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March 2013

Martha Reeves, RN, BA, CCRN
Medical Intensive Care Unit (MICU)
Charge Nurse

Type of project: Research
Title of project: Open vs. Closed Endotracheal Suctioning in Mechanically Ventilated Patients with Acute Respiratory Failure
Co-workers involved in this project: Arthur P. Wheeler MD, Kristen Majeske RN, Julie Foss RN, Glenda Harling RN, Aven McNab RN, Enqu Kent RN, Suzanne Hyde RRT, Paul Ring RRT, and Todd Rice MD
Description of project: We conducted an interdisciplinary, nurse-led, randomized, open-label, cross-over study comparing the effectiveness of secretion removal using two different methods of suctioning in patients expected to be mechanically ventilated for at least 96 hours. Open suctioning was performed using a red rubber catheter after disconnecting the patient from the ventilator. Closed suctioning was performed using inline Ballard maintaining the connection to the ventilator. Initial suction method was assigned by blinded envelope randomization. Each patient received suctioning every 4 hours and as needed per randomization. After 48 hours, patients crossed-over to the other suctioning method.

References used during this project:

  1. 1.6 Prevention of VAP:Type of endotracheal suctioning system (open vs closed) update from previous CPG. (2006, october 1). Retrieved september 2010, from

  2. Hermann Heinze, M. (2008). Functional Residual Capacity Changes After Different Endotracheal Suctioning Methods. Anesthesia and Analgesia The Gold Standard in Anesthesiology , 941-944.

  3. Hess, D. R. (2003). AARC Evidence-Based Clinical Practice Guidelines. Respiratory Care Journal, 48 (9): 869-879.

  4. Irene P. Jongerden, M., Maroeska M. Rovers, P., Mieke H. Grypdonck, P., & Marc J. Bonten, M. P. (2007). Open and Closed Endotracheal Suction Systems in Mechanically Ventilated Intensive Care Patients: A Meta-Analysis. Crit Care Med, 35(1): 260-270.

  5. Lorente, L. (January 2005). Ventilator-associated pneumonia using a closed versus an open. Crit Care Med Vol. 33, No. 1, 115-119.

  6. Subirana M, S. I. (2007). Closed tracheal suction systems versus open tracheal suction systems for mechanically ventilated adult patients. Cochrane Database of Systematic Reviews , Issue 4. Art. No.: CD004581. DOI: 10.1002/14651858.CD004581.pub2.

Why you chose this project: The best method of endotracheal suctioning is unknown. We compared volume and weight of sputum removed utilizing open versus closed suctioning methods in mechanically ventilated patients in the MICU. Literature primarily focuses on Ventilator Associated Pneumonias (VAP),  increased cost and length of hospital stay and infection rates related to method of suctioning.

Positive outcomes from this project:

  1. Increased teamwork and collaboration between Respiratory Dept and Nursing
  1. MICU nurses more comfortable with removing patients from ventilator and suctioning
  1. MICU remains VAP free for 632 days

Poster presentations:
1.) Open vs. Closed Endotracheal Suctioning in Mechanically Ventillated Patients with Acute Respiratory Failure - VUMC Nursing Research Day, Nashville, TN. October 17, 2012.


Future plans:
The study group is planning on publishing the following results:

  • Open suctioning was more likely to return measurable sputum
  • Closed suctioning resulted in more suction events
  • There is no difference in weight or volume of secretions between methods

If you have any questions about Martha's project she can be reached via email at