Single‐Use Versus Multiple‐Use Endotracheal Suction Catheters in Mechanically Ventilated Patients: A Feasibility Randomised Controlled Trial

BACKGROUND: In resource-limited settings, single-use open endotracheal suction catheters are commonly used multiple times. The current evidence of this practice on ventilator-associated pneumonia (VAP) among mechanically ventilated patients remains unclear. AIM: The aim of this study was to test the feasibility of single-use and multiple-use endotracheal suction catheters flushed with chlorhexidine versus standard care (multiple-use endotracheal suction catheters flushed with normal saline) to reduce VAP in resource-limited intensive care units (ICUs) and evaluate study methods for designing a future definitive randomised controlled trial (RCT). STUDY DESIGN: A three-armed feasibility RCT was conducted in three ICUs at a university hospital in Egypt. RESULTS: Sixty mechanically ventilated patients were randomized into three groups: Intervention I group, single-use catheters, Intervention II group, multiple-use catheters flushed with chlorhexidine, and Control group (standard care) multiple-use catheters flushed with normal saline. Data on feasibility parameters, intervention adherence, and patient outcomes were collected. Recruitment and retention rates were high across all groups, with 96.7% (n = 58) of participants completing the 3-day follow-up and 93.3% (n = 56) completing the 6-day follow-up. Adherence to intervention protocols was excellent, with 100% of participants receiving the designed interventions. No adverse events were reported. Chlorhexidine flushing and single-use catheters were practical and successfully implemented. Challenges of budget constraints, supply shortages and the need for staff training were observed. The incidence of VAP was 31.6% in the Intervention I group, 26.3% in the Intervention II group, and 40% in the standard care group. The relative risk of developing VAP compared with the control group was 0.79 (95% CI: 0.51-1.23) for Intervention I and 0.66 (95% CI: 0.42-1.03) for Intervention II. CONCLUSIONS: A full-scale RCT comparing single-use and multiple-use catheters with chlorhexidine flushing is feasible in resource-limited ICUs. Further investigation into the effectiveness of interventions on VAP prevention is needed in future definitive RCTs. RELEVANCE TO CLINICAL PRACTICE: This study highlights the practical implementation of endotracheal suctioning strategies, such as chlorhexidine flushing and single-use suction catheters, to potentially reduce VAP in resource-limited ICUs. These findings can inform clinical decision-making and infection control. TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT06207513.