Pathogenesis and Prevention of Tracheobronchial Damage with Suction Procedures

Abstract

The pathogenesis and prevention of mucosal hemorrhages and erosions in the tracheobronchial tree associated with suctioning were investigated. Several presently available commercial suction catheters were placed within the tracheobronchial tree of dogs and their effects observed by cinebronchofiberscopy. When vacuum was applied to the catheter and its eyes came into close proximity to the bronchial mucosa, the mucosa elevated and invaginated into the side hole or end hole or both, depending on the configuration of the catheter tip. The area became hemorrhagic immediately after cessation of vacuum. Thus, the design of present day suction catheters is unacceptable because no provision is made for preventing the eyes from contacting the wall of the airway being suctioned. For this reason, a new tip was designed: a bead was placed around the distal tip of an end hole catheter and four small holes punched just proximal to this bead (Argyle Aero-Flo Tip). The bead prevents the holes from contacting the side wall of the airway by offering a mechanical impediment, and, the interrelation of the proximal side holes to the bead and end hole produces an air cushion which promotes centering of the catheter within the airway. Gross and histologic examination of the tracheobronchial tree after controlled suction in dogs confirmed the safety of the new catheter. This newly designed suction catheter should minimize damage to the tracheobronchial mucosa which is caused by standard catheters, thereby minimizing bacterial colonization and disturbance in mucociliary transport in patients who require suctioning of the tracheobronchial tree.