COST EFFECTIVENESS OF DECREASING THE FREQUENCY WITH IN-LINE SUCTION CATHETER CHANGES.
Gary J. Hospodar, MA, RRT, RCP, California Pacific Medical Center, San Francisco, California, Howard Levy, MD, PhD, University of New Mexico School of Medicine, Albuquerque, New Mexico.
Case Report: One of the most frequently utilized procedures surrounding mechanical ventilation is endotracheal suctioning. While this care modality is considered routine to the respiratory care practitioner and other healthcare professionals, it remains an essential supportive treatment to providing appropriate patient care. Using the research published in 1997 by Kollef1 as a model, a six-month pilot evaluation was performed in the Medical Intensive Care Unit (MICU) at our university-affiliated teaching institution in 1998. Data that was evaluated included supply cost relationships; ventilator acquired pneumonia (VAP) rates and ventilator days while employing a protocol-driven system of in-line catheter utilization. In early 1998, after review of the literature, a multidisciplinary team was formed that comprised representatives of the medical staff, pulmonary services, infection control and quality improvement departments. An in-line suction catheter protocol was developed with associated monitoring for comparison to previously institutional-based benchmarked infection control VAP data. The hypothesis was that the less often the more critically ill patient ventilator circuit was interrupted, the lower the incidence of acquiring VAP. The frequency was decreased from daily to weekly and as needed as specified by a patient care protocol specific to diagnosis, secretion volume and ventilator settings. The protocol would immediately terminate and revert to pre-study practices if VAP benchmark was exceeded. The study used April 1998 VAP data as benchmark and study period was six months. We found that even with a increase in ventilator days, decreasing the frequency of in-line suction catheter exchanges had a marked impact on operational expense while maintaining or decreasing VAP for a adult critical care unit. Study period expense for the daily in-line catheter exchange was $5,186. Projected expense for the same period is $14,076. Actual study expense minus projected catheter use for the same period demonstrated a 63% reduction or cost savings of $8,890. Actual expense for single-use catheters during the same period was $782. Overall cost-effectiveness may vary based on in-line suction catheter negotiated prices, group purchasing contracts or other sources that address bulk contracting of supplies. Protocol modification to meet existing institutional requirements may further impact program outcomes. We recognize that more research on this topic is required but this pilot analysis supports that elimination of routine suction catheter changes is safe and reduces costs associated with providing mechanical ventilation without negatively impacting patient care outcomes.