Endotracheal Suction Catheter Research Articles

Suction circuit flushing with chlorhexidine decreases ventilator-associated pneumonia: a quasi-experimental study.

Endotracheal suctioning of mechanically ventilated patients differs across the world. In many low and middle-income countries, endotracheal suctioning is often performed with a sterile suctioning catheter that is used for 12 h or during the length of one nursing shift. The effect of flushing multiple used endotracheal suction system with chlorhexidine after suctioning to reduce ventilator associated pneumonia (VAP) remains unclear. The aim of the study is to assess the effectiveness of flushing multiple-used open endotracheal suction catheters and suctioning system with chlorhexidine gluconate 0.2% to reduce VAP in mechanically ventilated patients in a resource-limited Intensive Care Unit (ICU). Due to the difficulty of blinding the intervention for nurses who perform endo-tracheal suction procedures, we adopted a quasi-experimental method with a randomized controlled trial design. A sample of 136 ICU patients were allocated to the intervention (n = 68) or control group (n = 68) between May and November 2020. The intervention was flushing the multiple-used suction catheter and suction system with 40ml chlorhexidine gluconate 0.2% and in the control group we used normal saline to flush the catheter and suction system. The primary outcome was incidence of VAP and the cost of the flushing solutions was the secondary outcome measure. Patients in the intervention group had a lower incidence of VAP compared to patients in the control group; 15 (22.1%) vs 29 (42.6%), p = 0.01. The incidence of late-onset VAP was 26.2% in the intervention group and 49% in the control group (p = 0.026) and the early-onset VAP was 13.2% in the intervention group and 25% in the control group (p = 0.081). Chlorhexidine gluconate 0.2% reduced the cost of suction system flushing (median: 78.4 vs 300 EGP, p < 0.001). Using chlorhexidine gluconate 0.2% to flush multiple-used suctioning catheters after every endo-tracheal suction procedure might reduce the incidence of VAP in mechanically ventilated patients. Chlorhexidine gluconate 0.2% can be a cost-effective solution for flushing the suction circuit. Nurses working in resource-limited ICUs and using suctioning catheters multiple times might consider using chlorhexidine gluconate 0.2% instead of normal saline or distilled water when flushing the suction system. ClinicalTrials.gov, identifier NCT05206721.

Closed endotracheal suction catheter system related complications in mechanically ventilated COVID-19 patients.

Sir, In the current coronavirus disease 2019 (COVID-19) pandemic, about 15% of patients may develop severe disease and 5% critical disease requiring admission to an intensive care unit (ICU) and mechanical ventilation.[1] In mechanically ventilated patients, closed endotracheal suctioning system is used to prevent disconnection of circuit and consequent de-recruitment of alveoli and to prevent aerosolisation of droplets and potential contamination of surroundings.[23] However, in times of sudden surge in cases, trained ICU staff may not be always available. Moreover, efficiency is reduced after wearing personal protective equipment (PPE) and visibility may turn poor due to fogging of goggles. Therefore, inadvertent human errors may occur. We report two such cases involving the use of in-line closed suction catheter system (DAR™ closed suction system, Covidien Ireland Limited). In the first case, we noticed that the closed suction catheter was not completely withdrawn outside after suctioning was complete and the rotatory access knob was closed. Presence of part of the suction catheter inside the endotracheal tube led to increase in the peak airway pressures and frequent ventilator alarms that was initially interpreted as bronchospasm [Figure 1a]. However, a very close inspection revealed the actual problem. In another case, although the suction catheter was completely withdrawn, the rotating access knob was not closed, which led to significant leak in the circuit and activation of ventilator alarms [Figure 1b]. Inflated plastic sheath covering of the closed suction system revealed this problem. These kinds of problem may lead to unnecessary troubleshooting warranting treatment/interventions (like treating with bronchodilators in case of misdiagnosed bronchospasm or inflating the pilot balloon further in case of leak), which may even harm the patient (like barotrauma or alveolar de-recruitment). Fortunately, in both our cases, the actual problems were identified and no adverse events were seen. Problems like blocked tip of closed suction catheter leading to inadequate suctioning[4] and migration of piece of closed suction catheter leading to bronchial obstruction have been already reported.[5]Figure 1: (a) Closed suction catheter (black arrow) partially kept inside endotracheal tube and difficult to detect due to transparent colour of distal part of the catheter; (b) rotating access knob was not closed causing leak and overinflated plastic sheathing (white arrow)While the nursing staff were aware of the standard operating procedures for the closed suction system in ICU, impaired visibility due to fogging of goggles was the reason reported behind such inadvertent mistakes in both the cases. The fogging issue has been addressed by regular use of antifogging markers.[6] However, we would like to suggest two design modifications of the closed suction system. First, the colour of the in-line catheter may be made more conspicuous throughout the length of the catheter. The suction catheter of DAR™ closed suction system (Covidien Ireland Limited) is blue in the advancing end while being transparent towards the tail end [Figure 1b] and may evade detection if left inside the ventilator circuit with suboptimal visibility while working with PPEs. Second, an in-line self-sealing valve/diaphragm may be placed at the rotatory access knob to eliminate the risk of circuit leak in case the rotating access knob is inadvertently left open. To conclude, impaired visibility due to fogging of goggles may lead to inadvertent errors while operating equipment like closed suction catheter system in COVID-19 ICUs. Heightened vigilance and appropriate troubleshooting interventions might avoid and resolve such unintentional mistakes. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

