Am. J. Respir. Crit. Care Med., Volume 156, Number 2, August 1997, 466-472

Mechanical Ventilation with or without Daily Changes of In-Line Suction Catheters

MARIN H. KOLLEF, DONNA PRENTICE, STEVEN D. SHAPIRO, VICTORIA J. FRASER, PATRICIA SILVER, ELLEN TROVILLION, PAMELA WEILITZ, BENJAMIN VON HARZ, and ROBERT ST. JOHN

Department of Medicine, Pulmonary and Critical Care Division, Division of Infectious Diseases, Washington University School of Medicine, Departments of Respiratory Therapy, Nursing, and Infection Control, Barnes-Jewish Hospital, St. Louis, Missouri

The purpose of this study was to determine the safety and cost-effectiveness of not routinely changing in-line suction catheters for patients requiring mechanical ventilation. Patients were randomly assigned to receive either no routine in-line suction catheter changes (n = 258) or in-line suction catheter changes every 24 h (n = 263). The main outcome measure was the incidence of ventilator-associated pneumonia. Other outcomes evaluated included hospital mortality, acquired organ system derangements, duration of mechanical ventilation, lengths of intensive care and hospital stay, and the cost for in-line suction catheters. Ventilator-associated pneumonia was seen in 38 patients (14.7%) receiving no routine in-line suction catheter changes and in 39 patients (14.8%) receiving in-line suction catheter changes every 24 h (relative risk, 0.99; 95% CI, 0.66 to 1.50). No statistically significant differences for hospital mortality, lengths of stay, the number of acquired organ system derangements, death in patients with ventilator-associated pneumonia, or mortality directly attributed to ventilator-associated pneumonia were found between the two treatment groups. Patients receiving in-line suction catheter changes every 24 h had 1,224 catheter changes costing a total of $11,016; patients receiving no routine in-line suction catheter changes had a total of 93 catheter changes costing $837. Our findings suggest that the elimination of routine in-line suction catheter changes is safe and can reduce the costs associated with providing mechanical ventilation.

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