The Closed Suction Catheter
, is compatible with any ventilation mode. It has an On/Off valve that isolates the suction catheter tip, creating a closed cleaning chamber. The advantages of the closed suction catheter are physiologic and cost-effective.
The physiologic benefits of using a closed suction catheter over an adaptor are not yet clear. The cost of an in-line suction system is higher than that of an adaptor. However, the cost of an adaptor is still less than that of a disposable catheter.
The closed system allows for constant PEEP during aspiration maneuver, reducing the risk of cerebral and arterial deoxygenation. In addition, it facilitates emergency maneuvers and enables a single operator to perform the procedure. A closed suction catheter also helps to prevent bronchoaspiration, which is associated with significant complications including infections, granulomas, and bleeding of the tracheal mucosa.
The closed suction method is more convenient for critical care nurses than open suction. A closed suction catheter is often enclosed in a plastic film sleeve, minimizing the risk of desaturation, and limiting the risk of disseminating contaminated bronchial secretions. Closed suction is easier to use than open suction, and many critical care nurses believe it is more effective. In fact, some studies have linked the use of closed suction with a lower incidence of pneumonia and increased patient survival rates.
Using a closed-suction catheter may be a cost-effective option, as it will reduce the need to change the in-line suction catheter. Furthermore, it can decrease the risk of patient cross-contamination and health care provider exposure to respiratory secretions. However, institutions should ensure that they inspect closed-suction catheters regularly to detect soiling and mechanical failure. Cost-effectiveness studies should be based on evidence-based methodology.
A closed-suction catheter can also reduce hospital mortality. In this study, the cost of in-line suction catheter changes was $9 per change (excluding respiratory therapists' time). Assuming that an in-line suction catheter is cost-effective, a study of the cost-effectiveness of closed-suction catheters used in emergency medicine found that they reduced hospital mortality and improved patient outcomes.
The safety of closed suction catheters has been questioned by some. While there are many benefits of this method, it is not without its risks. For example, open suction catheters require sterile saline, which adds to the cost. A closed suction system is much more affordable and comfortable for patients and nursing staff.
A closed suction system is associated with an increased risk of nosocomial pneumonia, because repeated insertion of endotracheal tubes increase the chances of colonization. However, in a recent study, the authors concluded that the increased colonization rate in a group of patients who underwent closed suctioning was largely due to the higher frequency of suctioning in the closed suction system.