Laboratory Test of a Visual Sputum Suctioning System

Abstract

BACKGROUND: Conventional sputum suctioning is a routine clinical practice, but complications may arise from the blind manipulation of the catheter. Recently, a visual sputum suctioning system (VSSS) was developed, and we tested this new system in a laboratory setting. METHODS: We used coagulant concentrations of 1.5% and 3.0% to simulate mucus and sputum. Conventional singlelumen and triple-lumen catheters were inserted separately into a beaker for sputum suctioning (15 s, 200 mm Hg). A micro-imaging fiber was integrated into the triple-lumen catheter to create the VSSS. The single-lumen catheter and the VSSS were inserted separately into the mouth cavity, the nasal cavity, the tracheostomy tube, and the endotracheal tube of a human analog model for further comparisons. RESULTS: As the suction channel of the triple-lumen catheter was reduced by 46.8%, the amount of simulant it suctioned was significantly less than that suctioned by the single-lumen catheter. However, under real-time guidance, the VSSS suctioned more simulant than the conventional single-lumen catheter in the human analog model. CONCLUSION: Sputum suctioning with the VSSS was feasible. Because of its real-time imaging guidance, the efficiency of the VSSS procedure was greater than that of the conventional single-lumen catheter. Therefore, this system may provide a new platform for sputum suctioning.

A new strategy for difficult airway management with visual needle cricothyroidotomy: a manikin study

“…To simulate real conditions, the surface was covered with red adhesive tape. In addition, as described previously [3], coagulant simulants comparable to human airway sputum were also randomly injected into the tracheal lumen. After routine draping, the experimental protocols used were as follows:…”

“…Recently, a 0.9-mm microimaging fiber was used by our research group to develop a visual sputum suction system [3]. In this study, the microimaging fiber was delivered into a 14G needle to guide visual needle cricothyroidotomy, to investigate the feasibility and efficiency of this video-assisted system.…”

“…1 shows the prototype of the visual needle cricothyroidotomy system. This system was designed to integrate a microimaging fiber (FVS-001MI, Blade Co, Beijing, China) which was previously described in detail [3], into a 14G needle (Smith Medical International Ltd, Hythe, Kent, UK) to facilitate visual guidance during penetration of the cricothyroid membrane.…”

Endotracheal Suctioning May or May Not Have an Impact, But It Does Depend on What You Measure!

“…5 This may in part explain the potential for adverse effects of endotracheal suctioning on lung function or risk of local trauma. For example, a closed suctioning procedure where the negative pressure is applied without any contact with mucus within the airway may have the potential for more deleterious effects on lung volume loss and may also push the secretions away from the suction catheter tip.…”

“…6 When the suction catheter comes into direct contact with the mucus, this may be expected to have a less deleterious effect on lung volume and also be more efficacious in terms of secretion removal, especially without any PEEP. 6 Hence, the development of optical fiber ports embedded within suction catheters 5 and endotracheal tubes 7 allows direct visualization during airway care to optimize secretion clearance, if the devices become commercially available 5 and are also viable to use. 5,7 Recent recommendations for endotracheal suctioning 8 advocate several key points to the procedure, including: to advance the suction catheter until resistance is met; to not apply suctioning routinely, but only as needed; to preferably use a closed suction catheter; to not use saline instillation; to pre-oxygenate; to use the shallow suctioning method; and to not apply suction pressure for more than 15 seconds.…”