SUBGLOTTIC SECRETION REMOVAL:

Transcription

1 ARROW REGIONAL TELEFLEX ANAESTHESIA ISIS Nullan utpat, Better vulputpatie access. ero Best dion practice. ulputat

2 SUBGLOTTIC SECRETION REMOVAL: A VAP REDUCTION STRATEGY Ventilator-Associated Pneumonia (VAP) is a nosocomial pneumonia that develops more than 48 hours after endotracheal intubation. 1 It is one of the most common infections acquired by adults and children in intensive care units (ICUs) and is a cause of significant patient morbidity and mortality, increased utilization of healthcare resources and excess cost. 2 During mechanical ventilation, secretions from the upper respiratory tract accumulate above the endotracheal tube cuff. Studies have shown that these secretions can seep past the cuff into the lower tract, increasing the incidence of ventilator-associated pneumonia. 3 Drainage of the subglottic secretions has been demonstrated as an effective strategy in reducing early-onset VAP. 4 THE CLINICAL CHALLENGE The endotracheal tube chosen for initial intubation doesn t always allow for easy access to this valuable practice until now. That is why we created the Teleflex ISIS with an attachable suction line. The versatile design eliminates the need to be selective during initial intubation, increasing the number of patients who can be viable candidates for subglottic secretion suctioning, a clinically proven strategy for VAP reduction. 2 1 American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospitalacquired, ventilator-associated and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171: Coffin S MD, MPH, Klompas M MD, Classen D MD, et al. Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals. Infect Control Hosp Epidemiol 2008; 29:S31-S40. 3 American Thoracic Society. Consensus Statement: Hospital Acquired Pneumonia in Adults: diagnosis, assessment of severity, initial antimicrobial therapy and preventative strategies. Am J Respir Crit Care Med. 1996;151: Dezfulian C, Shojania K, Collard HR, Kim HM, Matthay MA, Saint S. Subglottic secretion drainage for preventing ventilatorassociated pneumonia: a meta-analysis. Am J Med 2005; 118:11-18.

3 TELEFLEX ISIS ENDOTRACHEAL TUBE FOR SUBGLOTTIC SECRETION SUCTIONING The unique convertible nature of the Teleflex ISIS frees clinicians from the uncertainty of choosing which tube is best for the patient at the time of intubation. Teleflex ISIS features an integrated suction port and separate suction line, allowing for subglottic secretion removal, on-demand. When needed, the suction tube attaches to the Teleflex ISIS via a secure locking connection. Both connection ports can be sealed upon disconnection, reducing the risk of exposure to patient secretions when not in use. This versatile design allows you to make the right choice, every time. THE ISIS ADVANTAGE Convertible design Simplifies tube selection at initial intubation Use the suction line only when you need it HIGH VOLUME, LOW-PRESSURE CUFF Effective seal at low pressures Design reduces pressure on the tracheal walls PILOT BALLOON Tactile feedback allows for a visual gauge of cuff inflation PLACEMENT RING Provides a visual depth indication to aid in proper tube placement SUCTION LUMEN Allows the removal of accumulated secretions Custom design reduces likelihood of mucus obstruction 5 5 Pearce M, Mujica Lopez KI, Rubin BK et al. In vitro evaluation of endotracheal tubes with intrinsic suction. Virginia Commonwealth University School of Medicine, Department of Pediatrics Richmond, VA USA

4 EASY TO HOLD CONNECTOR Custom designed connector Enables easy handling when connecting/ disconnecting suction tubing No force applied on patient s Endotracheal Tube (ETT) SUCTION LINE WITH INTEGRATED CAPS Design allows for easy connection to the suction port Easy handling when connecting suction tubing Caps seal suction line when not in use Sold separately INTEGRATED SUCTION PORT Design allows for easy connection to the suction line Strategically designed for placement outside the patient s mouth Cap seals suction port when not in use

