Techniques Closed Suction Influence on Oxygen Saturation In Patients Using Mechanical Ventilation In Intensive Care Unit Room

@#Introduction: The problem in patients who are intubated with endotracheal tube is the occurrence of accumulation of secretions. One of the actions to reduce the secretion is closed suction. This research monitors the patient's oxygensaturation and also reveals the effect of closed suction on oxygen and AaDO2 saturation (alveolar-arterial oxygen difference) in patients who were mechanically ventilated in the Intensive Care Unit (ICU) of Dr. Kariadi Hospital. The design of this study uses pre experiment. Methods: The research process has been carried out on April 2, 2019 until May 26, 2019 in the Intensive Care Unit with a total sampling technique, on 15 respondents. Result: The results of the study showed that there was effect of closed suction technique on the value of oxygen saturation in patients with mechanical ventilation (p-value = 0.010). Conclusion: Closed suction can lead to decrease of air volume in the lungs up to 1200 ml. So hyperoxygenation must be done before closed suction as it can reduces the incidence of hypoxemia by 49%. Before closing the suction, it is recommended to do hyperoxygenation.

Drain tip culture following total knee arthroplasty.

Background: Placing a suction drain following total knee replacement is usual practice which is been followed by many surgeons. Closed suction drainage following arthroplasty is a routine with the aim of preventing wound hematoma and thereby reducing the risk of infection. Surgical site infections (SSI) in orthopaedic surgeries are disastrous and often lead to significant morbidity and mortality. Usefulness of drain tip culture in predicting the wound infection is been tested but results are controversial. Methods: It is a prospective study of 546 drains (352 patients) who underwent unilateral or bilateral Total Knee Arthroplasty (TKA). The drain tip was sent for culture at the time of removal. Cultures from the SSI were also collected. Cases that had at least six months of follow up were included in the study. Results: Drain tip culture was positive in total of 18 patients. Three patients had developed deep infection and 10 patients had superficial infection. All three patients with deep infection and 9 out of 10 patients of superficial infection were drain tip culture positive. Out of 9 culture positive superficial infections, one had different bacteria identified from the wound site. Drain tip culture was positive in 3.39% of drains and infection (wound culture) was positive in 2.26% of wounds. On statistical analysis we found drain tip culture has sensitivity of 91.66%, specificity of 98.64%, positive predictive value of 61.11% and negative predictive value of 99.8%. Conclusion: Drain tip culture positivity helps in predicting the future chance of developing the infection. If drain tip culture is negative, then there is almost near nil chances of infection.

Comparison between autologous blood transfusion drainage and closed-suction drainage/no drainage in total knee arthroplasty: a Meta-analysis / 实用医学杂志

Objective To assess the clinical efficiency , safety and potential advantages of autologous blood transfusion (ABT) drains compared with the closed-suction/no drainage. Methods Pubmed, Embase, Cochrane Library, CBMdisc, CNKI, VIP and WANGFANG were searched comprehensively. The statistical anal-ysis was conducted by using the Cochrane Collaboration review Manager 5.3.5. Results The pooled data of seventeen RCTs including a total of 1 993 patients showed that the patients in the ABT drainage group might benefit from the low rate of blood transfusion [ 16 . 59% and 37 . 47%, OR: 0 . 28 ( 0 . 14 ~ 0 . 55 ); 13 . 05% and 16.91%, OR: 0.73 (0.47 ~ 1.13), respectively]. The ABT drainage and the closed-suction drainage/no drainage have the similar clinical efficiency and safety length of hospital stay and wound infection on days 3 post-operative haemoglobin. Conclusion This systematic review provides the evidence that the ABT drainage offers a safe and efficient alternative to CS/no drainage with the lowered blood transfusion rate.

