Just starting to use NAVA at our institution and I have a few concerns...
How often does the edi catheter become clogged with tube feeds? Or does it at all?
With the cost of the edi catheter is NAVA for everyone or just those hard to wean patients?
Every ventilator manufacturer can argue why their equipment is better, but what are the statistics in an unbiased, independant randomized trial? I have not seen and hard data in regards to an independant randomized trial.
who is responsible for placing the edi tube at your institution? nursing or resp.?
Once placement is confirmed via x-ray, is there a need to confirm via daily x-rays?
How do you assess the catheter has not become corrupted? (collection of tube feeds at the end)
What is the length or age of a catheter once in use? (Do you change with vent. circuits?)
And NAVA, is this still a closed loop approach to ventilation? If so, does anyone know how close we are to seeing open loop ventilation?
And finally, I have found it's the physicians who do not like change. Show me an RT who does not want their job to be easier and I will show you someone who does not work at my facility!
Response to bing....
Congratulations...you are about to enter a new frontier in mechanical ventilation
We have been using nava on a regular basis and have not had any catheters clogged for feeding. We have used gavage and continuous feeds.
Nava can be used on patients with an intact respiratory drive, who are breathing spontaneously.There are some exclusion criteria. Your institution must decide.
Published data is now available; search the net.The chatter on NAVA is increasing daily. I suggest you also search you tube: NAVA VENTILATION. By the way, evidenced based practice follows clinical based practice. The traditional forms of ventilation like A/C, SIMV, PSV also lacked evidence based practice when they were first introduced.
Both Rts and RNs are involved with catheter placement at our institution. I believe its important to get Rns involved and claim dual ownership for this process.
They already place NG and Og tubes and verify placement. Its a process of education for both parties. Some Rts prefer to do placements.Its all good.
Confirmation of edi placement is the sole responsibiblity of the RT. This process is confirmed using an edi placement set up screen with ecg waveform analysis.
An xray is not required for confirmation.
We have never had a corrupt edi catheter.
Catheters are patient population specific and come in an array of sizes and lengths. Manufacturer guidelines are available.Once you place enough of these catheters, it is a relatively simple procedure.
The catheters are approved by the FDA for useage for 5 days. Many institutions I have heard exceed these limits. You will have to decide for yourselves.
Nava is closed loop because the chemoreceptors and load receptors feed information back to the central control center in the brain.... medulla oblongta.. which helps regulate the patients drive.Nava is neurally triggered and not pneumatically triggered. Therin lies the key to its effectiveness.
Education and an interdisciplininary approach is required for any change to succeed. You need MD support and superusers to champion change.
I hope this helps.