Closed Suction Systems
Ventilator-Associated Pneumonia (VAP)
In-line (closed) suction systems are ideal as they contribute to the reduction of environmental contamination and prevent exposure to respiratory pathogens. Most published clinical practice guidelines for the reduction in ventilator-associated pneumonia (VAP), suggest that in-line catheters do not require routine changes (Hess, 2003). Breaking the ventilator circuit to change an in-line catheter places patients, RRTs and other health care providers at risk. The controversy, therefore, lies in the fact that it is preferable, for infection control purposes, to only change the in-line suction catheter when needed (i.e., visibly soiled, not functioning appropriately) and not routinely breaking the circuit. However, certain manufacturers of in-line suction catheters/systems are now recommending that all in-line suction systems be changed every 24 hours.
Standards related to the practice of routine replacement of in-line suction catheters for mechanically ventilated patients appear to have discrepancies depending on the source being used to support the practice. Most in-line suction products state in their literature that the catheter requires changing every 24 hours. Public Health Agency of Canada (PHAC) does not address the specific issue of routine suction catheter changes. PIDAC suggests that facial protection is routinely required for breaches to the integrity of a mechanical ventilation system which would include changing in-line suction catheters.
References
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