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PubMed1992

The use of closed suction drainage after lumpectomy and axillary node dissection for breast cancer. A prospective randomized trial.

Closed suction drainage has been used to prevent seroma formation after lumpectomy and axillary node dissection for breast cancer. To study the efficacy of closed suction drains, the authors conducted a prospective randomized study from 1987 to 1990 of 227 axillary dissections. One hundred eight were randomized to a drain group (DG) and 119 to a no drain group (NDG). Drains were removed on the first postoperative day just before patient discharge. Postoperatively, all palpable axillary collections were aspirated on each follow-up visit. The volume aspirated, the number of aspirations, the time to seroma resolution, and all complications were recorded. The mean number of aspirations in the DG was significantly lower than the NDG (2.2 +/- 2.2 versus 3.3 +/- 2.1; p less than or equal to 0.002). Mean volume aspirated in the DG (146.3 +/- 181.1 mL) was less than the NDG (266.1 +/- 247.6 mL; p less than or equal to 0.003), and the time to seroma resolution was decreased in the DG as compared with the NDG (11.5 +/- 10 days versus 18 +/- 10.1 days; p less than or equal to 0.0002). Closed suction drainage after lumpectomy and axillary node dissection is advantageous in decreasing the incidence and degree of seroma formation and need not delay early hospital discharge.

Aged↗
PubMed2002

Endotracheal suctioning: open versus closed with and without positive end-expiratory pressure.

An open system of delivery of supplemental oxygen was compared with a closed system during endotracheal suction (ETS) at zero end-expiratory pressure (ZEEP) and 10 cm H2O positive end-expiratory pressure (PEEP). Four protocols in a 2 x 2 design were administered in random order to 12 anesthetized and oleic acid-injured animals. Statistically significant differences were found between protocols for arterial carbon dioxide tension (PaCO2), arterial oxygen saturation (SaO2), airway pressure (Paw), right atrial pressure (Pra), intrathoracic pressure (Pit), arterial pressure, and right ventricular afterload. Intrathoracic pressure and systolic aortic pressure differed between open and closed systems. Statistically significant differences between ZEEP and PEEP were found for PaCO2, SaO2, Paw, Pra, Pit, aortic pressure, and right ventricular afterload. Suctioning through a closed system made little difference in subject responses, but clinically significant differences existed when suctioning subjects on and off PEEP.

Animals↗
PubMed1984

High-frequency jet ventilation and tracheobronchial suctioning.

Oxygenation and ventilation were assessed in 15 postoperative patients before, immediately after, and 3 min after 15 sec of tracheobronchial suctioning in the presence or in the absence of high-frequency jet ventilation (HFJV). When HFJV was continued during suctioning, the mean PaO2 decrease was only 15 +/- 9 torr, compared to a 90 +/- 16 torr decrease when HFJV was discontinued. This difference demonstrates that continuation of HFJV during tracheobronchial suctioning prevents a decrease in PaO2.

Bronchi↗
PubMedDate not supplied

A current conflict: use of isotonic sodium chloride solution on endotracheal suctioning in critically ill patients.

The use of isotonic sodium chloride on endotracheal suctioning is still commonly performed in intensive care units (ICUs). According to the studies, isotonic sodium chloride instillation may decrease oxygen saturation, increased intracranial pressure, arterial blood pressure, and cause cardiac dysrhythmias, cardiac arrest, respiratory arrest, and nosocomial infection. Endotracheal suctioning should not be used as a routine or standard clinical practice because of these negative effects. This article reviews effects of isotonic sodium chloride solution before endotracheal suctioning of mechanically ventilated patients.

Arrhythmias, Cardiac↗
PubMedDate not supplied

The efficacy of facilitated tucking for relieving procedural pain of endotracheal suctioning in very low birthweight infants.

