Protocol for cleaning ET tubes

RE: Protocol for cleaning ET tubes

Dove — Fri, 01 Dec 2017 00:37:42 GMT

We rinse out and soak in instrument disinfectant (reprodis), we use e/t brushes to clean inside and out, followed by a rinse and a 15 minute soak in Miltons. They are then left to air dry.

When my baby was in the neonatal unit all the baby bottles and feeding equipment were soaked in Miltons.

RE: Protocol for cleaning ET tubes

Aims_RVN — Thu, 30 Nov 2017 08:20:40 GMT

What about milton? No issues with inhalation burns etc on the data sheet. 'no need to rinse' and 'sterile for 24hrs' any thoughts?

RE: Protocol for cleaning ET tubes

Meow1950 — Wed, 29 Nov 2017 20:36:47 GMT

[quote user="amie grey"]

You're right, but when i researched into the chemical options they had warnings for airway irritation and burns from inhalation. Hibi causes ulceration (there an article link posted above) although i feel it is easier to ensure it is fully washed off compared to chemical soaking into the plastic?

I think they are one use for a reason but i'm sure we can get some more life out of them! Otherwise GA prices are forever going up with changes.

[/quote]

I have to say we had no issues in the practice that I worked in that used chemical sterilisation. They were all rinsed thoroughly and as someone else mentioned the cuffs were inflated during disinfection and also rinsed thoroughly before deflating again. But just because we didn’t have any issues doesn’t mean they don’t exist. Do you still have any of the articles you read about them causing irritation? Would be good to have a read and see what the best option is

RE: Protocol for cleaning ET tubes

talchi — Wed, 29 Nov 2017 14:22:35 GMT

we remove from the patient, rinse, then soak in a milton solution for an hour or so. we then rinse and air dry. we store on a rack in an enclosed cupboard...

RE: Protocol for cleaning ET tubes

apache — Tue, 28 Nov 2017 21:48:57 GMT

[quote user="Susanna Taylor"]store in covered area - I believe this is now part of the RCVS practice guidelines[/quote]

Careful now, this is how silly 'rules' become enshrined in folklore. There's 3 mentions of endotracheal tubes in the small animal PSS standards:

1.2.6 A range of endotracheal tubes must be available

18.2.9 Endotracheal tubes and anaesthetic circuits should not be stored on the wall of the operating theatre

Furthermore if you are going for an award then you additionally have to look at:

1.5.5 Endotracheal tubes and breathing systems must be cleaned and stored appropriately. Systematic approach to maintaining cleaning and disinfection standards. Team members will be asked to explain the process.

RE: Protocol for cleaning ET tubes

Susanna Taylor — Tue, 28 Nov 2017 12:15:33 GMT

My preferred cleaning protocol

1) Dont let dirty tubes dry out as is harder to clean, so either wash quickly or leave to soak in water. Could use enzymatic cleaner but would need to check maximum contact time. leaving cuffs partially inflated helps too. Risk of fully inflated is that they get damaged, but depends on what else is in the tub with them.

2) scrub with soft brush all over, rinse

3) disinfect in any disinfectant suitable for surgical instruments for correct time

4) rinse, rinse, rinse, inside and out

5) leave to dry, deflate cuff

6) store in covered area - I believe this is now part of the RCVS practice guidelines, but at least good practice to prevent airborne contaminations. Here is a picture of a custom made perspex cover for an ETT rack

Personally, I'm not a fan of disposing things where there is a way to clean them; just for the sake of being green.

RE: Protocol for cleaning ET tubes

Aims_RVN — Tue, 28 Nov 2017 11:30:16 GMT

I think they are one use for a reason but i'm sure we can get some more life out of them! Otherwise GA prices are forever going up with changes.

RE: Protocol for cleaning ET tubes

Aims_RVN — Tue, 28 Nov 2017 11:26:22 GMT

From dental procedures yes, although the cuffs are inflated and soaked in hibi. Our in-house dermatologist reckons Chlorhexidine may be showing to be ineffective for some bugs now, perhaps this may become a regular issue with those using hibi in their protocols?

As scary as the thought may be, we have actually autoclaved some tubes (they didn't melt hoorah) so with a clean slate we are going to store them covered in a draw then re-swab to check for any issues. Fingers crossed, otherwise regular throw outs of tubes and chemical disinfection may be the only way forward other than using only as one use and increasing GA prices.

RE: Protocol for cleaning ET tubes

Alison Clare Hickman — Tue, 28 Nov 2017 11:15:53 GMT

[quote user="Chris Geddes"]Is blood on your ET tubes a regular occurrence?![/quote]

Chris Geddes - yes it will be for dental procedures!

RE: Protocol for cleaning ET tubes

Chris Geddes — Tue, 28 Nov 2017 10:53:39 GMT

Is blood on your ET tubes a regular occurrence?!

RE: Protocol for cleaning ET tubes

Meow1950 — Mon, 27 Nov 2017 21:29:51 GMT

My personal opinion is that the ideal procedure is soaking in enzymatic cleaner to breakdown blood, mucus etc followed by a manual clean with a brush, followed by a disinfectant suitable for cleaning tubes (someone help me out with the name, medistel?). And then hung on a rack away from possible contamination. Obviously to avoid irritation or degradation of the ET tubes the correct concentration and soaking times should be observed.

It was my understanding that hibiscrub was a tracheal irritant? I may be wrong...

I suppose in an ideal world all ET tubes should be one use only

RE: Protocol for cleaning ET tubes

Robyn — Mon, 27 Nov 2017 17:18:31 GMT

We clean with hibi, soak in Milton for 15-20min, and scrub before rinsing thoroughly. The ET brushes also get soaked at the same time. I'd be interested to have a few swabs done too right enough! Ours also get stored on a rack in kennels/prep, but I don't think we'd physically have anywhere else to store them. Something worth thinking about though, I've always felt weird about how close to the sink they are...

RE: Protocol for cleaning ET tubes

Chris Geddes — Mon, 27 Nov 2017 16:06:39 GMT

More and more people are using ET tubes once, and I'd say your Pseudomonas culture would push me further towards the door! Also think about the time you would save not washing and drying etc - ok not a huge amount, but nor is the cost of a single use ET tube. If you wanted to, you could could always put a few pounds onto the cost of an anaesthetic to pay for them. If you do re-use, enzymatic cleaner would be better - CHX is known to cause pharyngeal burning - see link below. Also best to store them in a cupboard not out in the open where they're likely to become covered in bugs!

https://veterinarypracticenews.com/the-pros-and-cons-of-scrubbing-with-betadine-chlorhexidine/

RE: Protocol for cleaning ET tubes

James Colver Cert. Ed, RVN — Mon, 27 Nov 2017 09:32:16 GMT

Hi - it's a contentious issue but I like to soak them in enzymatic cleaner (e.g. enzystel, brush through, (pipe cleaner for smaller tubes) then into disinfectant (e.g. medistel) for no longer than 30 mins, rinsing THOROUGHLY - cuff inflated throughout.

As for racks in the prep room - maybe keeping them in a drawer would be a better idea - especially if you do dental work / ear flushing in the prep room as well..?