar libre de secreciones, y lo inadecuado porque no verifica y usa sonda de aspiración apropiado para cada TET o TQT, omite observar y valorar la SatO2 y las cifras de signos vitales y no deja cómodo al paciente...

The objective of the study was to determine the knowledge and practices that nurses perform in the aspiration of secretions in patient intubated adults HNERM 2014 emergency service. Material and Method: The study is application level, quantitative, descriptive cross-sectional method. The sample was obtained by probabilistic sampling of proportions for simple finite and random population comprised 38. The technique was the survey and observation, and instruments were a form questionnaire and collation, applied prior informed consent list. Results: 100 per cent (38), 63 per cent (24) meet and 37 per cent (14) does not know. Practice 68 per cent (26) are inadequate and 32 per cent (12) adequate. About 39 per cent practices before (15) inadequate and 61 per cent (23) adequate; over 34 per cent (13) are inadequate and 66 per cent (25) appropriate, and after the procedure 34 per cent (13) is inadequate and 66 per cent (25) adequate. Conclusions: The highest percentage knows that it is necessary to lubricate the tip of the probe with distilled water and one of the contraindications is by foreign body airway obstruction; and a significant proportion do not know that the first step that is carried out is to assess vital signs and oxygenation of the patient States; practice is suitable because it washes the hands, repeat the procedure until clear of secretions, and inadequate because it does not check and used suction probe suitable for every TET or TQT, omits to observe and assess the SatO2 and numbers of vital signs and does not leave the patient comfortable...