PURPOSE: This study compared the efficacy of a behavioral pain reducing intervention (facilitated tucking) with standard neonatal intensive care unit (NICU) care for decreasing procedural pain (endotracheal suctioning) in very low birthweight (VLBW) infants. STUDY DESIGN AND METHODS: A prospective randomized crossover design with infants as their own controls were used. The sample consisted of 40 VLBW infants, 23-32 weeks gestation, and weighing 560-1498 g with tracheal intubation. The infants were observed twice during each endotracheal suctioning experience; one suctioning was done according to normal nursery routine; another was done using facilitated tucking (the caregiver "hand-swaddling" the infant by placing a hand on the infant's head and feet while providing flexion and containment). The Premature Infant Pain Profile (PIPP) measured the infant's pain response, and severity of illness of each infant was measured by the Score for Neonatal Acute Physiology (SNAP) and the NTISS (Neonatal Therapeutic Intervention Scoring System). Repeated measures analysis of variance (RMANOVA) determined the efficacy of facilitated tucking for reducing procedural pain (PIPP) and the effects of order of intervention vs. control. Regression analyses examined the relationship of gestational age, severity of illness, and number of painful procedures to the pain response. RESULTS: There was a significant difference between the PIPP scores for tucking and nontucking positions (p = 0.001) and a nonsignificant interaction with order (p = 0.64) as well as a nonsignificant main effect for order (p = 0.46). In the regression analyses, all predictors taken together did not significantly predict PIPP scores in the tucked position (p = 0.11) or nontucked position (p = 0.57). CLINICAL IMPLICATIONS: Facilitated tucking is a developmentally sensitive, nonpharmacological comfort measure that can relieve procedural pain in VLBW infants. Nurses need to be increasingly aware of infant pain during daily care taking, and to use validated pain assessment instruments. Further clinical research on individual pain assessment is needed for better understanding of the quality and significance of pain for each infant, and the factors that affect pain expression.

Clinical Nursing Research↗
PubMed1989

A simple device for controlling suction force in neurosurgical operations.

A simple and inexpensive device for controlling suction force in neurosurgical operations is described. This device is interposed in the suction tubing on the sterile surgical field. This has the advantage of allowing the surgeon to alter the suction force quickly and easily, according to his or her preference. The total cost is minimal, and the device may be assembled with supplies currently available in most operating rooms.

Humans↗
PubMed1996

A continuous microneurosurgical irrigation and suction system: technical note.

OBJECTIVE: We describe a continuous microneurosurgical irrigation and suction technique. This technique automatically clears the operative field, frees the surgeon to perform microdissection with both hands, and actually aids in dissection of the arachnoid layer. TECHNIQUE: The suction catheter (MicroVac; P.M.T., Inc., Hopkins, MN) described by Spetzler and Iverson and an additional continuous microirrigation technique are discussed. The catheter design has a sump effect and is secured in a dependent position in the operative field to continuously remove blood, irrigate the area, and reduce cerebrospinal fluid accumulation. The irrigation system consists of standard intravenous tubing with an angiocatheter used to direct a precise stream into the operative field. RESULTS AND CONCLUSION: The irrigation and suction system, when properly adjusted, continuously clears the operative site of minute amounts of blood that may obscure the surgeon's view and assists in dissection of the arachnoid layer. It has been used since 1991 with excellent success and satisfaction.

Arachnoid↗
PubMedDate not supplied

Home cleaning-disinfection procedure for tracheal suction catheters.

The cost effectiveness of home care for pediatric tracheostomy patients has become a concern. One major cost component of this care is the tracheal suction catheter. This study was designed to assess the microbiologic effectiveness of a practical cleaning-disinfection procedure, consisting of hydrogen peroxide, 100 degrees C soapy water and 100 degrees C rinse water, which might permit reuse of tracheal suction catheters in the home setting. The procedure was found to be highly effective, completely eliminating bacterial growth from more than 90% of catheters seeded with Staphylococcus aureus or Pseudomonas aeruginosa in the laboratory. Further, studies with catheters used for suctioning patients in the Pediatric Intensive Care Unit confirmed the eradication of all bacterial organisms.

Catheterization↗
PubMed1991

Transmission of Salmonella worthington by oropharyngeal suction in hospital neonatal unit.

An outbreak of Salmonella worthington infection in a neonatal unit occurred in a pediatric ward of Holy Family Hospital, Rawalpindi, Pakistan. The index case was a prematurely born male child from whose clinical specimens S. worthington was recovered. After this finding 40 infants kept in that nursery were included in an investigation. Major symptoms were diarrhea, septicemia and jaundice. Three developed meningitis. Disease morbidity rate was 45% and mortality occurred in 16.6% of the total positive cases. The source of infection was traced to a contaminated rubber tubing of a suction apparatus which was used for oropharyngeal suction of the babies. S. worthington was recovered from the clinical specimens of all 18 babies who received suction. Multiple drug resistance of these S. worthington strains was found.

Cross Infection↗
PubMed1986

Suction-assisted lipectomy for correction of 202 figure faults in 101 patients: indications, limitations, and applications.