A novel way of removing an endotracheal suction catheter foreign body in a preterm neonate: A case report and review of literature

Airway obstruction by foreign bodies (FBs) in preterm neonates is a rare occurrence. Most of these FBs are iatrogenic and related to medical devices used in the neonate. We describe a case of an endotracheal FB resulting from the cut end of an in-line closed suction catheter. The FB caused collapse/consolidation of different lung lobes with changes in its position. It was missed for a long period of about 3 weeks and was removed by applying direct suction through an endotracheal tube. Different innovative devices have been used to retrieve endotracheal FBs in small preterm neonates; however, this method is not reported in literature to our knowledge.

Comparing Changes in Pain and level of consciousness in Open Endotracheal Suction Catheters with Two Sizes: 12 and 14: a Randomized Clinical Trial

Comparing Changes in Pain and level of consciousness in Open Endotracheal Suction Catheters with Two Sizes: 12 and 14: a Randomized Clinical Trial

Current Status of Home Medical Care Waste Collection by Nurses in Japan

ABSTRACTA questionnaire survey was conducted to determine the current status of home medical care (HMC) waste collection by nurses for individual items and whether the collection rate differs with city size. The questionnaire was mailed to 1,022 nursing offices, of which 645 offices provided valid responses. Offices were classified into three groups according to the local population size. Responses indicated that used syringes and needles, except for pen-type self-injection needles, were collected by >50% of HMC nurses. On the other hand, enteral nutrients, nutritional adjustment diet vessels, feeding tubes, portable injectors, ventilator masks, endotracheal suction catheters, tracheal cannulas, continuous ambulatory peritoneal dialysis (CAPD) bags, and urinary catheters and bags had a low collection rate in comparison with syringes or needles. The collection percentage of used syringes, needles, and infusion needles (p < 0.05) and that for infusion bags, tubes, and catheters (p < 0.001) differed among the three population groups. Although municipalities are responsible for collect all HMC waste, sharp or infectious items should be collected by HMC doctors or nurses. On the contrary, nonhazardous HMC waste should be collected by municipalities.Implications: This paper illustrates the status of waste collection of individual home medical care (HMC) items by HMC nurses. Infectious waste, such as needles and syringes, is collected by nurses. The collection rate of infectious waste by nurses in large cities was low compared with that in small cities. Although municipalities are responsible for collecting all HMC waste, sharp or infectious items should be collected by HMC doctors or nurses, whereas nonhazardous HMC waste should be collected by the municipalities.

Training Nurses About Applying Disinfection Technique For Safe Reuse Of Disposable Suction Catheters For Neonates On Mechanical Ventilation.

