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The Influence of Suction Catheter Tip Design on Tracheobronchial Trauma and FIuid Aspiration Efficiency

WILLIAM J. LINK, PhD^*, EDMUND E. SPAETH, PhD, WILLIAM M. WAHLE, MD, WILLIAM PENNY, MS, and JOHN L. GLOVER, MD^||

*Assistant Professor. Department of Surgery, Marion County General Hospital, Indiana University Medical Director, Hospital Group, Applied Research, American Hospital Supply Corporation, Glendale, California. Assistant Professor, Department of Pathology, Marion County General Hospital, Indiana University Medical Center. Senior Analyst, Hospital Group, Applied Research, American Hospital Supply Corporation. ||Professor, Department of Surgery, Marion County General Hospital, Indiana University Medical Center.

Abstract

The suctioning efficiency and trauma-producing characteristics of five commercially available tracheobronchial suction catheters (Pharmaseal Tri-Flo, NCC Gentle-No, Argyle Aero-Flo, Argyle Dual Side-Hole, and Pharmaseal Whistle-Tip) were experimentally evaluated in anesthetized healthy dogs. The tendency of catheters to invaginate or "grab" tracheobronchial mucosa was observed with a broncho-fiberscope during suctioning. Mucosal grabbing was seldom seen even at high (> 300 torr) vacuum levels with the catheter tip in the trachea. All catheters were observed to invaginate mucosa in lobar and segmental bronchi, with the frequency of grabbing being a function of airway anatomy, airway size, catheter orientation, tip design, and vacuum level. Catheters with multiple side-holes appeared to invaginate mucosa less frequently than the single side-hole catheter.

Repeated suctioning of anesthetized healthy dogs followed by tracheobronchial excision, gross observation, and histologic examination of mucosal tissue biopsies demonstrated significant differences in the frequency and sererity of lesions caused by the tracheobronchial suction procedure. All catheters were observed to damage airway lining, the damage related to multiple side-hole catheters appearing to be associated entirely with the act of catheter insertion and not with the application of vacuum. Only the Whistle-Tip design produced measurable damage beyond that related to catheter insertion.

The average tip-suctioning effectiveness for each catheter, determined in vitro by aspirating a thin, uniform layer of simulated mucus, was found to be significantly higher for the Tri-Flo and Whistle-Tip catheters than the others, the Aero-Flo being least effective. Preliminary attempts to demonstrate this difference in suctioning effectiveness by comparing the performance of the catheters which displayed the highest and lowest tip suction effectiveness in a standardized clinical suctioning procedure revealed no significant difference in the percentage of mucus removed by either catheter. Additional studies should clarify this apparent contradiction.

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				S. Shah, K. Fung, S. Brim, and B. K. Rubin An In Vitro Evaluation of the Effectiveness of Endotracheal Suction Catheters Chest, November 1, 2005; 128(5): 3699 - 3704. [Abstract] [Full Text] [PDF]