Since its introduction in the United States, suction-assisted lipectomy has proven to be a safe, effective technique for correction of figure faults. It has been greeted with considerable skepticism by many practitioners, however, owing to the poor results many have obtained in their initial attempts to apply similar techniques. Suction lipectomy using the blunt technique is a safe procedure that can yield consistently good results when appropriately applied. It is suggested that the principal reason others have had difficulty involves problems in patient selection. The technique may not be effective for the correction of generalized obesity and cannot be expected to dramatically alter overall appearance. Patients should be selected for treatment of specific "figure faults" and educated as to what may realistically be expected. The patient's emotional and psychological condition must be taken into consideration. We report a series of 101 patients treated with a total of 202 separate suction lipectomy procedures with good results and only two minor complications. A survey of patients treated by the method reveals a generally high level of satisfaction and some of the ambivalence that might be anticipated from such a technique.

Adipose Tissue↗
PubMed2004

A randomized study of closed wound suction drainage for extensive lumbar spine surgery.

STUDY DESIGN: A prospective randomized study. OBJECTIVES: To study the risk of infection, hematoma, and neurologic deficits following extensive lumbar spine surgery in patients with or without prophylactic closed wound suction drain placement. SUMMARY OF BACKGROUND DATA: One randomized study assessing prophylactic drain placement in one-level lumbar spine surgery suggested that the use of a wound drain is not effective at preventing infection and may actually increase the rate of this complication. Our study was designed to determine the efficacy of closed wound suction drainage in preventing complications after extensive lumbar spine surgery. METHODS: Eighty-three consecutive patients undergoing extensive lumbar spine surgery were prospectively randomized to one of two groups. Forty-two patients had a closed wound suction drain placed before wound closure and 41 patients did not have a drain placed. The two groups were then assessed for differences in postoperative infection rate, incidence of hematoma and neurologic deficits, operating room time, estimated blood loss, hemoglobin and hematocrit values, temperature, dressing drainage, and length of hospital stay. RESULTS.: No infections, epidural hematomas, or new neurologic deficits were encountered in either group of patients. The only significant finding was a higher temperature in the "no drain" group the first day after surgery (P = 0.0437). CONCLUSIONS: Based on the findings in this and other studies, the decision to use or not use a wound drain following lumbar spine surgery should be left to the surgeon's discretion.

Blood Loss, Surgical↗
PubMed2007

Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: a meta-analysis.

BACKGROUND: Closed suction systems (CSS) are increasingly replacing open suction systems (OSS) to perform endotracheal toilet in mechanically ventilated intensive care unit patients. Yet effectiveness regarding patient safety and costs of these systems has not been carefully analyzed. OBJECTIVE: To review effectiveness of CSS and OSS, with respect to patient outcome, bacterial contamination, and costs in adult intensive care unit patients. DATA SOURCE: Search of MEDLINE, CINAHL, EMBASE, and Cochrane databases and a manual review of article bibliographies. STUDY SELECTION: Randomized controlled trials comparing CSS and OSS in adult intensive care unit patients were retrieved. DATA EXTRACTION/SYNTHESIS: Assessment of abstracts and study quality was performed by two reviewers. Data were combined in meta-analyses by random effect models. Fifteen trials were identified. No significant differences were found in incidences of ventilator-associated pneumonia (eight studies, 1,272 patients) and mortality (four studies, 1,062 patients). No conclusions could be drawn with respect to arterial oxygen saturation (five studies, 109 patients), arterial oxygen tension (two studies, 19 patients), and secretion removal (two studies, 37 patients). Compared with OSS, endotracheal suctioning with CSS significantly reduced changes in heart rate (four studies, 85 patients; weighted mean difference, -6.33; 95% confidence interval, -10.80 to -1.87) and changes in mean arterial pressure (three studies, 59 patients; standardized mean difference, -0.43; 95% confidence interval, -0.87 to 0.00) but increased colonization (two studies, 126 patients; relative risk, 1.51; 95% confidence interval, 1.12-2.04). CSS seems to be more expensive than OSS. CONCLUSIONS: Based on the results of this meta-analysis, there is no evidence to prefer CSS more than OSS.

Blood Gas Analysis↗
PubMed2006

Control and performance characteristics of eight different suction biopsy devices.

