Single‐Use Versus Multiple‐Use Endotracheal Suction Catheters in Mechanically Ventilated Patients: A Feasibility Randomised Controlled Trial

Background
In resource-limited settings, single-use open endotracheal suction catheters are commonly used multiple times. The current evidence of this practice on ventilator-associated pneumonia (VAP) among mechanically ventilated patients remains unclear.

Aim
The aim of this study was to test the feasibility of single-use and multiple-use endotracheal suction catheters flushed with chlorhexidine versus standard care (multiple-use endotracheal suction catheters flushed with normal saline) to reduce VAP in resource-limited intensive care units (ICUs) and evaluate study methods for designing a future definitive randomised controlled trial (RCT).

Study Design
A three-armed feasibility RCT was conducted in three ICUs at a university hospital in Egypt.

Results
Sixty mechanically ventilated patients were randomized into three groups: Intervention I group, single-use catheters, Intervention II group, multiple-use catheters flushed with chlorhexidine, and Control group (standard care) multiple-use catheters flushed with normal saline. Data on feasibility parameters, intervention adherence, and patient outcomes were collected. Recruitment and retention rates were high across all groups, with 96.7% (n = 58) of participants completing the 3-day follow-up and 93.3% (n = 56) completing the 6-day follow-up. Adherence to intervention protocols was excellent, with 100% of participants receiving the designed interventions. No adverse events were reported. Chlorhexidine flushing and single-use catheters were practical and successfully implemented. Challenges of budget constraints, supply shortages and the need for staff training were observed. The incidence of VAP was 31.6% in the Intervention I group, 26.3% in the Intervention II group, and 40% in the standard care group. The relative risk of developing VAP compared with the control group was 0.79 (95% CI: 0.51–1.23) for Intervention I and 0.66 (95% CI: 0.42–1.03) for Intervention II.

Conclusions
A full-scale RCT comparing single-use and multiple-use catheters with chlorhexidine flushing is feasible in resource-limited ICUs. Further investigation into the effectiveness of interventions on VAP prevention is needed in future definitive RCTs.

Relevance to Clinical Practice
This study highlights the practical implementation of endotracheal suctioning strategies, such as chlorhexidine flushing and single-use suction catheters, to potentially reduce VAP in resource-limited ICUs. These findings can inform clinical decision-making and infection control.

Trial Registration: ClinicalTrials.gov, identifier NCT06207513