The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

COMPARISON OF SECRETION RETRIEVAL: SINGLE USE CATHETER VS MULTIUSE CATHETER AND SIGH VS MANUAL BREATH

Linda M. Folk RRT-Critical Care Support Services University of Michigan Medical Center, Ann Arbor, Michigan

Introduction: Inline multiuse suction catheters (IMU) have been on the market for over 10 years. While they seem to be beneficial in reducing the risk of unintentional contamination of the patients airway and very likely protecting the healthcare provider, some practitioners feel they are not as efficient at secretion removal as a single use (SU) catheter. The purpose of this study was to evaluate the secretion retrieval capabilities of a SU catheter and IMU catheter. Method: Study Design 1: Ten patients were selected from the Critical Care Medicine Unit of a University Hospital. They were selected based on three criteria: the diagnosis of pneumonia, hemodynamic stability and stable ventilator settings (FIO_{2} < .60 and < = 5 PEEP). Each patient was suctioned every two hours x 4, alternating between the IMU (TrachCare, 14 Fr., Ballard Corp.) and the SU catheter (Davol Suction Catheter, 14-16 Fr., C.R. Bard Inc., Cranston, RI). Each suction session was identical in number of passes, volume of instilled normal saline, FIO_{2} (1.0) and sigh breaths (1.5 times V_{t}). When the patient was suctioned with SU catheter, they were removed from the ventilator during suctioning and returned to the ventilator in-between passes with sigh breaths. Sighs were also used in-between passes when using the IMU. Pulse oximetry was measured on all patients during the procedure. Secretions were collected in identical sputum traps and weighed and measured. Study Design 2: Ten patients were selected as in Study 1. Patients were suctioned every two hours x 4 using only the IMU (Concord Steri-Cath, 14 Fr., Keene, NH) alternating removing the patient from the ventilator, manually ventilating ten times and returning the patient to the ventilator to suction, with sighing the patient ten times in-between passes at 1.5 times the V_{t}. Secretions were collected, weighed and measured in the same manner as study 1. In Study 2, all volumes, pressures and flows were measured with the BICORE C-P 100 Pulmonary Monitor (BICORE Monitoring Systems, Irvine, CA). Results: Study Design 1: All patients tolerated both methods well with no incidences. There was no statistically significant difference between the SU or the IMU catheter in weight or volume (p= .840 and p= .664 respectively). Study Design 2: All patients tolerated this study well with no incidences. There was no statistically significant difference between using the ventilator with sigh breaths or manually ventilating in between passes (p= .095, p= .224 respectively). There was a statistically significant difference in the peak inspiratory pressure (mean 41 ± 9.3 vs 49 ± 6.5 respectively), peak inspiratory flowrate (1.11 l/m ± .16 vs 1.36 l/m ± .13) and inspiratory volume (1.09 ml ± .23 vs .94 ml ± .08) between the two methods (p= .003, p= .003, p=.03 respectively). Conclusion: There is not a statistically significant difference in secretion retrieval when using a SU or IMU or when using manual ventilation or mechanical ventilation with sigh breaths to hyperoxygenate the patient. This would suggest that practitioners do not need to remove patients from mechanical ventilation to suction provided the ventilator has 100% FIO_{2} and sigh capabilities.

OF-97-174

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