The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts

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
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.


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