Determinants of Successful Selective Tracheobronchial Suctioning

Haberman, Paul B.; Green, Joseph P.; Archibald, Carol; Dunn, Deon L.; Hurwitz, Sheldon R.; Ashburn, William L.; Moser, Kenneth Μ.

doi:10.1056/nejm197311152892004

Cited by 16 publications

(5 citation statements)

References 3 publications

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“…This deficiency in catheter design may be explained by the less than ideal torque properties of most suction catheters. Haberman et al (1973) have already indicated that repositioning failures are due to the inability of the operator to apply controlled torque to the catheter. Perhaps the increased torque control that ideally should be designed into catheters would guard against the potential hazard of kinking.…”

Section: Discussionmentioning

confidence: 99%

“…Even in infants, in whom the left and right main bronchi diverge from the trachea at almost equal angles, Bush (1963) observed that a straight catheter entered the right main bronchus far more commonly than the left. Haberman et al (1973) have developed some practical guidelines that maximise the change of aspirating the left main bronchus. They recommended the use of angletipped catheters that had been packed straight rather than coiled, and that orotracheal rather than nasotracheal tubes be used.…”

mentioning

confidence: 99%

“…We have used many of the guidelines suggested by Haberman et al (1973) for catheterising the left main bronchus in a large number of patients. Our success rate was similar to that in previous studies and our experience has encouraged us to propose a further recommendation related to the length of catheters.…”

mentioning

confidence: 99%

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Selective tracheobronchial aspiration.

Scott¹,

Sandham²,

Rěbuck³

1977

Thorax

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(1959) found that an angulated catheter entered the left main bronchus through a tracheostomy tube far more readily than a straight catheter. Straight plastic catheters seldom entered the left bronchus regardless of the patient's head position (Kirimli et al., 1970). Even in infants, in whom the left and right main bronchi diverge from the trachea at almost equal angles, Bush (1963) observed that a straight catheter entered the right main bronchus far more commonly than the left. Haberman et al. (1973) have developed some practical guidelines that maximise the change of aspirating the left main bronchus. They recommended the use of angletipped catheters that had been packed straight rather than coiled, and that orotracheal rather than nasotracheal tubes be used. They also suggested that the patient's head should be turned to the right during catheter insertion. In 24 patients they had a 46% success rate in entering the left main bronchus, their successes increasing to over 60% in those patients with tracheostomies.We have used many of the guidelines suggested by Haberman et al. (1973) for catheterising the left main bronchus in a large number of patients. Our success rate was similar to that in previous studies and our experience has encouraged us to propose a further recommendation related to the length of catheters. Material and methodsForty-one patients in the Respiratory Intensive Care Unit were studied, 15 with tracheostomies and 26 with orotracheal tubes. The catheters were washed through with a radio-opaque solution, Lipiodol-Lafay (Denver Laboratories (Canada Limited)) for visualisation on the chest film. A total of 40 insertions was made on each group of patients, 20 with straight catheters and 20 with angled catheters.Intensive care unit nurses performed the aspirations. Specific attempts were made to place the catheter in the left main bronchus using catheter manipulation. In view of the minimal improvement reported by Haberman when turning the head to the contralateral side, this procedure was not followed. Initially the catheter was advanced until a resistance was met. A chest radiograph was then taken to determine the position of the catheter. All patients tolerated the procedure well.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Selective tracheobronchial aspiration.

Scott¹,

Sandham²,

Rěbuck³

1977

Thorax

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“…Left lung atelectasis and pneumonia may occur in intubated patients if secretions are not removed from the left main stem bronchus. 54 It is difficult to perform selective left endobronchial suctioning because of the more acute branching angle of the left main stem bronchus. 55 A new technique has recently been developed that identifies the location of the endobronchial suction catheter by listening to the sounds produced during suctioning.…”

Section: Selective Bronchial Suctioning Guided By Differential Ausculmentioning

confidence: 99%

Practical Applications of Lung Sounds Research

Krumpe¹

1985

Semin Respir Crit Care Med

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“…When these devices were put into general use, secretion management protocols had been standardized but, nevertheless, constituted a dangerous practise. In the early days of mechanical ventilation, suctioning induced hypoxia (Bartlett & Finegold, 1978; Good, Wolz, Anderson, Dreisin & Petty, 1979; Haberman et al ., 1973), arrhythmia (Freedman & Goodman, 1982; Kubota et al ., 1980), and cardiac arrest (Kubota et al ., 1982). Pneumonia often resulted from insufficient left brachial tree suctioning (Hart & Mahutte, 1992).…”

Section: Introductionmentioning

confidence: 99%

Closed suctioning system: Critical analysis for its use

Harada

2010

Japan Journal Nursing Sci

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Aim: To determine the efficacy and effectiveness of the closed suctioning system. Method: Literature review articles were accessed from the following databases: PubMed, EMBASE, CINAHL, and Cochrane Library. The literature review criteria included: all publication styles except meta-analysis, participants that were Ն18 years, written in English, and published between 1973 and 2008. Results: This literature review revealed that the efficacy and effectiveness of the closed suctioning system remains to be demonstrated. The device manufacturers' studies focused on cost reduction, crosscontamination, and preservation of the oxygen saturation of patients during endotracheal suctioning; however, the clinical studies focused on the use of closed suctioning systems to prevent ventilator-associated pneumonia. The reviewed studies had small sample sizes with heterogeneous demographics and nonrandomized controls. Recent studies suggest that closed suctioning systems are no better than open suctioning systems in terms of mortality, morbidity, or the cost-benefit ratio. A few studies did indicate that the closed suctioning system might reduce the loss of lung volume and oxygen desaturation. Conclusion:The studies reviewed in this article suggest that the evidence on the efficacy and effectiveness of closed suctioning systems is inconclusive. Only limited populations will benefit clinically from the use of this device. There is a need for further studies with randomized controlled trials to explore the use of closed suction systems and to update current clinical practise guidelines.

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Determinants of Successful Selective Tracheobronchial Suctioning

Cited by 16 publications

References 3 publications

Selective tracheobronchial aspiration.

Selective tracheobronchial aspiration.

Practical Applications of Lung Sounds Research

Closed suctioning system: Critical analysis for its use

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