I think that studies (and common sense) shows that they do reduce the VAP rate. The problem is that the clinicians have to keep the port clear'd and also do other things like keep HOB up, cuff pressures AT LEAST 20cwp (none of this minimal leak, better called maximal drip, technique).
Also I find it humorous when people say they can really pick and choose whom they will use them on. You never know which patient will end up on a vent the longest.
I have some protocols for Hi-Lo Evac use I can email to you
whitnack@pacbell.net
Posts: 171 | Location: Palo Alto, CA USA | Registered: November 14, 2002
Howdy ,fellow resp.person I've been in the business for 25 years and I'm looking for some info/experiances/feedback with the e-vac tubes.The particulars ;on what is done when thick secretions block the evacuation port,troubleshooting tricks...
In Canada a recent nationwide VAP initiative made recomendations based on a multicenter study. Some of the obvious recommendations were to reduce breaking the circuit, using inline suction, disposable circuits, inline med tx, and one other was the use of OETT which would allow for hypopharyngeal suction. I have personally not seen them used at our institution and the only feedback I have received is that they clogg alot furthermore because of the added expense it is not the first tube people reach for. They do however work but havent really caught on yet near as I can tell.
Interesting to note that the center(s) that compiled the data (by using the HiLo tubes) regarding the Canadian guidelines for VAP prevention are presently not using these tubes (quote as of summer 2004).
I have been using the Hi-Lo ETT only for over two year now. If they need a tube or if they come in the ED with a standard we switch it out. our only VAP's in the past 2 years are on patients that have needed a trach and it was after the trach was placed that the acquired the VAP.
