Examining the Benefits of Less Frequent In-line Suction Catheter Changes

Purpose:
The Purpose of this evidence-based practice (EBP) project was to examine practices related to the frequency of changing in-line suction catheters on ventilated patients with a focus on patient safety and cost effectiveness.

Significance:
Mechanically ventilated patients are 6 to 21 times more susceptible for ventilated associated pneumonia (VAP). The institution's practice was daily in-line suction catheter changes at an average cost of $23,000 per month.

Strategy and Implementation:
Three studies were reviewed in addition to a review of the guidelines set forth by the AACN. The review revealed that less frequent catheter changes provides safe patient care, while reducing the overall patient and hospital costs. In fact, less frequent changes have been shown to decrease the avenue for bacterial transmission. The Infection Control Committee and additional skilled intensive care nurses reviewed the findings and a three-month trial was approved by the ICU committee and conducted on two critical care units. During this time, the practice of catheter changes was decreased from daily to weekly. The trial spanned from March through May 2009 and included all intubated and mechanically ventilated patients from the two critical care units. Education was provided to staff through email, flyers, and face-to-face instruction. Routine quality data was collected and was then compared to the three months prior to the study where daily suction catheter changes had occurred.

Evaluation:
Three months prior to the trial period included 1,801 ventilator days, while the trial months consisted of 2,618 ventilator days. Quality data showed three patients had acquired VAP during the trial period; whereas the previous three months showed VAP occurred in four patients.

Implications for Practice:
Results of this trial indicated that less frequent changes of in-line suction catheter was not only cost effective, but a safe alternative. The policy was changed to weekly suction catheter changes. One implication is that less frequent in-line suction catheter changes may reduce VAP cases.