A Closed-Suction Catheter with a Pressure Valve Can Reduce Tracheal Mucosal Injury in Intubated Patients / 대한구급학회지

BACKGROUND: Endotracheal suctioning is associated with complications that include bleeding, infection, hypoxemia, cardiovascular instability, and tracheal mucosal injury. Recently, a closed-suction catheter with a pressure valve (Acetrachcare, AceMedical Co., Republic of Korea) was developed. We hypothesized that this new catheter might reduce tracheal mucosal injury compared to a conventional closed-suction catheter (Trachcare, Kimberly-balla RD, USA). METHODS: This prospective, randomized study enrolled medical and surgical patients who required mechanical ventilation for more than 48 hours. Patients were randomized into two groups: one group was suctioned with the conventional closed-suction catheter (CCC) and the other group was suctioned with the closed-suction catheter with pressure valve (CCPV). Bronchoscopy was performed 48 hours later, and the severity of tracheal mucosal injury was graded on a 5-point scale, as follows: 0 = normal; 1 = erythema or edema; 2 = erosion; 3 = hemorrhage; and 4 = ulceration or necrosis. RESULTS: A total of 76 patients (37 with CCPV and 39 with CCC) were included. There were no significant differences between the groups regarding demographic characteristics, changes in hemodynamic parameters during suction, incidence of pneumonia, length of intensive care unit (ICU) stay, or ICU mortality. On bronchoscopic evaluation, the use of the CCPV led to a significant decrease in tracheal mucosal injury (median tracheal mucosal injury grade 1 [IQR 0-1] vs. 2 [IQR 1-3], p = 0.001). CONCLUSIONS: We conclude that the novel closed-suction catheter with pressure valve may reduce tracheal mucosal injury compared to conventional catheters.

Comparative analysis of the amount of postoperative drainage after intraoral vertical ramus osteotomy and sagittal split ramus osteotomy

OBJECTIVES: The purpose of this retrospective study was to compare the amount of postoperative drainage via closed suction drainage system after intraoral vertical ramus osteotomy (IVRO) and sagittal split ramus osteotomy (SSRO). MATERIALS AND METHODS: We planned a retrospective cohort study of 40 patients selected from a larger group who underwent orthognathic surgery from 2007 to 2013. Mean age (range) was 23.95 (16 to 35) years. Patients who underwent bilateral IVRO or SSRO were categorized into group I or group II, respectively, and each group consisted of 20 patients. Closed suction drainage system was inserted in mandibular osteotomy sites to decrease swelling and dead space, and records of drainage amount were collected. The data were compared and analyzed with independent t-test. RESULTS: The closed suction drainage system was removed at 32 hours postoperatively, and the amount of drainage was recorded every 8 hours. In group I, the mean amount of drainage was 79.42 mL in total, with 31.20 mL, 19.90 mL, 13.90 mL, 9.47 mL, and 4.95 mL measured at 0, 8, 16, 24, and 32 hours postoperatively, respectively. In group II, the mean total amount of drainage was 90.11 mL, with 30.25 mL, 25.75 mL, 19.70 mL, 8.50 mL, and 5.91 mL measured at 0, 8, 16, 24, and 32 hours postoperatively, respectively. Total amount of drainage from group I was less than group II, but there was no statistically significant difference between the two groups (P=0.338). There was a significant difference in drainage between group I and group II only at 16 hours postoperatively (P=0.029). CONCLUSION: IVRO and SSRO have different osteotomy design and different extent of medullary exposure; however, our results reveal that there is no remarkable difference in postoperative drainage of blood and exudate.

