Chest
Volume 95, Issue 4, April 1989, Pages 885-887
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Clinical Investigations in Critical Care
Selective Left Endobronchial Suctioning in the Intubated Patient

https://doi.org/10.1378/chest.95.4.885Get rights and content

Suctioning of secretions from the left endobronchial tree is frequently necessary but often difficult in intubated patients. We examined the effectiveness of a catheter designed expressly for this purpose. Special curved tip (Bronchitrac-L) suction catheters were fitted with thin, radiopaque tubing to facilitate x-ray visualization. Eighty-one attempts at left endobronchial placement were made on 74 stable adult intensive care unit patients. The suction catheter was inserted into the oral endotracheal tube or tracheostomy tube just prior to an x-ray filming of the chest. In 15 of 66 patients, the tip of the oral endotracheal tube was too distal (<2 cm above the carina) to allow proper functioning of the catheter. Patients with a properly positioned oral endotracheal tube were analyzed separately and showed 56 percent of the catheters went to the left bronchus. When the head was turned to the left prior to placement, successful left bronchus placement occurred in 65 percent. When the catheter was placed through a tracheostomy tube, 100 percent went into the left bronchus (n = 15). There were no catheter-induced complications in this study. The curved tip catheter is an effective means of suctioning the left bronchial tree in patients with tracheostomy tubes. Its reliability in patients with oral endotracheal tubes is reduced but more effective than current methods.

Section snippets

METHODS

Special curved tip (Bronchitrac-L) catheters were provided by the manufacturer.8 A flexible, radiopaque, vascular catheter had been aseptically inserted into each suction catheter to facilitate x-ray visualization (Fig 1). A prospective study, utilizing 81 attempts at left endobronchial placement, was made on 74 consecutive stable adult ICU patients requiring suctioning. Catheter placement was performed immediately prior to daily chest roentgenogram usually through an adaptor. Following chest

RESULTS

Suction catheters were adequately visualized by x-ray film in each case (Fig 2). Six of 81 attempts (7 percent) resulted in failure to pass the catheter beyond the tip of the oral endotracheal tube. The inserted radiopaque markers were not found to greatly affect the configuration or compliance characteristics of the suction catheters. In vitro trials in lung models performed by the manufacturer demonstrated a continued left sided placement with this particular radiopaque marker in place. Table

DISCUSSION

The current study demonstrates that the curved tip suction catheter is successful in allowing catheter entry into the left bronchus. The specific end-curve and catheter bend allow a high rate of left bronchus entry particularly in patients with tracheostomy tubes. In patients with oral endotracheal tubes with tips greater than 2 cm above the carina, the rates of left bronchial entry are better than those found in similar studies using both straight or curved/angled tip suction catheters.

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Manuscript received May 31: revision accepted August 29

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