1996 OPEN FORUM Abstracts
TWO SURVEYS OF VENTILATOR CIRCUIT CHANGE FREQUENCY: RCP'S RECOMMENDATIONS AND FAMILIES' PRACTICES
T. Nikolai Wilson RRT RPFT, The Children's Medical Center, Dayton, Ohio & Richard D. Branson, RRT. University of Cincinnati Medical Center, Cincinnati, Ohio.
Background: The concern for provision of safe and effective quality health care in an era of cost containment has affected how care in the home is provided. Disposable v entilator circuits are costly. Reduction in home care costs could be achieved with less frequenct circuit changes. Also to be considered is the risk of patient injury during circuit changes and the care giver's time. Recent studies document the safety and cost savings in the hospital environment with ventilator circuit changes at frequencies greater than 48 hours as previously recommended (CDC guidelines). No guidelines currently exist for the frequency of circuit changes in the home environment. Purpose: We developed two surveys in an attempt to determine the patterns related to ventilator circuit change frequency in the home. Methods: Two separate surveys were mailed to home care respiratory therapists through Aequitron Medical's clinician network, and to home ventilator users through The International Ventilator Users Network (IVUN) and The Congenital Central Hypoventilation Syndrome Network (CCHS). In March of 1994, 450 surveys were mailed through the clinician's network. Three hundred and fifty surveys were mailed in May of 1995 and in August of 1995 to the home ventilator users through the IVUN and CCHS network. Results: Valid responses were received from 45/277 (16%) home care therapists. Recommendations for circuit change frequency were as follows: 11 at >5 days to weekly, 13 at every 3 days, 14 at every 2 days and 3 at 2 to 3 times per week. For heated wire circuits, the most frequent recommendation was weekly (6 responses). Valid responses were received from 208/350 (60%) ventilator users or family members. There was no consistency in the frequency of circuit changes in the home. The frequency of ventilator circuit changes ranged from daily to every 3-4 months. One hundred and twenty six respondents reported the use of the invasive positive pressure ventilation. Of this group, the reported frequency of ventilator circuit changes is: QOD (n=21), 3 times per week (n=27) and weekly (n=27). The total number of hospitalizations for both invasive and non-invasive groups within the past twelve months was low: 79% of respondents reported no hospitalizations (164/208), and 13% reported one hospitalizations (26/208) during the previous twelve months. Discussion: The only published guidelines for ventilator circuit changes are for the critical care setting. The validity of application of these standards in the home care arena must be studied and documented. This survey validates the need for controlled clinical trials of less frequent ventilator circuit changes in the home environment. This survey also documents the need for useful guidelines for ventilator circuit change frequency at home. We believe the low number of hospitalizations could indicate that circuit change frequency does not influence infection rate in the home due to decreased chance of nosocomial infection.