2003 OPEN FORUM Abstracts
COMPARING THE USE OF NASOPHARYNGEAL SUCTION (NPS) WITH A CATHETER VS OLIVE-TIP DEVICE (OTD) IN SUCTIONING BRONCHIOLITIS PATIENTS AT TWO REGIONAL MEDICAL CENTERS IN UTAH.
Kim Bennion BS RRT, Julie Ballard BS RRT, Scott Daniel RRT, and Debbie Forbush BS CRT. Respiratory Care Services, Dixie Regional Medical Center (DRMC), St. George, Utah and Primary Children's Medical Center, Salt Lake City, UT.
Introduction: Our facility is a 150-bed regional medical center of the Intermountain Health Care Corporation (IHC), which operates 22 acute care facilities in the intermountain west. Our sister hospital, Primary Children's Medical Center (PCMC), had utilized a bronchiolitis clinical practice guideline (CPG) for seven years and had subsequently reported a decrease in albuterol use, oxygen need and patient respiratory distress symptoms.1,2,3 Although the CPG specified utilizing the NPS technique of suctioning with a catheter inserted into the hypopharynx, it was our impression that using an OTD which uses suction but does not advance into the hypopharynx would be as effective. We sought to compare outcomes of OTD and NPS catheter techniques.
Methods: The CPG was defined by a standing admission order sheet (SAO). The Bronchiolitis Score (BS), a respiratory symptom-based scoring system, was based on respiratory rate, breath sounds and retractions, each being scored on a scale of 0-3. Scores were described for respiratory distress as: 0-1 normal, 2-3 mild, 4-6 moderate and 7-9 severe. The mainstays of care were identified as hydration, NPS with a catheter all the way into the hypopharynx, oxygenation and the utilization of an inhaled medication only if deemed effective after a treatment (tx) trial. A tx trial is comprised of a baseline score, NPS with a catheter, post suction score 10-15 minutes post suction, and an inhaled medication tx with a score 10-15 minutes post tx. An improvement was defined as a decrease in the score by > 1 from pre- to post-intervention (suction or tx). Data on suction interventions and scores were extracted from our data systems. Inclusion criteria were: (1) primary diagnosis of bronchiolitis, (2) age < 24 months, (3) suctioned at sometime during their stay and (4) a complete set of scores (baseline and post suction). Patients were scored according to whether or not their scores improved, remained unchanged or worsened after each suctioning episode.
RESULTS: Outcomes for the use of the OTD at DRMC versus the catheter technique at PCMC are reported in Table 1. There was a significant difference between the DRMC and PCMC results (P <0.0001).
CONCLUSION: Suctioning with the OTD did not replicate the results found with the catheter technique. NPS suctioning with a catheter into the hypopharynx appears to be a superior technique when compared to the OTD when suctioning bronchiolitis patients.
1Respir Care (abstract), Zemlicka-Dunn, 2001;46:1071
2Respir Care (abstract), McKinley, 2001;46:1071
3Respir Care (abstract), Bennion, 2001;46:1072
Table 1: Suctioning outcomes with Nasal OTD and NPS catheter
|Suctioning Outcome||DRMC # (%) OTD||PCMC # (%) Catheter|
|Improved||201 (26)||1080 (60)|
|No Change||478 (63)||664 (37)|
|Worse||81 (11)||45 (3)|
|Total # Suctioning Episodes||760 (100)||1789 (100)|