الفهرس 
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Abstract
Critical care patients frequently needed to be intubated to protect their airway .They may require intubation for weeks or longer and this prolonged time increases the risk of serious patient’s complications. These complications include ventilator-associated pneumonia, tracheomalacia, airway injury, laryngeal injuries, cardiac dysrhythmia, barotrauma, bedsores, bleeding, thromboembolism, muscle atrophy and some of those complications increase with the duration of intubation and may increase mortality. So, it is required to maintain tracheal tube patency allover the time to prevent its blockage risk. Tracheal tube blockage is typically defined as the obstruction and narrowing of the internal diameter of the tube. This obstruction may be partial or complete blockage. There are innumerable factors responsible for the blockage of the tracheal tube as patient related factors, nurse administrative factors, nurse characteristics, nurse clinical practice. Also factors related to tracheal tube as tube size and cuff pressure and factors related to oxygen therapy .Hence, this study was conducted to identify factors associated with tracheal tube blockage in tracheally intubated patients.
The aim of this study:
A descriptive research design was used to identify factors associated with tracheal tube blockage in tracheally intubated patients
Materials and method:
This study was carried out at the following ICUs at Alexandria Main University Hospital; unit I that includes14 beds, unit II that includes12 beds, and unit III that includes15 beds and Elmoassat hospital general ICU that includes 16 beds. These general ICUs receive patients who have variety of disorders in the acute stage of illness admitted directly from the emergency room or transferred from other hospital departments.
A convenience sample of 105 adult tracheally intubated patients from the first day of intubation was included in this study.
To accomplish the aim of the current study; one tool was used for data collection. Tool one “Factors associated with tracheal tube blockage assessment tool”. This tool was developed by the researcher after reviewing the relevant literature to assess factors associated with tracheal tube blockage in tracheally intubated patients. It consists of two parts:
Part I: Demographic and clinical data record.
This part was used to assess demographic and clinical data .Demographic data such as age, sex. Clinical data such as past history data as history of smoking, co-morbidities, admission related data as admission medical diagnosis, reasons of intubation, laboratory investigations as bleeding profile, hematocrit and white blood cells count, medications such as sedatives and anticoagulant. These parameters were recorded by the researcher in an assessment sheet.
Part II: factors associated with tracheal tube patency
This part includes: factors related to patient as neurological status, dehydration status, presence of lung infection, bleeding tendency. Factors related to health care provider (nurse).These factors divided into; administrative factors as nurse patient ratio, lack of supplies and lack of supervision. Nurse characteristics as sex, age, years of experience, education and receiving training. Also factors related to nurse tracheal suction practice as negative suction used , suction catheter size ,suction frequency, time , duration and incidence of trauma. Finally factors related to tracheal tube and oxygen therapy used as type of tracheal tube , tube size , duration of tube, cuff pressure measured, presence of humidifier and mode of mechanical ventilator
The study design was accomplished as follow:
• An official letter from the Faculty of Nursing was sent to the appropriate authorities in the Main University Hospital (MUH). Permission to conduct the study with explanation of the aim of the study was obtained.
• The study tool was developed by the researcher after reviewing the related literature. And this study tool was submitted to a jury of 5 experts in critical care nursing, critical care medicine to assess the content of the tool and all necessary modifications were made.
• A pilot study was carried out on eight patients who represent 10% of sample size in order to test the feasibility and applicability of the tool and all the necessary modifications were made accordingly. The pilot sample was excluded from the study subjects.
• Reliability was not tested because the tool is not a Likert scale and was developed by the researcher with its value measured based on the answer of yes or no.
• Data were collected by the researcher during approximately (four months) starting from the beginning of August 2019 till the end of November 2019.
Results of the current study were as follow:
Most of the studied patients were males; aged 40-60 years old. The findings of the present study show that there was no significant association between tracheal tube patency and patient’s demographic data. But there was significant association as regard to history of smoking, comorbidities of respiratory disorders and hypoventilation as reason of intubation.
Regarding patient related factors associated with tracheal tube blockage. There was statistically significant association between bleeding tendency of the studied patients and tracheal tube patency, this finding was evidenced by the statistically significant association for Prothrombin time (p< 0.00), partial prothrombin time (p< 0.00) and INR (P= 0.047).
There was statistically significant association between tracheal tube blockage and ventilator associated pneumonia. This finding was evidenced by the statistically significant association for presence of ventilator associated pneumonia (p< 0.001) and increased white blood cells count (p< 0.001)
There was statistically significant association between tracheal tube blockage and neurological dysfunction for the studied patients as decrease level of consciousness (p=< 0.001) and muscle weakness (p=< 0.001)
There was statistically significant association between tracheal tube blockage and dark urine (p < 0.001), weak pulse (p < 0.001) and delayed skin turgor (p < 0.001), while there was no significant difference in relation to recent weight loss (p= 0.331), diarrhea(p=0.055) and fluid balance(p=0.090)
As regard nurse administrative related factors, there was statistical significant association between tracheal tube blockage and low nurse patient ratio (p= 0.001), resources unavailability (p<0.001) and lack of supervision (p<0.001)
As regard nurse characteristics, there was statistical significant association between tracheal tube blockage and nurse education level (p < 0.001), while there was no significant association in relation to nurse sex (p=0.175) and nursing training (p=0.069).
As regard nurse tracheal suction practice, there was significant association between tracheal tube blockage and negative suction pressure (p< 0.001), continuous negative pressure (p< 0.001), high suction frequency (p< 0.001), large suction catheter size (p< 0.001), incidence of trauma during suction(p=0.002) and increased suction duration (p< 0.001)
As regard tracheal tube related factors, there was statistical significant association between tracheal tube blockage and tube size (p=0.002).While there was no significant association between tracheal tube blockage and cuff pressure (p=0.099).
There was statistical significant association between tracheal tube blockage and presence of humidifier water (p< 0.001) and ventilator mode (p< 0.001)
Conclusion
Based on the findings of the current study, it can be concluded that:
The majority of the studied tracheally intubated patients have developed tracheal tube blockage. There were multiple factors that could contribute to tracheal tube blockage in tracheally intubated patients. Factors related to patients as presence of VAP and bleeding tendency, factors related to nurse inappropriate suction technique, low nurse patient ratio, factors related to tube as tube size , PCV mode and absence of humidifier were the most significant risk factors to tracheal tube blockage.
Recommendations
• Assess the patients’ need for tracheal suctioning and provide appropriate care.
• Identify the updated protocols which used to reduce the incidence of tracheal tube blockage.
• Emphasis on presence of humidifier and suitable water level.
• Develop educational programs to raise critical care nurses awareness regarding assessment of factors which can effect tracheal tube patency.
• Formulate evidence-based guidelines and standards for assessing intubated patients who are risky to tube blockage.
• Frequent measuring of cuff pressure and modify it to acceptable level
• Replication of the current study on large sample size, longer duration of data collection and different setting for generalization of the results.