Suctioning of the left bronchial tree in critically ill patients

Bronchial electrocardiography to determine left or right main bronchial placement of an endotracheal suction catheter tip

OBJECTIVE

To assess the utility of a blue lined angle tipped and electrode tipped catheter, to guide left and right main bronchus cannulation.

DESIGN

A prospective study.

SETTING

An 11-bed general intensive care unit in a 900-bed teaching hospital.

PATIENTS

50 intubated intensive care patients, in sinus rhythm with normal P and QRS mean frontal axis, who required endobronchial suctioning for routine respiratory management.

INTERVENTIONS

Endobronchial electrocardiography was used to position a blue lined angle tipped and electrode tipped suction catheter into the right and left main bronchi.

RESULTS

Selective cannulation of the left main bronchi was determined by observing a biphasic or inverted P wave in 42 patients, or biphasic or inverted QRS complex in 31 patients. In 8 patients in whom no changes in the ECG were found, bronchoscopic placement of an ECG electrode into the left main bronchus demonstrated a biphasic or inverted P wave in 8 patients and a biphasic QRS complex in 3 patients, confirming the failure to cannulate the left main bronchus in these 8 patients.

CONCLUSIONS

Using a blue lined, angle tipped and electrode tipped catheter for endotracheal suctioning, endobronchial electrocardiography may be a simple method to signal left or right main bronchus cannulation.

Selective left endobronchial suctioning in the intubated patient

Suctioning of secretions from the left endobronchial tree is frequently necessary but often difficult in intubated patients. We examined the effectiveness of a catheter designed expressly for this purpose. Special curved tip (Bronchitrac-L) suction catheters were fitted with thin, radiopaque tubing to facilitate x-ray visualization. Eight-one attempts at left endobronchial placement were made on 74 stable adult intensive care unit patients. The suction catheter was inserted into the oral endotracheal tube or tracheostomy tube just prior to an x-ray filming of the chest. In 15 of 66 patients, the tip of the oral endotracheal tube was too distal (less than 2 cm above the carina) to allow proper functioning of the catheter. Patients with a properly positioned oral endotracheal tube were analyzed separately and showed 56 percent of the catheters went to the left bronchus. When the head was turned to the left prior to placement, successful left bronchus placement occurred in 65 percent. When the catheter was placed through a tracheostomy tube, 100 percent went into the left bronchus (n = 15). There were no catheter-induced complications in this study. The curved tip catheter is an effective means of suctioning the left bronchial tree in patients with tracheostomy tubes. Its reliability in patients with oral endotracheal tubes is reduced but more effective than current methods.

Selective placement of bronchial suction catheters in intubated neonates

Flexible suction catheters were passed through the endotracheal tubes of infants undergoing mechanical ventilation, just before chest radiographic examination for clinical purposes. With the head straight, 7 of 10 straight catheters entered the right main bronchus but with the head turned, 17 of 20 straight catheters and 19 of 20 curved tip catheters entered the contralateral bronchus.