AbstractBackground: Endotracheal suctioning is designed to efficiently eliminating broncho-pulmonary secretions from the airway while avoiding the potential hazards of ventilator associated pneumonia (VAP). However, the cost of frequent tracheal suctioning for ventilated neonates admitted to the neonatal intensive care unit (NICU) has become a concern. One major cost component to provide this nursing care in a competent way is the use of a disposable suction catheter each time. The aim of the present study was to train nurses about applying disinfection technique for safe reuse of disposable suction catheters for neonates on mechanical ventilation, and to evaluate whether the repetitive use of disposable suction catheters is cost-effective over the single use. Methods: A quasi-experimental design was used. The disinfection technique was applied on 60 disposable endotracheal suction catheters used by a convenient sample of neonates (n=30) who admitted to the NICU affiliated to El-Mansoura University Children's Hospital suffered from respiratory distress (RD) that required mechanical ventilation. An assessment sheet contained 2 checklists about the steps of suctioning the airway and catheter’s disinfection was used. Results: The studied neonates admission weight was ranged from 905–3600 gm, gestational age was from 26–43 weeks; the period of intubation was between 2–26 days. The applied steps were found to be highly effective, completely (100%) eliminating bacterial growth of catheters seeded with Staphylococcus Aureus, Klebsiella, Pseudomonas, and E-coli. Furthermore, it does not contaminate the catheters that are cultured negative for bacterial growth. Conclusion: Applying the study disinfection technique ensured safe reuse of disposable suction catheters for neonates on mechanical ventilation and reduced NICU΄s financial burden. Recommendation: For safe reuse and cost saving, suction catheters might be disinfected and reused. Further studies to find-out for how long could the nurse reuse the disposable suction catheter after disinfection is needed.

Lung Volume Changes During Cleaning of Closed Endotracheal Suction Catheters: A Randomized Crossover Study Using Electrical Impedance Tomography

Airway suctioning in mechanically ventilated patients is required to maintain airway patency. Closed suction catheters (CSCs) minimize lung volume loss during suctioning but require cleaning post-suction. Despite their widespread use, there is no published evidence examining lung volumes during CSC cleaning. The study objectives were to quantify lung volume changes during CSC cleaning and to determine whether these changes were preventable using a CSC with a valve in situ between the airway and catheter cleaning chamber. This prospective randomized crossover study was conducted in a metropolitan tertiary ICU. Ten patients mechanically ventilated via volume-controlled synchronized intermittent mandatory ventilation (SIMV-VC) and requiring manual hyperinflation (MHI) were included in this study. CSC cleaning was performed using 2 different brands of CSC (one with a valve [Ballard Trach Care 72, Kimberly-Clark, Roswell, Georgia] and one without [Portex Steri-Cath DL, Smiths Medical, Dublin, Ohio]). The maneuvers were performed during both SIMV-VC and MHI. Lung volume change was measured via impedance change using electrical impedance tomography. A mixed model was used to compare the estimated means. During cleaning of the valveless CSC, significant decreases in lung impedance occurred during MHI (-2563 impedance units, 95% CI 2213-2913, P < .001), and significant increases in lung impedance occurred during SIMV (762 impedance units, 95% CI 452-1072, P < .001). In contrast, cleaning of the CSC with a valve in situ resulted in non-significant lung volume changes and maintenance of normal ventilation during MHI and SIMV-VC, respectively (188 impedance units, 95% CI -136 to 511, P = .22; and 22 impedance units, 95% CI -342 to 299, P = .89). When there is no valve between the airway and suction catheter, cleaning of the CSC results in significant derangements in lung volume. Therefore, the presence of such a valve should be considered essential in preserving lung volumes and uninterrupted ventilation in mechanically ventilated patients.

Letters to the Editor

9 July 2009 Dear Editor, ENDOTRACHEAL SUCTION CATHETER AS A FOREIGN BODY IN A NEONATE Endotracheal suction is a routinely performed procedure in ventilated infants. Endotracheal suctioning is associated with various complications like bacterial colonization, bronchial perforation and rupture of the catheter.1 We report a case of a cut endotracheal suction catheter acting as a foreign body in the tracheobronchial tree causing acute airway obstruction. A term infant with a birth weight of 3742 g required resuscitation with size 3.5-mm endotracheal tube (Portex Tracheal Tube, Smiths Medical Int Ltd, Hythe, Kent, UK). Closed endotracheal suction catheter was attached to the ET tube (Kimberly-Clark Ballard Trach Care closed suction system for neonates, Ballard Medical, Draper, UT, US) (Fig. 1). The endotracheal tube was cut short to reduce dead space. The tip of the suction catheter was accidentally cut, which migrated down to the tracheobronchial tree. Inspection of the suction catheter revealed the presence of the cut end. The suction catheter was not radio-opaque and was difficult to visualize on the X-ray. With change in contrast of the film, the cut end of the catheter was identified in the right main bronchus. A chest X-ray (Fig. 2) showed the collapse of the right upper lobe. The catheter was removed with a rigid bronchoscope and a 1.8-cm length catheter (distal part of the closed suction system) was removed from the right main bronchus. The baby was successfully extubated within 24 h of the removal of the suction catheter. Tracheobronchial foreign bodies are extremely rare in neonates. In hospitalized infants, the foreign bodies include shearing of plastic sheath of the endotracheal stylet2 and rare cases of rupture of closed endotracheal suction catheters.3 A closed system is used frequently and this becomes part of the ventilatory circuit. Shortening an ETT to a length appropriate for patient use (e.g. a 4.0-mm inner diameter endotracheal tube shortening, from 20.7 to 11.3 cm reduces its resistance by 22%.4) If the ET tube is to be shortened, the suction catheter needs to be withdrawn completely. Visualization of the suction catheter is difficult and care needs to be exercised before any shortening of the ET tubes is attempted. The black mark at the tip of the inline suction suction should be within the dome before cutting. This case highlights the need to exercise care with cutting of the ET tubes especially when an inline suction is attached.