5 USAGE REFERENCE GUIDE STEP 1*: ATTACHING THE SUCTION LINE Open the tethered cap on the purple integrated suction port on the Teleflex ISIS Endotracheal Tube. Attach the Teleflex ISIS Suction Line by aligning the two tabs on the purple suction port on the endotracheal tube with the two grooves in the round suction attachment connector (Fig. 1). Turn the suction connector clockwise (Fig. 2) until the connector locks into place (Fig. 3). STEP 2*: PREPARE WALL SUCTION Set the suction regulator to the minimum suction pressure required to effectively remove subglottic secretions. Continuous Suction: Less than -20 mmhg Intermittent Suction: Between -100 and -150 mmhg for seconds 6. STEP 3*: ATTACH THE SUCTION LINE AND TUBING Once the appropriate suction pressure is set for subglottic secretion suctioning, attach the distal end of the Teleflex ISIS suction connector to suction tubing (Fig. 4). FIGURE 4 CLEARING BLOCKAGES* If the suction lumen becomes blocked, attach a syringe to the machine end connector and apply a bolus of up to 5 cc of air into the suction system as shown (Fig. 5). FIGURE 5 MAINTAIN APPROPRIATE CUFF PRESSURE* Use a cuff pressure manometer like the EndoTest (Fig. 6) to routinely monitor cuff pressures. FIGURE 1 FIGURE 6 FIGURE 2 To decrease the risk of tracheal tissue obstructing the suction lumen without decreasing suction efficacy: 1. Stop suction when there is no mucus flow. 2. Briefly reverse the suction flow if you notice a sudden increase in suction at the proximal port, as this suggests occlusion 7. 6 AARC Clinical Practice Guidelines, [Respir Care 1993; 38 (5): ] 7 Mujica-Lopez KI, Pearce MA, Narron KA, Perez J, Rubin BK. In Vitro Evaluation of Endotracheal Tubes with Intrinsic Suction, CHEST 2010; 138(4): ORDERING INFORMATION TELEFLEX ISIS PRODUCT INFORMATION - RÜSCH FIGURE 3 *Note: The following instructions are for example only to help familiarize the clinician with its handling of the product and do not represent the product s full instructions for use, including its associated cautions and warnings. For a copy of complete instructions, please see your sales representative. CODE NO. PRODUCT DESCRIPTION OUTSIDE DIAMETER (OD) CUFF RESTING DIAMETER **Distance from distal TIP to distal edge of purple integrated suction port on the endotracheal tube SUCTION PORT DISTANCE** Endotracheal Tube, 6.0 mm 9.2 mm 21 mm 24.6 cm Endotracheal Tube, 6.5 mm 9.9 mm 25 mm 24.6 cm Endotracheal Tube, 7.0 mm 10.6 mm 26 mm 25.6 cm Endotracheal Tube, 7.5 mm 11.3 mm 28 mm 25.6 cm Endotracheal Tube, 8.0 mm 12.0 mm 28 mm 27.1 cm Endotracheal Tube, 8.5 mm 12.6 mm 28 mm 27.5 cm Endotracheal Tube, 9.0 mm 13.2 mm 29 mm 27.8 cm Suction Accessory Line EndoTest 1 QTY.

6 Teleflex is a global provider of medical products designed to enable healthcare providers to protect against infections and improve patient and provider safety. The company specializes in products and services for vascular access, respiratory, general and regional anesthesia, cardiac care, urology and surgery. Teleflex also provides specialty products for device manufacturers. The Teleflex family of brands includes arrow, beere medical, deknatel, gibeck, hudson rci, kmedic, pilling, pleur-evac, rüsch, sheridan, smd, taut, tfx oem, vasonova and weck, all of which are trademarks or registered trademarks of Teleflex Incorporated or its affiliates. Teleflex Incorporated (nyse:tfx) has annual revenues of approximately $1.8 billion and customers in more than 130 countries. TELEFLEX INCORPORATED - LATIN AMERICA 4024 Stirrup Creek Drive, Suite 720 Durham, NC USA la.cs@teleflex.com TELEFLEX.COM SPACE FOR LOCAL CONTACT INFORMATION (VARIABLE DATA) Teleflex, EndoTest, ISIS and Rüsch are trademarks or registered trademarks of Teleflex Incorporated or its affiliates Teleflex Incorporated. All rights reserved. AJLA-AN v1