1996 OPEN FORUM Abstracts
A PROSPECTIVE RANDOMIZED TRIAL OF MECHANICAL VENTILATION WITH DAILY IN-LINE SUCTION CATHETER CHANGES VERSUS NO ROUTINE IN-LINE SUCTION CATHETER CHANGES.
Marin H. Kollef M. D., Donna Prentice MSN, Steven D. Shapiro M. D., Patricia Silver MEd, Darnetta Baker-Clinkscale MBA, Benjamin Von Harz RRT. Pulmonary and Critical Care Division, Washington University School of Medicine; and Departments of Nursing and Respiratory Therapy, Barnes-Jewish Hospital, St. Louis, MO.
Background: Current medical practice requires the daily changing of in-line suction catheters for patients receiving mechanical ventilation (MV). However, the need for daily in-line suction catheter changes has never been prospectively validated, subjects patients to daily disruptions of their ventilator circuit, and may represent a needless cost. Therefore, we performed a prospective, randomized, controlled trial comparing patients receiving daily in-line suction catheter changes to no routine in- line suction catheter changes. Method: Patients were randomized at the start of mechanical ventilation to receive either daily in-line suction catheter changes versus no routine changes. The main outcome measure was the occurrence of ventilator- associated pneumonia (VAP). Secondary outcomes included hospital mortality, duration of mechanical ventilation, and hospital length of stay. Results: To date, 283 patients have been enrolled in the study. Patient demographics, severity of illness using APACHE II, and outcomes were similar between the two study arms.
Variable No Routine Daily P-Value
(n = 138) (n = 145)
Age, yr: 58.6 ± 20.5 57.4 ± 20.1 0.621
Male/Female 75/63 69/76 0.255
APACHE II Score: 17.0 ± 7.2 17.2 ± 7.1 0.792
VAP, n (%): 17(12.3) 19(13.1) 0.843
Mortality, n(%): 33(23.9) 36(24.8) 0.858
Changes: 0.3 ± 0.9 3.4 ± 5.9 < 0.001
MV, days: 4.3 ± 6.3 4.5 ± 7.1 0.716
of Stay, days: 11.9 ± 10.2 13.5 ± 10.8 0.211
Conclusions: A practice of no routine in-line suction catheter changes is safe and reduces the number of ventilator circuit disruptions. We estimate that a policy of no routine in-line suction catheter changes will result in a cost savings of $54,000 per year at our hospital. We recommend that in-line suction catheters only be changed if they are visibly soiled or develop mechanical malfunction.