In-line vs traditional suctionning

BittyBabyGrower, MSN, RN · Oct 31, 2004

We just went to inline in the past 2 years. All our kids have to have a link on and we have to have a written order to not use inline. All osc/HFV are to be inlined unless have really horrible secretions, then you two man sx.

Not all places use them, I don't think they are a standard of care yet, plus they are expensive....we do a chargable on them.

Mimi2RN, ASN, RN · Oct 31, 2004

We have been using the inline suction on all the vents, I like the system. It's not a separate charge for us.

Gompers, BSN, RN · Nov 1, 2004

We've had them on the unit for several years, but about a year or two ago we switched to all inline suctioning. We've always used them on the oscillators so that we don't lose the MAP, as mentioned above. We've also stopped using saline as much as we did before. Some people have a hard time breaking the habit, but most of us will only use it if absolutely necessary (like with thick plug-like secretions and a tiny 2.5 ETT). We do still use saline each time to clear the suction catheter but it doesn't get into the baby. Some people do 2-person suctioning if they think the baby has a huge plug but really I don't think it makes a difference. I believe we change our set-up weekly, but I think it's gross and wish we'd do it every single day. They are charge items in our Omnicell.

Even with weekly changes - we've noticed a huge decrease in bacterial pneumonias. Much less pseudomonas, especially.

dawngloves, BSN, RN · Nov 1, 2004

We use it for our oscillators, but this is a recent standard. If we beg hard enough we can use it for conventional kiddos with a lot of secrections.

TiffyRN, BSN, PhD · Nov 1, 2004

We generally use in-line suctions. There is one of our Neo's (in a group of about 12) that doesn't like them (thinks they increase chance of extubation). I love them because I can suction without recruiting help.

BittyBabyGrower, MSN, RN · Nov 2, 2004

I don't like them on the teeny ones with the 2.5 tubes in...it seems the tubes get bend and kinked and they area pretty heavy, esp if we are using the BabyLogs or VIP Bird vents....they have the extra sensor on the end and that baby is heavy!

NoCrumping · Nov 3, 2004

I have worked in 2 units, one used them for every single vent,conventional included, and the other used it as "nurse" preference, but it was discouraged by everyone. In that unit, I believe it was because none of the nurses really were trained on them , and there was a learning curve to overcome. Personally, after using them, it seems primitive and dangerous to *NOT* use them...... in terms of contamination rate, losing map, etc...and of course, it is so much easier to use them, in my opinion. I went to that unit that doesnt use them, and when my preceptor told me how I had to suction these kids, without inline, I thought it was completely idiotic, and it seemed like I would never get the hang of it....... I was naive , and thought inline was the new "norm", since I was trained on them....

Tiki_Torch · Nov 3, 2004

We use inline suction catheters one every ventillated baby whether they are on conventional, jet, or oscillator. We change them every morning on day shift and they are a charge item.

I initially learned the two-person method using saline and a catheter. The hospital I worked at was just beginning to change over to the inline catheters as I left there. Of course there were nurses who were reluctant to change... change is often difficult... but our CNS and manager/physicians simply said, "This is what we are going to be using from now on." and they stuck to it. Now everyone there loves them for the same reasons mentioned here (not loosing MAP, being able to suction safely by yourself, and infection control issues).

I took a few years off and moved to another state. When returning to work I found the inline suction catheter use as the only real option and I have enjoyed it very much. If there are thick secretions and saline is needed before suctioning it's easy to do. I find that I rarely have to use saline before suctioning however. I know that the traditional way of suctioning can be done by one person but we always used two to be sure we didn't break the sterile field and to be able to hook the baby back up to the vent quicker. I truly love being able to suction by myself at any moment rather than having to ask someone to come help.

We recently viewed a video from Sensorimedics concerning their oscillator vent. They mentioned that babies on oscillators generally do not need suctioning during the first 48 hours. They also said it's best to turn the oscillator on pause when suctioning. At our hospital we suction while the oscillator is running and our doctors want us to suction at least q2h while all babies are on any type of vent regardless of the need. I was taught to suction when the baby shows signs he/she needs it based on their oxygen saturation level, breath sounds, etc. My current hospital also uses the tiny 2.5 ET tubes which can clog up easier than the larger ones. I also remember over the years that babies on oscillators generally did not have much secretions until they changed over to a conventional vent where for the next day or two they would have lots more secretions. I'm assuming the oscillator pushes the secretions way out into the farthest areas of the lungs and once the oscillator is no longer in use, the secretions begin moving into the larger airways. I have no idea if this is true though... does anyone know for sure?

Bottom line for me is I love the inline suction catheters. Maybe the fact that our hospital changes them every 24 hours is more often than other hospitals but I must say that we do not seem to have a lot of incidence of babies getting pneumonia that seems to be related to being on the vents. This hospital is very, very infection control conscious in their practices.

nekhismom · Nov 4, 2004

The hospital I used to work at did in-line for all babies. We needed a special order to use the "old" way to sx. I didn't even know how to do it the old way. We also changed ours q 24. I don't know if it was chargeable or not, because the RT's had to change them.

At the new place, we can't use in-line on babies under 1200 gms, or babies on jet vents. The new place doesn't use the oscillator anymore.

The first time i had to use the "old" way to sx, I thought IMMEDIATELY of infection. I much prefer the in-line suction to the old way. It seems especially counter productive to disconnect a baby on the jet to suction, then have to start the jet again. Like you all have mentioned, you lose MAP, etc. I hope we will consider going to in-line soon for all babies.

fergus51 · Nov 4, 2004

Why can't you use them on jets? I would think it's even more important to use them on jets than on conventional vents.

nekhismom · Nov 9, 2004

I have NO idea, just told that's what the policy is. I'm in a teaching hospital, and sometimes things like this get overlooked with everything else the unit has going on. I just started this new place, so I'll have to do some research into it.