Suction cannister disposal required?

Specialties Operating Room

Published

My current hospital (I'm a traveler) uses a small disposable canister for anesthesia suction. It is our practice to replace it between cases only if there is waste visible. Suction tubing is replaced every case regardless.

Pretty much every hospital I've been to follows the same practice for changing disposable surgical suction canisters between cases (and of course the tubing from the field).

So that brings several questions to mind that I've never heard addressed during my 20 years of practice. Why change cannisters clean or not? How do you know they are "clean"? After all, certainly air containing some patient molecules have hit the cannister. What about the tubing to the vacuum supply? Internal wall suction supply? Those are certainly known to get gunked up from surgery over years and are certainly infectious.

One might argue that continuous suction means one way traffic only. But that argument doesn't hold for chest tube practices as we try to maintain a sterile drainage system at all times.

So I'm truly interested if anyone has any references for this. Nothing in AORN (nothing!), nor does the hospital I'm at mention specific practices in the P&P manual. Any chances for increase infection rates with contaminated suction cannisters?

Neptunes bring up similar questions. The first generation machines tend to gross me out as there is always blood when you take the manifold out (for again questionable disposal between cases) that is not touched during the wash cycle. We just got the latest models and the new horizontal manifold appear to do much better in not leaving any blood behind during manifold removal - and the new machines have a clearly visible detergent wash cycle as well.

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I personally change them out all the time, every time. For MAC's or mod/sed's, they're usually set up, but set off to the side just in case we need to use them and that's the only instance where I don't change them. In this case, we leave the tubing wrapped in its paper wrap so that it's kept neatly in order, and the yankauer is left completely wrapped. When the paper wrap is broken, yankauer wrap is opened, or both is when I change out the entire system. I know some circs that leave them in place if they are visibly clean, but I just can't get myself to do that. My hospital has recently invested in isolyzer so that we can be more environmentally friendly. We are suppose to empty this isolyzer powder into the suction canisters to absorb the contents until the liquid becomes a solid and then throw the entire system into the normal room trash as opposed to our hazardous waste bins. Anyway, we also received new Neptunes like you're describing and are night and day better than the old, disgusting system. I love the disposable ports.

Here's some food for thought...our anesthesia group seems to think that at the end of a case, they can disconnect the yankauer from the tubing and connect the tubing itself to the foley catheter to quickly drain the urine out of the bag. It's convenient for them, and their canisters are marked in mL's so that they can get totals for their records. They usually do this before they extubate so that means they connect that same tubing back to the yankauer and suction out the patient! They all agree that it's a one-way system and can't cause any problems as long as they don't use the yankauer itself to empty the bag, keep the suction on at all times, and only apply suction to the foley bag until the urine is drained. This has been brought up to our superiors and anesthesia's superiors and the practice continues. To this date, we haven't had any complications with them doing that, but that just goes to show they seem to be pretty confident that it's a one-way system. I just tell them not to worry about it and that I'll get a total and drain it for them so they don't do it in my room. I just know one day someone's going to wake up with a bladder injury from using that suction, mind you they set their suction to full. Plus, it's just plain gross. I have no problem doing one extra task for anesthesia if it saves me the embarrassment of one day possibly explaining myself to the board as to why I didn't advocate for the patient and stop them from doing it.

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We can easily find a dozen practice scenarios and things that raise eyebrows, but where is the rationale, or even better, research? That is what I'm looking for. Not even AORN seems to have recommendations.

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Specializes in CRNA, Finally retired.

30 years ago, when I started giving anesthesia, I tried to get the OR nurses to stop emptying the suction canister between cases because it was so wasteful and increased turnover time. She gave me the explanation that maybe there is "reverse" suction. Maybe space aliens will land in the OR and use them for blowing bubbles. Actually, in the past few decades, I rarely even suction patients. If they're comfortable enough they don't make secretions and they should be awake enough when extubated to protect their own airway. Unless someone has experience with a suction canister spontaneously spewing its contents into the room, I will continue to believe in science - not a custom based on someone's fantasy but it's time you OR people got together and get some papers written on this.

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Actually, without science, your belief that nothing will happen is also baseless. Why do we insist on a sterile pathway to suction on chest tubes?

It also seems that anesthesia somewhere every year believes that fluid pathways on IV's are also one-way and several (to dozens) patients are infected from the use of multidose vials used on several patients tracked to a specific provider. Fluids are different than gases, but do you really know that there is no way that retrograde infections are possible on suctions used by anesthesia and field suction? I don't.

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Specializes in CRNA, Finally retired.

Whoa there. There's no relationship between using multidose vials with sloppy technique is way different than merely changing tubing and suction catheter on a suction and leaving the canister. With all the drug shortages we have, we often use multi-dose vials among several patients without ill effect because you're always using a sterile syringe on a vial that's been wiped hard with alcohol. Sterile on sterile = sterile. The problems come when multidose vials are not used immediately because they don't have preservatives in them and can't sit around once opened. If you extend the logic that multi-dose vials can never be reused, then you'd have to toss every instrument out that touched the patient and bring in a new instrument that is needed in place of the one you threw away because it "might" be contaminated. Either a vacuum is or it isn't. It can't be both. We have to reply on logic all the time because we don't have definitive answers to a lot of the voo-doo we participate in. 40 years of experience (thoughtful experience)lends credence to the idea that changing tubing and catheter is adequate. Suction bottles in endoscopy don't get changed between cases. They get emptied when they're full. We don't see any upswing in infections in patients who have had an upper or lower endoscopy..never. So I'm going to trust my judgement on this one-like the other ten or so times a day that we have to just fly by the seat of our pants and make the most logical choices available.

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Of course my analogies are bad - but there is zero research out there or even guidelines. Sure, doing clean procedures such as endoscopy seems unlikely to cause issues, but do you really know? Let's do bronchs on TB patients without changing the suction or irrigation. Doesn't seem logical that that would be safe, but logic doesn't always play out against actual research.

I'm not an expert on multi-dose vials - but they are against hospital policy except for IM flu shots and I've never used them at any of perhaps 50 hospital I've worked in. Wiping with alcohol (which very few anesthesia providers ever do anyway - when was the last time you saw one wipe a port) is not sufficient to guarantee patient safety in surgery, and every year I see reports of multiple cross infections in the OR from multidose vials being used on multiple patients.

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Specializes in CRNA, Finally retired.

Actually, I can't recall hearing of any reports of multiple cross infections that didn't involve criminal behavior (and 2 CRNA's and MD are indicted for homicide in the Nevada case). HepC has been reported from addicts in the OR using syringes and then placing them back on the anesthesia cart for patient use. Of course, shame on anesthesia for being naive enough to leave drug-filled syringes in the open. We have had such severe drug shortages in anesthesia that we have had periods where we couldn't give a decent anesthetic without sharing vials of Versed, Fentanyl, Propofol and neostigmine. This can be done safely as long as the practitioner never double dips. Of course the preservative free stuff has to be thrown out at the end of the day. Irrigation is different (I think) because there are moments when the positive pressure pump is inactive. Of course we need to do the studies - just amazed with all the costs involved that no one has done it yet. None of my sites are exposed to students. These studies would be great stuff for the nursing students.

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None of your sites are exposed? If you have something relevant to post, you can excerpt here via cut and paste. That is legal if you don't copy the entire article.

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Hi NedRN sorry for the OT post but I am not active enough on here to send you a private message. Regarding an older post you made on another topic I have some questions if you could be so nice as to help me out with answering just a few, my email is [email protected] if you could send me an email that would be so great. Thank you and again sorry for "thread jacking" :)

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