Closed-Suction Drainage and Cerebrospinal Fluid Leakage Following Microvascular Decompression : A Retrospective Comparison Study

OBJECTIVE: We performed this study to investigate whether the use of closed-suction drainage following microvascular decompression (MVD) causes cerebrospinal fluid (CSF) leakage. METHODS: Between 2004 and 2011, a total of 157 patients with neurovascular compression were treated with MVD. MVD was performed for hemifacial spasm in 150 (95.5%) cases and for trigeminal neuralgia in 7 (4.5%) cases. The mean age of the patients was 49.8+/-9.6 years (range, 20-69). Dural substitutes were used in 44 (28.0%) patients. Ninety-two patients (58.6%) were underwent a 4-5 cm craniotomy using drainage (drainage group), and 65 (41.4%) did a small 2-2.5 cm retromastoid craniectomy without closed-suction drainage (no-drainage group). RESULTS: Eleven (7.0%) patients experienced CSF leakage following MVD based on the criteria of this study; all of these patients were in the drainage group. In the unadjusted analyses, the incidence of CSF leakage was significantly related with the use of closed-suction drainage following MVD (12.0% in the drainage group vs. 0% in the no-drainage group, respectively; p=0.003; Fisher's exact test). Those who received dural substitutes and the elderly (cut-off value=60 years) exhibited a tendency to develop CSF leakage (p=0.075 and p=0.090, respectively; Fisher's exact test). In the multivariate analysis, only the use of closed-suction drainage was significantly and independently associated with the development of CSF leakage following MVD (odds ratio=9.900; 95% confidence interval, 1.418 to infinity; p=0.017). CONCLUSION: The use of closed-suction drainage following MVD appears to be related to the development of CSF leakage.

Nursing of patients with acute respiratory distress syndrome receiving constant small amount of continuous airway humidification and closed suction method for prevention of sputum formation / 中国实用护理杂志

Objective To investigate the effect of constant small amount of continuous airway humidification and closed suction method to prevent sputum formation of patients with acute respiratory distress syndrome. Methods 115 cases with acute respiratory distress syndrome were randomly divided into the observation group (60 cases)and the control group (55 cases).The observation group was given small amount of constant continuous airway humidification and closed suction method.The control group was given open suction and intermittent airway humidification.The treatment effect was compared between the two groups. Results 24 h after intubation,difference of sputum viscosity between the two groups was not significant.72 h and 120 h after intubation,sputum viscosity of the control group was significantly higher than the observation group.In the sputum formation,24 h,72 b and 120 h after intubation,the control group was significantly higher than the observation group.At the end of suction,and 1 min,3 min,5 min after the suction,the oxygen saturation degree of the observation group was significantly higher than the control group.Whatever in the process of humidification or suction,the incidence of adverse reactions in the observation group was significantly lower than the control group,the difference was obvious. Conclusions Combination of constant small amount of continuous airway humidification and closed suction method can effectively reduce the sputum formation of patients with acute respiratory distress syndrome,which is worthy of clinical promotion.

Comparison of the Pattern in Semi-Quantitative Sputum Cultures Based on Different Endotracheal Suction Techniques / 대한구급학회지

BACKGROUND: The endotracheal suction was one of the critical requirements for severe neurosurgical patients in the prevention of the airway-obstruction, pneumonia, atelectasis, and so on. There were two types of suction methods, closed and open. In the literature, many reported the comparison of the two methods with variable factors, yet, it was still controversial. In this study, we compared the two types of endotracheal suction methods based on the pattern of the sputum cultivation, which was not discussed in the previous studies. METHODS: In 2010, 85 patients who had intubation tube for more than 10 days were evaluated in this study. A total of 55 patients were managed with an open suction method, while the other 30 patients were managed with a closed suction method. All patients' sputum culture was reported semi-quantitatively, and had been classified into 3 different groups, according to the culture pattern. The control group was defined in which the bacterial count was not increased, whereas the non-control group was those with bacterial count increased. We investigated patients' age, gender, disease-type, suction techniques and the pattern of sputum cultivation. RESULTS: The non-control group was 45.45% in the open suction group, while it was 16.67% in the closed suction group. On the other hand, more control group was observed in the closed suction group (36.67%), than in the open suction group (25.45%) (p < 0.05). There was no statistically significant difference in the analysis based on the pattern of sputum cultivation, age, gender, and disease-type. CONCLUSIONS: We suggest that the closed suction methods were more effective in the management of endotracheal tube, according to the pattern of sputum culture.