PURPOSE: To determine the control and performance characteristics of eight different suction biopsy devices. MATERIALS AND METHODS: Physician control of the syringe and needle was measured precisely with the validated linear displacement method during the aspiration phase and during five biopsy passes. The visual analog scale was used to measure operator difficulty in the following domains: (i) attachment to the needle, (ii) generation of vacuum, (iii) detection of loss of vacuum, (iv) release of the vacuum, and (v) clearing of the sample from the needle. RESULTS: Performance in various phases of the biopsy procedure varied widely among the biopsy devices tested. Unintended forward penetration (ie, loss of control in the forward direction) was significant with the reverse aspiration syringe (31.5 +/- 1.7 mm), three-ringed control syringe (25.4 +/- 4.1 mm), BioSuc-C7 syringe (28.3 +/- 1.9 mm), conventional syringe with a plunger lock (6.1 +/- 1.5 mm), syringe pistol (9.2 +/- 2.4 mm), and conventional syringe (3.8 +/- 2.9 mm) but was significantly less for the reciprocating procedure device (RPD; 0.7 +/- 0.7 mm; P </= .001) and RPD syringe holder (0.6 +/- 0.6 mm; P </= .001). The mean performance rankings were the best for the RPD (3.42 +/- 2.57) and RPD syringe holder (4.29 +/- 2.50) and worst for the conventional syringe (6.14 +/- 2.67; P </= .001) and conventional syringe with a plunger lock (6.86 +/- 3.80; P </= .001). CONCLUSIONS: Each of the suction biopsy devices has unique advantages and disadvantages. Suction biopsy devices with the least favorable overall performance were the conventional syringe and the conventional syringe with a plunger lock. The highest overall performance was seen with the RPD and RPD syringe holder.

Biopsy↗
PubMed2003

A minimalist approach to the care of the indwelling closed suction drain: a prospective analysis of local wound complications.

Despite their long-standing and prevalent use, closed suction drains lack a standardized postoperative care protocol. The authors present a prospective analysis of local wound problems associated with a minimalist approach to care of the drain exit site. A total of 73 patients undergoing a variety of procedures had 192 closed suction drains left in place on average over 10 days after surgery. Drain care consisted of daily showering with soap and water for the skin, no dressings, and stripping and emptying of the drain by the patient. Ninety-one percent of the patients followed the drain protocol and showered postoperatively without particular attention to the drains. There were 5 major complications of fluid collections leading to open wounds, 5 minor wound complications, and 2 wound complications unrelated to drain exit site care. Patient follow-up averaged 10 months. Overall, these data underscore the safety and efficacy associated with a simple approach to the management of closed suction drains.

Adult↗
PubMed1988

Vertigo following aural suction: can it be prevented?

Suction toilet of mastoid cavities leads to unpleasant vertigo in many patients. We have shown that suction causes cooling within the cavity, in a series of 20 patients. This is of the same order of magnitude as a cold air caloric, showing the temperature drop to be an important factor. The relevant physical principles are examined. During suction a flow of cold, dry room air replaces the warm, moist cavity air, causing cooling both directly and by vaporization of water. Introducing humidified air at near body temperature should eliminate these effects and a study is being set up to evaluate the potential clinical applications of the method in the ENT Outpatient Department.

Adult↗
PubMed1990

Aural suction without vertigo.

Vertigo induced by aural suction was abolished by maintaining a constant temperature in the mastoid cavity during the procedure. This was achieved using humidified air at 38 degrees C at the wider end of the aural speculum. The cavity temperature fell by a maximum of 0.2 degrees C (average) in 24 patients, none of whom experienced rotatary vertigo despite prolonged suction. This contrasted with a maximum temperature drop of 8.9 degrees C (average) in the same group of patients, 18 of whom then suffered vertigo and nystagmus, when the cavity temperature was not controlled during suction.

Female↗
PubMed2006

How we do it: Transoral suction diathermy adenoid ablation under direct vision using a 45 degree endoscope.

Keypoints * Adenoid ablation using suction diathermy is associated with a number of difficulties, mainly associated with the use of the mirror. Transoral and transnasal 0 degree endoscopes have also been utilised but again have limitations. We describe a technique that overcomes the above problems. * A prospective case series of patients undergoing suction diathermy adenoidectomy under direct vision using a transoral 45 degree endoscope connected to a monitor was conducted, performed by surgical trainees and under direct supervision of the consultant trainer (J.R.-J.). * Intra-operatively, trainees had to demonstrate to the trainer the appropriate anatomy, completed adenoid ablation, and haemostasis. * Fifty-six cases have been performed. In every case, it was possible for the trainer to monitor the trainee's technique throughout the entire procedure. No complications have been reported. * We describe a modified technique which overcomes the disadvantages previously encountered by conventional suction diathermy adenoid ablation.

Adenoidectomy↗
PubMed1979

Cellular aggregation and trauma in cardiotomy suction systems.

Experiments in dogs showed that the high levels of cellular aggregation and trauma caused by cariodtomy suction can be considerably reduced by the avoidance of air aspiration. A hypothesis is proposed to explain this on the basis of shear stresses in the inlet cannula. Roller pump suction was also found to be slightly more traumatic than vaccum suction, but contact of the blood with the pericardium had no effect so long as the pericardium and epicardium had been previously washed with saline.

Air↗