My sister is a Cystic Fibrosis patient who is ventilator dependent. She often coughs up her secretions directly into her flex tube and they need to be changed about four times per day.
For some time the respiratory therapists were rinsing the flex tubes out with tap water in the washroom sink. This bothered me because the flex tubes would look gummy after rinsing.
My sister has requested the her flex tubes no longer be rinsed and that a sterile tube be used instead. This did not please a couple of the RTs and they are upset that they can not rinse them out. Are sterile flex tubes a good idea for a cystic fibrosis patient on long term ventillation?
|<Dave Tolle RRT, RCP (ret)>|
To clarify your situation. When the ventilator circuits are changed they do use a sterile circuit? During the use of that circuit the flex tube becomes fouled with a build up of expelled mucous..correct? That tube is then rinsed and immediately replaced or are there several flex tubes available for interchanging that are merely rinsed between uses?
Flex tubes can be constructed of many materials. If your using the soft silicone flex tubes they can be pulled straight and the mucous quickly removed (milking) into a receptacle then reset without any rinsing. This procedure introduces no new elements to the circuitry and is safe. If there is a battery of these flex tubes they should be rinsed in sterile water, then hydrogen peroxide, then rinsed in sterile water again and well drained prior to being reused. If standard disposable stiff flex tube is used it comes in large rolls that are sterile if handled properly. On one occassion where I had an extremely heavy mucous producer we used a water trap inline configured to capture and hold flex tube mucous. It allowed us to manage the mucous without even removing the circuit from the user. Understand that this must be done considering any impact it may have on rebreathed deadspace as well as any weight it may transfer to the tracheal stoma.
Tap water is not sterile water. It is safe to drink. Tap water comes out of a faucet. Faucets are not sterile and may well be contaminated, especially in a care setting. It certainly is not ideal for the purpose you've described.
The staff have not changed the circuit for over 10 weeks, but they do have a HME to protect the line and provide humidity. How often should the circuit be changed?
They change the HMEs about 3-4 times/day because my sister has a very productive cough and the HME occasionally fills with sercretions.
I don't think a water trap on the line would be too comfortable for my sister as she already has some trouble with the weight of the HME.
The flex/extension tubes become filled with expelled mucous and it is often too think and sticky to be drained by milking into a receptacle. When the flex/extension tube would become filled the RTs would disconnect the tube from both ends and rinse it out with tap water in the washroom sink. After rinsing they would connect the flex/extension tube to the rest of the circuit. This doesn't sound like proper procedure and some staff are a little upset that we have raised our concerns about this issue.
Let me preface this by saying that I am not a professional. I am, however, a vent dependent trach patient.
In the home setting, we change circuits weekly (Pulmonetic circuits). That includes the circuits and all the little extension pieces. If I blow mucus into any of these components, they are changed then and there. (I blow mucus into my Omniflex connectors almost every morning.) Those components are soaked in a mixture of very hot water and vinegar--one part vinegar, three parts hot water.) If they are terribly dirty, we throw them away.
Personally, I would have to say something about such prolonged use of a circuit. Unless it is a circuit with which I am unfamiliar, ten weeks seems like far too much time.
|<Dave Tolle RRT, RCP (ret)>|
It's known that cystics generate large amounts of thick sputum and that they're vulnerable to infection. An artificial nose is a passive type of humidifier that works by capturing exhaled humidity recycling it for subsequent breaths. This may be inadequate in keeping secretions thin for a cystic patient. An active humidifier (using a heated resevoir of sterile water) delivers a higher level of humidity to aid in secretion thinning. Cystics must keep their lungs as clear as possible to avoid airway plugging problems and infection.
Circuit changes, especially for a highly productive patients prone to infection should me much more frequent. Daily changes are more the norm.
I would suggest that you contact an RT department at the nearest university hospital and find there a resource person with whom you can discuss the full scope of care regarding your sister. Its seems apparent that her situation requires some broader and quicker oversight than you can achieve piecemeal here. Best of everything for you.
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