• Alberto Lucchini, Marta Canesi, Gaia Robustelli, Roberto Fumagalli, and Stefano Bambi.
• Alberto Lucchini, RN, is nurse chief, General Intensive Care Unit, San Gerardo University Hospital, Monza, and is coordinator, Anesthesia and Intensive Care, University of Milano-Bicocca, Milan, Italy. Marta Canesi, RN-MSN, Pediatric Oncohematology Ward/BMTC, Fondazione MBBM, Monza, Italy. Gaia Robustelli, RN-MSN, is a staff nurse, Intensive Care Unit, Treviglio-Caravaggio Hospital, Treviglio, Italy. Roberto Fumagalli, MD, is a director, Department of Experimental Medicine, University of Milano-Bicocca, Milan. Stefano Bambi, PhD, MSN, RN, is a staff nurse, Intensive Care Unit, Azienda Ospedaliero Universitaria Careggi, and is PhD student in nursing science, University of Florence, Florence, Italy.
• Dimens Crit Care Nurs. 2016 Sep 1; 35 (5): 283-90.

IntroductionTracheal suctioning is recalled by mechanically ventilated patients as the most painful procedure during their stay in the intensive care unit.AimThe aim of this study was to evaluate whether the implementation of American Association of Respiratory Care suction guidelines positively affects the levels of patients' pain.Materials And MethodsThis is a prospective observational study on adult patients admitted to 2 general intensive care units. Pain levels in sedated mechanically ventilated patients were recorded before, during, and after tracheal suctioning, using the Critical Care Pain Observation Tool (CPOT).ResultsForty-seven patients were enrolled, with a mean age of 61.72 (±18.46) years. Median CPOT value was 0 (quartile 1 [Q1] [25%], 0; quartile 3 [Q3] [75%], 0; min, 0; max, 2) during the procedure. The Critical Care Pain Observation Tool reached a median value of 3, while 5 minutes after suctioning. Postprocedural CPOT median score was 0 (Q1 [25%], 0; Q3 [75%], 0; min, 0; max, 2). The median number of passes during suctioning was 1 (Q1, 1; Q3, 2). The sizes of suction catheters used in the recorded procedures were as follows: 12F in 27 cases (57%), 14F in 18 cases (38%), and 10F in 2 cases (5%). The median size of the endotracheal tube was 7.5 mm (Q1, 7.5; Q3, 8). The correct ratio between endotracheal tube diameter and suction catheter was used in 24 procedures (51%).ConclusionsDespite the low number of patients, this study showed that the implementation of the American Association of Respiratory Care 2010 endotracheal suctioning guidelines into practice helps to reduce procedural-induced pain. Therefore, training and continuing education are important for clinical staff performing tracheal suctioning.

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