A complication of a closed-tube endotracheal suction catheter

A complication of a closed-tube endotracheal suction catheter

AnIn Vitro Evaluation of the Effectiveness of Endotracheal Suction Catheters

Introduction: Tracheal suction catheters (TSCs) are used to clear mucus from an endotracheal tube (ETT). The clearance rate is critical because airway mucus stasis leads to obstruction, but prolonged catheter suctioning can lead to hypoxemia. The rate of mucus clearance from an ETT is thought to be influenced by the properties of the mucus, the pressure used to suction the mucus, and the diameter of the catheter. In this study, different adult TSCs were evaluated for their ability to suction mucus simulants that had properties similar to airway mucus. Methods: Six different 14F TSC designs were evaluated. All catheters had the same end hole size, but the two side holes were sized at 3 mm, 4 mm, or 5 mm. A coagulant (Polyox Water Soluble Resin Coagulant NF; Dow Chemical Company; Cary, NC) was mixed with water at concentrations of 0.5%, 1.5%, and 3.0% to simulate mucus or sputum. Suction effectiveness was evaluated by the mass percentage of the coagulant suctioned over 10 s at 100 mm Hg from an 8.0 ETT. Measurements and results: The 1.5% and 3.0% simulants had properties comparable to human airway mucus and sputum. Suction effectiveness was less with the 3.0% coagulant simulant compared with the 1.5% and 0.5% simulants. Suction effectiveness was greater (p < 0.01) with TSCs that had nonparallel holes and a side hole diameter of 5 mm when tested with the 1.5% and 3.0% simulants. However, no best catheter could be identified among TSCs when tested with the more liquid-like 0.5% simulant. Conclusions: Greater TSC side hole diameter and nonparallel positioning was important for suctioning mucus simulants that are similar to mucus or sputum. The distance between side holes, end hole size, suction force, and duration of suctioning were not tested but could also have an effect on TSC performance. Introduction: Tracheal suction catheters (TSCs) are used to clear mucus from an endotracheal tube (ETT). The clearance rate is critical because airway mucus stasis leads to obstruction, but prolonged catheter suctioning can lead to hypoxemia. The rate of mucus clearance from an ETT is thought to be influenced by the properties of the mucus, the pressure used to suction the mucus, and the diameter of the catheter. In this study, different adult TSCs were evaluated for their ability to suction mucus simulants that had properties similar to airway mucus. Methods: Six different 14F TSC designs were evaluated. All catheters had the same end hole size, but the two side holes were sized at 3 mm, 4 mm, or 5 mm. A coagulant (Polyox Water Soluble Resin Coagulant NF; Dow Chemical Company; Cary, NC) was mixed with water at concentrations of 0.5%, 1.5%, and 3.0% to simulate mucus or sputum. Suction effectiveness was evaluated by the mass percentage of the coagulant suctioned over 10 s at 100 mm Hg from an 8.0 ETT. Measurements and results: The 1.5% and 3.0% simulants had properties comparable to human airway mucus and sputum. Suction effectiveness was less with the 3.0% coagulant simulant compared with the 1.5% and 0.5% simulants. Suction effectiveness was greater (p < 0.01) with TSCs that had nonparallel holes and a side hole diameter of 5 mm when tested with the 1.5% and 3.0% simulants. However, no best catheter could be identified among TSCs when tested with the more liquid-like 0.5% simulant. Conclusions: Greater TSC side hole diameter and nonparallel positioning was important for suctioning mucus simulants that are similar to mucus or sputum. The distance between side holes, end hole size, suction force, and duration of suctioning were not tested but could also have an effect on TSC performance.

