New Suction Catheter Curbs Ventilator Microaspiration Risk

A novel subglottic suction system positions a suction catheter above the endotracheal tube (ETT) cuff, reducing the risk of ventilator-associated pneumonia (VAP).

The Vyaire Medical (Mettawa, IL, USA) Tri-Flo subglottic suction system is intended for the removal of secretions in orally intubated patients above the ETT cuff; Tri-Flo can be used with most standard breathing tubes. The single-use system includes a 14FR suction catheter, a suction guide, and a plastic securement clip with a clear silicone strap. The system is compatible with ETTs seven to 8.5 mm in diameter, eliminating the need for specialty ETTs. A slim system profile allows easy tracking over the ETT for easy access, with a white handle marked with a clear insertion depth indicator.


Placement directly over the ETT cuff ensures tighter miscroaspiration control, thus reducing the leakage of pathogen-laden secretions past the ETT cuff into the lower respiratory tract, one of the main causes of VAP. Benefits of the system include easy placement, even after intubation, with the catheter kept securely in place with the provided clip; integrated eyelets and a control port that help increase suction efficiency; reduction in clogs; catheter changes that are quicker and easier than tube replacement; and reduced trauma to the patient.

“We developed a delivery device, the Tri-Flo subglottic suction system, that enables the care provider to get a suction catheter to the cuff post-intubation,” said mechanical engineer Kate Garrett, VP of airway technologies at Vyaire, and co-developer of the Tri-Flo subglottic system. “If a patient who has the basic tube in place comes into the ICU, you can effectively convert them, leaving the suction catheter in place to continuously or intermittently suction off fluids over their stay.”

“If your patient is intubated by the EMS in the field and you know that patient will require long-term care, you have the option of pulling out the standard tube and putting in a specialized endotracheal tubes, which can be dangerous, or using the Tri-Flo subglottic suction system,” said professor Richard Branson, MD, of the University of Cincinnati (OH, USA). “It’s a very simple but clever and effective way to do something everyone wants to do, but hasn’t.”

Tube related reflux and secretion may cause VAP, acute kidney injury (AKI), and aspiration pneumonia (AP), serious complications that can lengthen hospital stays and even be fatal. Currently, ICU nurses and doctors must monitor for such complications, but due to the constant nature of intubation, many time-sensitive abnormalities go unnoticed, resulting in a high complication rates; 25% of ICU patients develop VAP and nearly half of those patients never recover. Another 50% of patients who are admitted to an ICU and stay more than 24 hours end up with an AKI.

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