Prolonged Application of Closed In-Line Suction Catheters Increases Microbial Colonization of the Lower Respiratory Tract and Bacterial Growth on Catheter Surface

Freytag, Christiane; Thiès, Frank; König, Wolfgang; Welte, Tobias

doi:10.1007/s15010-002-3066-1

Cited by 47 publications

(17 citation statements)

References 28 publications

(29 reference statements)

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“…Comparison of open-and closedsuction systems suggests that the incidence of ventilatorassociated pneumonia (VAP) is unchanged. [60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78] Popular opinion suggests that by preventing disconnection of the circuit during suctioning, the risk of VAP is reduced, listing this as an important feature of closed-circuit suctioning. Although this is an attractive hypothesis, it has not been specifically studied.…”

Section: Maintaining the Endotracheal Tube Lumenmentioning

confidence: 99%

Management of the Artificial AirwayDiscussion

2014

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Management of the artificial airway includes securing the tube to prevent dislodgement or migration as well as removal of secretions. Preventive measures include adequate humidification and appropriate airway suctioning. Monitoring airway patency and removing obstruction are potentially life-saving components of airway management. Cuff pressure management is important for preventing aspiration and mucosal damage as well as assuring adequate ventilation. A number of new monitoring techniques have been introduced, and automated cuff pressure control is becoming more common. The respiratory therapist should be adept with all these devices and understand the appropriate application and management.

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Section: Maintaining the Endotracheal Tube Lumenmentioning

confidence: 99%

Management of the Artificial AirwayDiscussion

2014

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“…[16][17][18][19] Although it is critical that cleaning of the CSC is performed after suctioning, it is evident from these data that there must be a valve present between the patient's airway and the cleaning chamber to prevent interruption to ventilation and loss of lung volume during this procedure. For the purposes of this study, catheter-cleaning time was standardized to 5 s. In clinical practice, this period may be much longer depending on how thick and tenacious the patient's secretions are and how difficult they are to remove from the catheter.…”

Section: Discussionmentioning

confidence: 99%

Lung Volume Changes During Cleaning of Closed Endotracheal Suction Catheters: A Randomized Crossover Study Using Electrical Impedance Tomography

et al. 2013

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BACKGROUND: Airway suctioning in mechanically ventilated patients is required to maintain airway patency. Closed suction catheters (CSCs) minimize lung volume loss during suctioning but require cleaning post-suction. Despite their widespread use, there is no published evidence examining lung volumes during CSC cleaning. The study objectives were to quantify lung volume changes during CSC cleaning and to determine whether these changes were preventable using a CSC with a valve in situ between the airway and catheter cleaning chamber. METHODS: This prospective randomized crossover study was conducted in a metropolitan tertiary ICU. Ten patients mechanically ventilated via volume-controlled synchronized intermittent mandatory ventilation (SIMV-VC) and requiring manual hyperinflation (MHI) were included in this study. CSC cleaning was performed using 2 different brands of CSC (one with a valve [Ballard Trach Care 72, Kimberly-Clark, Roswell, Georgia] and one without [Portex Steri-Cath DL, Smiths Medical, Dublin, Ohio]). The maneuvers were performed during both SIMV-VC and MHI. Lung volume change was measured via impedance change using electrical impedance tomography. A mixed model was used to compare the estimated means. RESULTS: During cleaning of the valveless CSC, significant decreases in lung impedance occurred during MHI (؊2563 impedance units, 95% CI 2213-2913, P < .001), and significant increases in lung impedance occurred during SIMV (762 impedance units, 95% CI 452-1072, P < .001). In contrast, cleaning of the CSC with a valve in situ resulted in non-significant lung volume changes and maintenance of normal ventilation during MHI and SIMV-VC, respectively (188 impedance units, 95% CI ؊136 to 511, P ‫؍‬ .22; and 22 impedance units, 95% CI ؊342 to 299, P ‫؍‬ .89). CONCLUSIONS: When there is no valve between the airway and suction catheter, cleaning of the CSC results in significant derangements in lung volume. Therefore, the presence of such a valve should be considered essential in preserving lung volumes and uninterrupted ventilation in mechanically ventilated patients.

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“…There are more clinical data available that support non-routine change, and show that the extension of the intervals between catheter changes beyond 24 h is in fact safe [6,7,11]. However, in one study, application of a closed suction system for 72 h enhanced microbial growth on the catheter tip and on the adjacent catheter segment [1]. Yet, most manufacturers still required that their systems be replaced after 1 day.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, after 24 h or more, microorganisms may settle on polymer surfaces and multiply on the catheter. Therefore, the literature is controversial about whether a potential overgrowth of pathogens increases the risk of pulmonary infection [1][2][3]. Like other closed suction systems, it has been recommended that the OptiFlo Ò be changed every 24 h in accordance with the manufacturer's instructions (P.J.…”

Section: Introductionmentioning

confidence: 99%

Experimental Contamination of a Closed Endotracheal Suction System: 24 h vs 72 h

et al. 2008

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Prolonged Application of Closed In-Line Suction Catheters Increases Microbial Colonization of the Lower Respiratory Tract and Bacterial Growth on Catheter Surface

Abstract: Normal saline instillation in conjunction with endotracheal suctioning may lead to a dispersion of microorganisms into the lower respiratory tract. More effective self-cleaning mechanisms are necessary to decontaminate the CISC surface after suctioning.

Cited by 47 publications

References 28 publications

Management of the Artificial AirwayDiscussion

Management of the Artificial AirwayDiscussion

Lung Volume Changes During Cleaning of Closed Endotracheal Suction Catheters: A Randomized Crossover Study Using Electrical Impedance Tomography

Experimental Contamination of a Closed Endotracheal Suction System: 24 h vs 72 h

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