2010 OPEN FORUM Abstracts
INITIAL EXPERIENCE WITH REGISTERED RESPIRATORY THERAPISTS PLACING ESOPHAGOGASTRIC TUBES IN ADULT MECHANICALLY VENTILATED PATIENTS.
Richard G. Stairhime, Daniel D. Rowley, Linda L. Clarke, Frank J. Caruso; Pulmonary Diagnostics & Respiratory Therapy Services, University of Virginia Medical Center, Charlottesville, VA
BACKGROUND: Advanced respiratory physiologic monitoring and improved patient-ventilator synchrony are possible with insertion of a specialized esophagogastric sensing and monitoring catheter (EC). The catheter detects phrenic nerve action potentials that result in cyclic diaphragm myofiber depolarization. Correct placement of the EC requires competency and skill with inserting EC catheters, significant knowledge of ventilator modes, and understanding of scalar graphic waveforms. Registered respiratory therapists (RRT) clinical skill sets and knowledge in diagnostics and mechanical ventilation make them an appropriate group for expanding clinical responsibilities to include EC insertion. METHODS: Senior level RRTs were trained to insert ECs and to verify optimal placement in mechanically ventilated adult patients by completing a didactic educational package and undergoing observed, demonstrated competency. Catheter placement assignment was random based upon availability of senior level RRT and physician staff. A retrospective chart review was performed to evaluate catheter insertion success in adult ICU patients receiving mechanical ventilation within a 600 bed academic medical facility. RESULTS: 38 catheter insertions were attempted with 37 successful insertions. Of the 37 successful catheter insertions, 24 were inserted by RRTs and 13 by physicians. RRTs had a 70.8% first attempt success rate versus 53.8% for physicians. Mean time to insertion was 10.2 minutes for RRTs compared to 9.2 minutes for physicians. Time to insertion ranged from less than 5 minutes to greater than 60 minutes. The single unsuccessful insertion was attempted by a physician who failed on three successive tries. Failure may have resulted from the catheters marked flexibility. No patient complications were identified in any of these insertion attempts. CONCLUSION: Registered Respiratory Therapists can successfully and safely insert ECs in adult patients. Procedure time and insertion success may improve with increased catheter stiffness or development of an introducer wire. Sponsored Research - None