The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

NAVA EDI CATHETER INSERTION BY RESPIRATORY CARE PRACTIONERS IN THE ADULT PATIENT POPULATION

Paul D. Luehrs1, Kelly Joplin1, Jon Scillian1



Background: NAVA (Neurally Adjusted Ventilatory Assist) is a new mode of ventilation offered on the Maquet Servo-i ventilator. NAVA is a mode that uses a specialized naso/orogastric tube (Edi catheter) to detect the electrical activity in the diaphragm. The electrical signal is then used to trigger the ventilator. Historically nursing has been the discipline responsible for the insertion and maintenance of naso/orogastric catheters. After a collaborative meeting to discuss the Edi catheter insertion process our RCPs began insertion the Edi catheter for the purpose of mechanical ventilation.

Methods: The process of inserting the Edi catheter in adult patients includes the typical naso/orogastric catheter procedure along with the Edi catheter-Servo-i ventilator interface procedure. The Edi catheter-Servo-i ventilator interface procedure requires the participation of an RCP familiar with the Edi catheter insertion procedure and placement verification process. Because the RCP is recognized as a competent critical care clinician and the specialized skills needed to verify the Edi catheter placement the nursing respiratory therapy collaboration identified the RCP as the clinician responsible for the Edi catheter insertion. The NEX (nose, esophageal, xiphoid process) method of measuring the approximate depth of catheter insertion is then added to the Edi catheter size co-efficient which equals the Edi catheter depth. Possible complications include: bleeding, esophageal puncture and tracheal catheterization.

Results: Eight patients have had an Edi catheter successfully placed by an RCP. The length of time from beginning of insertion to completion ranges from 5 minutes to 25 minutes based on the difficulty level. Edi catheter inversion was suspected on 2 patients hypothesized as being a result of cardiac sphincter abnormalities or hiatal hernias. The Edi catheter depth calculation was accurate with an average of + 1.5 cm.

Conclusion: Based on our experience inserting placing Edi catheters RCPs are excellent candidates to perform this procedure in the adult population.