American Association for Respiratory Care

Background: Bronchoscopy aids in viewing airway anatomy to determine treatment plans. Current infection prevention guidelines for bronchoscope reprocessing are rigid, time consuming, and create risk. Respiratory therapists (RTs) assist in bronchoscopy procedures from set up to equipment reprocessing. Cost often inhibits departments from purchasing unlimited reusable scopes which are fragile and limits availability. We aim to reduce risk in reprocessing, repair, purchase costs, and evaluate the convenience impact of disposable bronchoscopes (DB) in a 766-bed hospital facility (Level 1 Trauma Center, Academic Adult Care Facility). Methods: An IRB exempt retrospective review (7/1/2022 to 09/30/2023) assessed frequency and cost of bronchoscopy services for ICU patients (119 beds). Affected RTs and providers were educated on the use of DB. The new equipment and process was implemented in February of 2023 with appropriate education, EMR, and policy updates. The following data metrics were reviewed for the 7 months pre and post go live to determine impact: number of bronchoscopies completed, number of ventilator days, time per procedure, number of trained RTs, and cost per procedure. Results: After implementation of DB, RT time per procedure was reduced by 43 min. RT labor cost per procedure was reduced by $35.11, however supply cost per procedure was increased by $163.34 (excludes original capital purchase for reusable supplies). Additional capital costs for reusable bronchoscopes were estimated at $113.38 per procedure (based on 3,192 bronchoscopies over 7-year life span for 9 scopes and 3 carts). Ease of use of DB allowed for additional staff to be trained, increasing available trained RTs from 20% to 67.5% (Table 1). There was no difference in number of bronchoscopy procedures performed per 1,000 ventilator days pre- and post-implementation (27.01 to 28.18). The total additional cost for disposable equipment was $14.85 per procedure. Conclusions: Our facility prioritizes value efficiency, and while DB incurs added costs, reduced RT procedure time offsets labor expenses. The increase of trained RT caregivers for this procedure, increases availability, access, and provides opportunities for RT career growth. The absence of notable procedure increases suggests that enhancing access and availability may not significantly impact utilization. Further research must be done relative to infection prevention impact and within outpatient and pediatric care environments.Assessment of Utilization Pre- and Post-Implementation of Disposable Bronchoscopy Products Pre-Implementation(7/2022-1/2023)Post-Implementation(3/2023-9/2023)Reusable Procedures26718Disposable Procedures0246Total Procedures267264Ventilator Days9,5689,369Procedures per 1,000 Ventilator Days27.9128.18Table 1 details the number of procedures with reuseable and disposable bronchoscopy products in our adult facility pre- and post-implementation of disposable products.Cost Impact of Reusable vs. Disposable Bronchoscopes Reusable BronchoscopesDisposable BronchoscopesRT Time per Procedure78 min35 minNumber of RT Trained / Total RTs15 / 7450 / 74Average Wage of Trained RTs$45.11$40.33RT Labor Cost per Procedure$58.64$23.53Material Cost per Procedure$18.95$350.00Reprocessing Cost per Procedure$90.00$0.00Maintenance Service Contract per Procedure$77.71$0.00Total Cost per Procedure (excluding capital investment)$245.30$373.53Total Capital Investment$361,908.96$0.00Total Cost per Procedure (including capital investment)$358.68$373.53Table 2 reviews the cost impact of service delivery with each product line in our adult facility.

Children requiring a tracheostomy to maintain airway patency or to facilitate long-term mechanical ventilatory support require comprehensive care and committed, trained, direct caregivers to manage their complex needs safely. These guidelines were developed from a comprehensive review of the literature to provide guidance for the selection of the type of tracheostomy tube (cuffed vs uncuffed), use of communication devices, implementation of daily care bundles, timing of first tracheostomy change, type of humidification used (active vs passive), timing of oral feedings, care coordination, and routine cleaning. Cuffed tracheostomy tubes should only be used for positive-pressure ventilation or to prevent aspiration. Manufacturer guidelines should be followed for cuff management and tracheostomy tube hygiene. Daily care bundles, skin care, and the use of moisture-wicking materials reduce device-associated complications. Tracheostomy tubes may be safely changed at postoperative day 3, and they should be changed with some regularity (at a minimum of every 1-2 weeks) as well as on an as-needed basis, such as when an obstruction within the lumen occurs. Care coordination can reduce length of hospital and ICU stay. Published evidence is insufficient to support recommendations for a specific device to humidify the inspired gas, the use of a communication device, or timing for the initiation of feedings.

Among children and adolescents age 6 million children in the United States (8.4% of the population), resulting in almost 3.2 million asthma exacerbations annually (51% of children with asthma experience an exacerbation).[1][1] Both rescue and daily preventive

AimsThe aim of this study was to provide recommendations for training patients with hereditary angioedema, based on nursing clinical trial experience, to self‐administer subcutaneous C1‐INH (C1‐INH[SC]) used as routine prophylaxis.BackgroundA volume‐reduced, subcutaneous C1‐INH concentrate (C1‐INH(SC); HAEGARDA®; CSL Behring) was recently FDA‐approved for the routine prevention of hereditary angioedema attacks. Nurses will play an important role in patient training.DesignReview of a phase 3, randomized, placebo‐controlled, double‐blind, crossover trial of C1‐INH(SC) (COMPACT) and summary of recommendations for training patients based on nurses’ “hands‐on experience.”MethodsA panel of nurses with clinical trial experience provided recommendations for patient training.ResultsPractical suggestions and guidelines were compiled regarding patient selection, product reconstitution and administration and patient follow‐up. Successful patient self‐administration of C1‐INH(SC) can be greatly facilitated by qualified nursing intervention. The information provided in this paper will be useful to nurses anywhere who have an opportunity to interact with patients dealing with hereditary angioedema.

As we approach the end of the second decade of the twenty-first century, we must continue to move forward with an enlightened vision, building on the tremendous advancements made by the concrete pipe industry since its formation in the early 1900s.

As respiratory therapists spend 24 h per day with critically ill newborns in a neonatal intensive care unit, respiratory care is essential to the eventual recovery and discharge of these fragile patients with cardiopulmonary manifestations.

This article is an executive summary of a report from the Centers for Disease Control and Prevention Ventilator-Associated Pneumonia Surveillance Definition Working Group, entitled “Developing a new, national approach to surveillance for ventilator-associated events” and published in Critical Care Medicine. The full report provides a comprehensive description of the Working Group process and outcome.In September 2011, the Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group to organize a formal process for leaders and experts of key stakeholder organizations to discuss the challenges of VAP surveillance definitions and to propose new approaches to VAP surveillance in adult patients (Table 1).

Keywords: ventilator-associated pneumonia; intensive care unit; epidemiology; public health; critical care; mechanical ventilation

In September 2011, the Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group to organize a formal process for leaders and experts of key stakeholder organizations to discuss the challenges of VAP surveillance