A Comparison of the Opened Versus Closed-System of Suctioning : In Oxygen Saturation, Vital Signs and Suction Time / 성인간호학회지

PURPOSE: The purpose of this study was to compare the difference of change in oxygen saturation, vital signs and suction time taken for the suctioning during endotracheal suctioning performed with closed suction system and with opened suction system. METHODS: Data were collected from 31 adult patients with ventilator treatment who were admitted to a university hospital in Seoul and the collection period was from July 1 to November 15, 2005. Oxygen saturation, heart rate, respiration rate and mean arterial pressure were collected immediately prior to the suctioning intervention, during and 1 and 5 minutes after the suctioning from opened suction system and closed suction system. RESULTS: 1) The difference in oxygen saturation was statistically significant in recovery time for oxygen saturation to return to baseline values after suctioning was significantly rapid on closed suction system (p < .05). 2) The difference in heart rate, respiration rate and mean arterial pressure was statistically insignificant. 3) The suction time was shorter in closed suction system. CONCLUSION: Closed suction system is more efficient, as compared with the open suction system in the ventilator treatment.

Comparison of a Closed with an Open Endotracheal Suction: Costs and the Incidence of Ventilator-associated Pneumonia / 결핵및호흡기질환

BACKGROUND: Tracheobronchial suctioning using the closed suctioning system has physiological benefits for critically ill patients. Despite these benefits, there are concerns about increased colonization of tracheobronchial tree by pathogenic organisms. The cost is another hinder to the introduction of closed suction system. The aim of this study was to evaluate the incidence of colonization and ventilator associated pneumonia and the cost-effectiveness of closed suction compared with open suction. METHODS: During separated one month period, patients admitted MICU were cared by multiple-use, open suction, single-use, open suction and multiple-use, closed suction method, consecutively. Costs, colonization of tracheobronchial tree by MRSA and the incidence of ventilator-associated pneumonia (VAP) were analyzed. RESULTS: One-hundred and six patients were enrolled. Twenty patients were treated with multiple-use, open suction, while 42 and 44 patients were cared with single-use, open catheter and multiple-use, closed catheter, respectively. Colonization by MRSA and the incidence of VAP were not different among three ways of suctioning. The overall costs per patient per day for suctioning were 10.58 dollars for multiple-use, open suction, 28.27 dollars for single-use, open suction and 23.76 dollars for multiple-use, closed suction. CONCLUSION: Multiple-use, closed suctioning, when suction catheters were changed every 48 hrs, has the similar incidence of colonization of MRSA and occurrence of VAP and is a cost-efficient way of endotracheal suction.

The Effect of Closed-Suction Drainage After Total Knee Arthroplasty

PURPOSE: To assess the clinical comparison of closed suction drainage group and non drainage group after simultaneous bilateral total knee arthroplasty MATERIALS AND METHODS: We analyzed the thigh circumference, ecchymosis, wound infection, transfusion amount, knee score and range of motion in 100 cases(50 patients) done with PFC or PFC-sigma model between 1998 and 2000. Fifty cases of them(group I) were inserted hemo vac and the others(group II were not inserted hemo vac. RESULTS: The average thigh circumference in group I was 42.9 cm (preooperative), and 46.1cm (postoperative), in group II was 43.7 cm (preoperative) and 47.6 cm(postoperative). The knees that had no drains had a higher incidence of ecchymosis. However, the final result of knee score and range of motion of knee joint were not affected significantly by nonuse of closed suction drainage. There were no infection sign in both groups. CONCLUSION: The clinical comparison of closed suction drainage group and non drainage group after simultaneous bilateral total knee arthroplasty was not significantly different in wound healing, clinical and rehabilitation course. The use of suction drainage must be carefully selected after primary total knee arthroplasty.