The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

CLINICAL IMPLEMENTATION OF NEURALLY ADJUSTED VENTILATORY ASSIST (NAVA)

author1



Background: NAVA is a new mode of ventilation approved by Health Canada and the FDA that uses the electrical activity of the diaphragm (Edi) to control the timing and magnitude of pressure delivered by the ventilator. A specially formulated naso/orogastric catheter must be inserted to acquire Edi signals. Use of NAVA requires that RNs, RTs, and MDs acquire new competencies to correctly position these catheters and monitor and interpret the resultant Edi signals. St. Michael's Hospital (SMH), a 550-bed inner-city academic, health sciences centre in Toronto, Canada, was the first institution in North America to implement NAVA in clinical practice.

Methods: A working group of physicians (MD), respiratory therapists (RT), and nurses (RN) led the implementation and evaluation of NAVA at SMH. Based on existing literature and expertise acquired from partaking in NAVA research studies, the group developed clinical guidelines and an evaluation tool to assess the process of NAVA utilization in practice and clinician comfort (RN, RT, MD) with NAVA. The group selectively identified patients for NAVA and was physically present to support clinicians in the insertion of NAVA catheters, the interpretation of Edi signals, and the transition from conventional ventilation to NAVA. Plan, Do, Study, Act (PDSA) cycling was utilized to facilitate the incorporation of real-time clinician feedback and clinical observations into the guidelines. As a quality improvement initiative, we collected data on the ease of catheter insertion, detection of the Edi signal, and ability to transition from conventional ventilation to NAVA.

Results: 6/7 patients received sedation during the insertion process. 4 insertions were ranked "extremely easy"; 2 were ranked "somewhat difficult". The mean time for catheter insertion was 7 minutes. 5/7 patients were converted from conventional ventilation (PC or PS) to NAVA. We were unable to transition 2 patients due to signal inadequacy. 3/5 patients experienced asynchrony alarms while on NAVA.

Conclusion: Introducing NAVA in the clinical environment necessitated an inter-professional approach utilizing PDSA methodology. Written resources and on-site support were key to the adoption of the technology by the clinicians and the evaluation tool provided vital feedback on the process leading to meaningful practice-based refinements of the clinical guidelines. Our evaluation is ongoing.