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Use of Closed vs Open Tracheal Suction Catheters: Survey
of User Practice
Mark Siobal BS RRT, Respiratory Care Services, San Francisco
General Hospital, UCSF Dept. of Anesthesia.
Background: Utilization of closed tracheal suction catheters (CTSC) is currently common
practice. Evidence of physiologic benefit, reduced risk of infection,
ease of use, and reduced personnel time support this trend. Higher costs
and user perception of ineffective secretion removal present barriers
to the acceptance of CTSC as a standard of care. Continued use of open
suction catheters promotes the practice of ventilator circuit manipulation
and increases infection risk. To estimate the extent of use and prevalence
of practices that may counter benefits of CTSC, a user survey was conducted.
Methods: A
survey was distributed via email to respiratory care departments in 101
university affiliated and 61 community hospitals in North America. A total
of 38 responses were received.
| Freq. of CTSC use |
All Patients
26 |
Selected Patients
11 |
Not Used
1 |
|
| Freq. of catheter change |
Q 24 hrs
16 |
Q 48 hrs
6 |
³ Q 7 days
9 |
PRN
6 |
| Impact on Ventilator Associated Pneumonia |
Reduced
8 |
Unchanged
12 |
Increased
0 |
Undetermined
17 |
| Perception of effectiveness |
Always Effective
14 |
Often Effective
17 |
Sometimes Effective
4 |
Never Effective
2 |
| Hyperinflation with CTSC |
Always
4 |
Often
5 |
PRN
25 |
Never
3 |
Hyperinflation
method . . . |
Mech Vent.
16 |
Manual Vent.
12 |
Both
5 |
|
| Saline lavage during suction |
Always
7 |
Often
8 |
PRN
22 |
Never
0 |
| Use of open suction |
Often
4 |
PRN
21 |
Never/Rarely
12 |
|
Results: Use
of CTSC is the standard of practice in 68% of the responding facilities.
The majority of sites (59%) change catheters at ² 48 hour intervals. The
impact on ventilator associated pneumonia was reported to be reduced or
unchanged in 54% of the responding sites. User perception of effectiveness
was favorable in 84% of the respondents. User practice of hyperinflation
by disconnection from the ventilator, saline lavage to mobilize secretions,
and reverting to open suction, was prominent (57%, 100%, and 68% of respondents
respectively). Conclusion: The results indicate that despite a high perception
of effectiveness in removal of airway secretions, practices that result
in ventilator circuit manipulation and potential infection risks are common.
Modifications in catheter design and user technique are areas of refinement
that may reduce these practices. Further evaluation of the impact of the
humidification method, hyperinflation technique, use of saline lavage,
and catheter maintenance practices may also be helpful in optimizing use
of the device.
OF-01-183
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