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.

This article has been cited by other articles:

				R. G. Masterton, A. Galloway, G. French, M. Street, J. Armstrong, E. Brown, J. Cleverley, P. Dilworth, C. Fry, A. D. Gascoigne, et al. Guidelines for the management of hospital-acquired pneumonia in the UK: Report of the Working Party on Hospital-Acquired Pneumonia of the British Society for Antimicrobial Chemotherapy J. Antimicrob. Chemother., July 1, 2008; 62(1): 5 - 34. [Abstract] [Full Text] [PDF]

				I. I. Siempos, K. Z. Vardakas, and M. E. Falagas Closed tracheal suction systems for prevention of ventilator-associated pneumonia Br. J. Anaesth., March 1, 2008; 100(3): 299 - 306. [Abstract] [Full Text] [PDF]

				M. A. Seckel Ask the Experts Crit. Care Nurse, February 1, 2008; 28(1): 65 - 66. [Full Text] [PDF]

				L. Lorente, S. Blot, and J. Rello Evidence on measures for the prevention of ventilator-associated pneumonia Eur. Respir. J., December 1, 2007; 30(6): 1193 - 1207. [Abstract] [Full Text] [PDF]

				S. M. Koenig and J. D. Truwit Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention Clin. Microbiol. Rev., October 1, 2006; 19(4): 637 - 657. [Abstract] [Full Text] [PDF]

				T. W. Rice and J. P. Maloney Nutrition and Lung Disease Nutr Clin Pract, December 1, 2004; 19(6): 547 - 549. [Full Text] [PDF]

				P. Dodek, S. Keenan, D. Cook, D. Heyland, M. Jacka, L. Hand, J. Muscedere, D. Foster, N. Mehta, R. Hall, et al. Evidence-Based Clinical Practice Guideline for the Prevention of Ventilator-Associated Pneumonia Ann Intern Med, August 17, 2004; 141(4): 305 - 313. [Abstract] [Full Text] [PDF]

				M. L. Sole, J. F. Byers, J. E. Ludy, Y. Zhang, C. M. Banta, and K. Brummel A Multisite Survey of Suctioning Techniques and Airway Management Practices Am. J. Crit. Care., May 1, 2003; 12(3): 220 - 230. [Abstract] [Full Text] [PDF]

				M. L. Sole, J. F. Byers, J. E. Ludy, and C. L. Ostrow Suctioning Techniques and Airway Management Practices: Pilot Study and Instrument Evaluation Am. J. Crit. Care., July 1, 2002; 11(4): 363 - 368. [Full Text] [PDF]

				M. L. Sole, F. E. Poalillo, J. F. Byers, and J. E. Ludy Bacterial Growth in Secretions and on Suctioning Equipment of Orally Intubated Patients: A Pilot Study Am. J. Crit. Care., March 1, 2002; 11(2): 141 - 149. [Abstract] [Full Text] [PDF]

				Members of the Task Force:, E. Bouza, C. Brun-Buisson, J. Chastre, S. Ewig, J-Y. Fagon, C.H. Marquette, P. Munoz, M.S. Niederman, L. Papazian, et al. Ventilator-associated pneumonia: European Task Force on ventilator-associated pneumonia Chairmen of the Task Force: A. Torres and J. Carlet Eur. Respir. J., May 1, 2001; 17(5): 1034 - 1045. [Full Text] [PDF]

				M. H. Kollef and V. J. Fraser Antibiotic Resistance in the Intensive Care Unit Ann Intern Med, February 20, 2001; 134(4): 298 - 314. [Abstract] [Full Text] [PDF]

				A. F. Shorr and P. G. O'Malley Continuous Subglottic Suctioning for the Prevention of Ventilator-Associated Pneumonia : Potential Economic Implications Chest, January 1, 2001; 119(1): 228 - 235. [Abstract] [Full Text] [PDF]

				M. H. Kollef, N. J. Skubas, and T. M. Sundt A Randomized Clinical Trial of Continuous Aspiration of Subglottic Secretions in Cardiac Surgery Patients Chest, November 1, 1999; 116(5): 1339 - 1346. [Abstract] [Full Text] [PDF]

				M. H. Kollef The Prevention of Ventilator-Associated Pneumonia N. Engl. J. Med., February 25, 1999; 340(8): 627 - 634. [Full Text] [PDF]

				K. Little As needed in line suction catheter changes were as safe as and less expensive than daily scheduled catheter changes during mechanical ventilation Evid. Based Nurs., July 1, 1998; 1(3): 82 - 82. [Full Text]