PPT_JPNATC_BRONCHOALVEOLAR LAVAGE
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This document compares the efficacy of tracheal culture using a mucous extractor technique (TCMET) versus non-bronchoscopic broncheoalveolar lavage (NBBAL) in diagnosing chest infections in ICU patients. A study of 30 intubated patients found that TCMET had 100% sensitivity and 77.8% specificity compared to NBBAL, with an overall diagnostic accuracy of 80%. The study concluded that TCMET is a highly effective, cost-effective, and time-effective method for diagnosing chest infections in ICU patients.
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PPT_JPNATC_BRONCHOALVEOLAR LAVAGE
- 1. Is Tracheal Culture using Mucous Extractor Technique as efficacious as Non Bronchoscopic Broncheoalveolar Lavage in diagnosing chest infection in ICU patients? MS CHRISTINA VARGHESE STAFF NURSE NEUROSURGERY ICU JPNA TRAUMA CENTRE, AIIMS NEW DELHI
- 2. Introduction 28.8% of all neurosurgical patients contract infections inspite of prophylactic antibiotics. 12.3%of neurosurgical patients develop chest infections. 9-27% of all intubated patients develop VAP.
- 3. Background Respiratory secretion culture is used to assess chest infections of intubated patients. Routine procedure followed by the nurses in Neurosurgery ICU, JPNATC for obtaining respiratory secretion is by Mucous Extractor. Tracheal Culture using Mucous Extractor Technique (TCMET) is believed to be inferior to the Non Bronchoscopic BAL (NBBAL).
- 4. Aims & Objectives To assess the efficacy of TCMET in determining the chest infection. To assess the consistency in the results of chest infection between TCMET and NBBAL.
- 5. methodology Research Approach : Quantitative Research Design : Prospective Sampling Technique : Purposive sampling technique (Adult, intubated) Sample Size : 30 Sample Setting :TC3 ICU, JPNATC Duration of Study : September-October, 2011
- 6. Methodology Two samples of tracheal aspirate of each patient were obtained on the same day- 1) TCMET, by Nurses 2) NBBAL, by Doctors Both these tracheal aspirate samples from each patient were sent for culture.
- 7. Tracheal Culture using Mucous Extractor Technique (TCMET)
- 8. Tracheal Culture using Mucous Extractor Technique (TCMET)
- 9. Tracheal Culture using Mucous Extractor Technique (TCMET)
- 10. Tracheal Culture using Mucous Extractor Technique (TCMET)
- 11. Tracheal Culture using Mucous Extractor Technique (TCMET)
- 13. Articles for NBBAL On a sterile surface Two Suction catheters:16G & 10G A pair of gloves 500mL NS bottle with 100mL NS NS for flushing catheter tip Sterile blade
- 14. Preparation of Collection bottle To To the Suction Suction Catheter Unit Apparatus
- 15. Technique of NBBAL Cut short larger suction catheter (16G) by 2 from the distal end
- 16. Technique of NBBAL Insert smaller suction catheter (10G) into larger catheter.
- 17. Technique of NBBAL The tip of the smaller catheter is within larger catheter prior to introduction into ETT
- 18. Technique of NBBAL Introduce & advance this catheter unit till end of ETT
- 19. Technique of NBBAL Advance smaller catheter beyond larger catheter to collect respiratory secretions
- 20. Technique of NBBAL Withdraw smaller suction catheter into the larger catheter
- 21. Technique of NBBAL Withdraw the catheter unit from the ETT
- 22. Technique of NBBAL Flush smaller catheter with normal saline to collect into the collection bottle
- 23. Findings Of the total of 30 patients, 73.3% (n=22)were males having an average age of 37 years (19-60 yrs) and had been intubated for an average of 4.2 days(2-10 days) .
- 24. Findings 30 27 25 21 20 15 10 9 5 3 0 TCMET NBBAL Positive Culture Sterile
- 25. Findings (Gold Standard Test) NBBAL (Gold Standard) POSITIVE NEGATIVE TOTAL POSITIVE 3 (TP) 6 (FP) 9 TCMET NEGATIVE 0 (FN) 21 (TN) 21 TOTAL 3 27 30 TP = True Positives TN = True Negatives FP = False Positives FN = False Negatives
- 26. rESULT The probability that TCMET will show a positive culture result for an infected patient is 100% (Sensitivity). The probability that TCMET will show a negative culture result for a non infected patient is 77.8% (Specificity).
- 27. Result (Contd.) When a positive culture result is observed, there is 33.3% that it is infected (Positive Predictive Value). When a negative culture result is observed, there is 100% probability that it is non infected(Negative Predictive Value). 80% samples have been correctly diagnosed by TCMET (Diagnostic Accuracy).
- 28. TCMET Diagnostic Accuracy True Report False Report 20% 80%
- 29. Conclusions TCMET is highly effective in diagnosing chest infection in ICU patients. TCMET is cost effective and a time effective method. As TCMET can be done by the nurses, it is therefore recommended as a SOP in ICU patients.