how you keep your ET tubes supper sterilized?

RE: how you keep your ET tubes supper sterilized?

Alison Clare Hickman — Sun, 11 Aug 2019 10:52:27 GMT

I'll reply to my own post... I guess I've argued myself into the corner that *whatever* cleaning and disinfecting routine you use (including Chlorhexidine) it is the rinsing afterwards that is the important final step to remove any remaining irritant product. The water used, as I've stated, should be free from biofilm contamination.

There. That's it. In a nutshell. Solved. Gimme a medal...

RE: how you keep your ET tubes supper sterilized?

Alison Clare Hickman — Sun, 11 Aug 2019 10:43:02 GMT

Well, I fell down a wormhole researching this... There are a *lot* of previous posts just on vetnurse, let alone elsewhere, about same and pulling those together with my own experiences and the comments/ideas in this post here are my thoughts...

1. Chlorhexidine gluconate can cause tracheitis (can't reference it but lots of anecdotal evidence). Its true purpose is as a skin disinfectant and is also used successfully to clean/disinfect surgical instruments. However, it should not be used on mucous membranes. Ergo, I would avoid it for cleaning et tubes. 'Just in case' of failed sufficient plain water rinsing (query biofilm contamination from tap water??) and resulting oral/tracheal irritation.

2. Use diluted washing up liquid with hot water to remove mucous/gross contamination, rinse well, then follow with cold sterlisation in something like Medistel instrument disinfectant or equivalent. Observe strict soaking times. Rinse well with water. Could replace the washing up liquid with, say, Medistel Enzymatic cleaner instead... but that's more costly than w/up liquid...

3. Use Milton sterilising fluid or tablets after cleaning. Seems to be a popular choice and is successfully used to sterilise neonatal feeding equipment in hospitals... Rinse well.

4. Choice of cleaning and disinfecting routine followed by gas autoclaving.

5. Choice of cleaning and disinfecting followed by hanging to dry.

6. Put away in drawers after drying.

7. Hang on a rack after drying. Importantly a. Not in theatre and b. Not near dental machine (aerosol contamination)

8. Hang in a posh bespoke glass fronted cabinet. Oooh. Hexxxxpensssivvve.

One comment I found to be a very useful reminder.... When undergoing regular practice swab-test routines, don't forget to swab your et tubes and lumen cleaning brushes too The reporting nurse found pseudomonas on their tubes and cleaning brushes...

In summary: choose the cleaning and disinfecting protocol your practice prefers. There are several to choose from to suit every pocket and required level of sterility. Observe correct dilution and soaking times. Rinse rinse rinse rinse in purified water unless you are sure that your tap water is biofilm-free... Clean, disinfect and dry your lumen brushes and store them hygienically.

Autoclave if you wish - by gas would be the preferred method.

Store your dry tubes away from aerosol or other potential contaminations.

Conduct regular "how clean is my practice?" Swab tests. Act on any findings.

Phew. That's a few hours I'll never get back in my life... Hahahaha

RE: how you keep your ET tubes supper sterilized?

James Colver Cert. Ed, RVN — Sat, 10 Aug 2019 17:46:03 GMT

lol, just finished writing a piece on the evils of red rubber tubes, but that's another discussion altogether

RE: how you keep your ET tubes supper sterilized?

apache — Sat, 10 Aug 2019 14:26:25 GMT

[quote user="Nick Shackleton "]These tubes are meant to be single use only so we should be cleaning them as thoroughly as possible [/quote]

We use the traditional reusable rubber ones. I'm not re-using an item designed to be disposable, that seems unnecessarily risky and you might as well bend over and remove your own pants if anything goes wrong. In a time where we are concentrating on waste production then I really cannot see any reason to use a disposable tube with packaging and shipping when a reusable one is perfectly suitable and lasts a very long time if looked after.

[quote user="Alison Clare Hickman"] ummmm, have you ever met an RVN before?!?! (joking) - we are always obsessed with asepsis, cleaning and getting rid of anything remotely icky [/quote]

I appreciate that, hence my suggestion of warm/hot soapy water. Remove all contamination on the outside and run a brush through the inside. We'd do the same as an initial clean for contaminated instruments before autoclaving. I see no reason why we need to attempt to 'sterilise' ET tubes if free from any infectious material.

RE: how you keep your ET tubes supper sterilized?

jen09 — Sat, 10 Aug 2019 14:03:59 GMT

We have one nurse who insists everything(E.T tubes and surgical equipment) should be soaked in hibiscrub before soaking in Reprochem enzymatic cleaner, and then Reprochem High level instrument disinfectant. Can anyone shed any light to using hibiscrub on everything?

RE: how you keep your ET tubes supper sterilized?

James Colver Cert. Ed, RVN — Fri, 09 Aug 2019 20:45:29 GMT

I ask two questions in discussions like these where there is little evidence to draw from -

1) What would I have done for myself or my dog?

2) What are the majority of my counterparts doing?

RE: how you keep your ET tubes supper sterilized?

Alison Clare Hickman — Fri, 09 Aug 2019 09:36:50 GMT

apache [quote user="apache"]Why this obsession?[/quote] - ummmm, have you ever met an RVN before?!?! (joking) - we are always obsessed with asepsis, cleaning and getting rid of anything remotely icky

RE: how you keep your ET tubes supper sterilized?

Nick Shackleton — Fri, 09 Aug 2019 09:28:16 GMT

We clean in enzymatic cleaning solution then cold sterilise for 15 mins. Then rinsed thoroughly in water and hung to dry. Ensure that the cuff is inflated to ensure this area is cleaned well too.

Any tubes used for a patient with confirmed or highly suspicious of infectious/contagious disease then that tube is binned.

These tubes are meant to be single use only so we should be cleaning them as thoroughly as possible

RE: how you keep your ET tubes supper sterilized?

apache — Thu, 08 Aug 2019 22:37:09 GMT

Why this obsession? Has anyone ever seen an issue of infection transferred via ET tube? The mouth, throat and URT is not a sterile environment. I agree it's unacceptable not cleaning them properly, but I'm sure we've all used a cup that has been washed up in warm soapy water and we didn't pick up the herpes, Hepatitis, HIV or whatever that the previous user was carrying.

I'd be quite happy with hot soapy water unless a specific risk identified (would autoclave after known KC, suspected calicivirus in a cat etc).

RE: how you keep your ET tubes supper sterilized?

bumble bee — Thu, 08 Aug 2019 12:12:46 GMT

We use enzymatic cleaner & then soak for 15mins in miltons.

RE: how you keep your ET tubes supper sterilized?

James Colver Cert. Ed, RVN — Thu, 08 Aug 2019 06:46:36 GMT

We don't sterilise our tubes, just follow the 'usual' protocol with enzymatic/disinfectant but we keep them in a drawer - hate seeing them hanging up in prep rooms getting covered in all the dental spray etc.