Bronchial complication of a closed-tube endotracheal suction catheter

Iatrogenic bronchial complications in intubated premature infants are rare. The authors present one case of rupture of a closed-tube endotracheal suction catheter. Clinical presentation was a persistent pneumothorax that required chest tube placement in several days. A foreign body was confirmed in x-ray and computed tomography (CT) scan. Flexible bronchoscopy showed a piece of catheter in the left bronchus and using a rigid bronchoscope was possible to remove. No perforation was found. There are a few reports in the literature of iatrogenic bronchial complication in premature infants caused by closed-tube endotracheal suctioning catheters. Endobronchial rupture of this catheter has never been reported. J Pediatr Surg 37:1483-1484. Copyright 2002, Elsevier Science (USA). All rights reserved.

Bronchial perforation after closed-tube endotracheal suction

Iatrogenic bronchial perforation is an uncommon complication in intubated premature infants. The authors present 2 cases of bronchial perforation caused by closed-tube endotracheal suction catheters. These presented in the first 3 days of life with pneumothorax requiring chest tube placement. Medical management was unsuccessful because of the high-volume air leak present and surgical intervention was required. A bronchial perforation of the right lower bronchus was identified in both cases and was repaired in the second case. This represents the first report in the literature of iatrogenic bronchial perforation in premature infants by closed-tube endotracheal suctioning catheters. Bronchial perforation requires early recognition and prompt repair if successful outcome is to be obtained. J Pediatr Surg 35:1353-1335. Copyright © 2000 by W.B. Saunders Company.

The effect of suction catheter insertion and tracheal stimulation in adults with severe brain injury

To determine the effect of suction catheter insertion and tracheal stimulation on cerebrovascular and systemic vascular status in adults with severe traumatic brain injury. Quasi-experimental, within-subject design. Two university-affiliated critical care units. Thirty intubated and mechanically ventilated adults with severe brain injury. The participants' average age was 31 +/- 15 years. Mean intracranial pressure (MICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), and heart rate (HR) were measured. Endotracheal suction catheter insertion with tracheal stimulation was performed. Suction catheter insertion and tracheal stimulation, isolated from other components of the suctioning procedure, significantly increased MICP, MAP, and CPP. HR was not significantly increased. During the application of negative pressure for actual suctioning, MICP and HR significantly increased, whereas MAP and CPP did not significantly change compared with catheter insertion. Tracheal stimulation during suction catheter insertion initiates both cerebrovascular and systemic vascular responses during the suctioning procedure. Study findings suggest that a potentially productive direction for intervention research is to identify ways to minimize airway stimulation during the suctioning procedure.

Bronchial electrocardiography to determine left or right main bronchial placement of an endotracheal suction catheter tip.

To assess the utility of a blue lined angle tipped and electrode tipped catheter, to guide left and right main bronchus cannulation. A prospective study. An 11-bed general intensive care unit in a 900-bed teaching hospital. 50 intubated intensive care patients, in sinus rhythm with normal P and QRS mean frontal axis, who required endobronchial suctioning for routine respiratory management. Endobronchial electrocardiography was used to position a blue lined angle tipped and electrode tipped suction catheter into the right and left main bronchi. Selective cannulation of the left main bronchi was determined by observing a biphasic or inverted P wave in 42 patients, or biphasic or inverted QRS complex in 31 patients. In 8 patients in whom no changes in the ECG were found, bronchoscopic placement of an ECG electrode into the left main bronchus demonstrated a biphasic or inverted P wave in 8 patients and a biphasic QRS complex in 3 patients, confirming the failure to cannulate the left main bronchus in these 8 patients. Using a blue lined, angle tipped and electrode tipped catheter for endotracheal suctioning, endobronchial electrocardiography may be a simple method to signal left or right main bronchus cannulation.

Contamination present within the closed endotracheal suction catheter system (CESC) sheath and comparison of colonization present in patient's trachea

Contamination present within the closed endotracheal suction catheter system (CESC) sheath and comparison of colonization present in patient's trachea

Evaluation of a closed system endotracheal suction catheter

Evaluation of a closed system endotracheal suction catheter