Impact of Practice Changes for Frequency of Heated Circuit Replacement

Background: The AARC Clinical Practice Guideline (AARC CPG) for care of the ventilator circuit does not recommend routine circuit change for infection control purposes. Based on this, our practice for routine change of heated circuits was every 30 days unless visibly soiled. Joint Commission standards require that evidence-based guidelines cannot be less strict than manufacturer instructions for use (MIFU). MIFU frequency of replacement vary depending on the circuit type, ranging from 7-14 d for most circuits and 30 d for an oscillator circuit. The aim of this study was to evaluate the impact of replacing circuits per MIFU. Methods: A retrospective chart review (1/1/23 to 12/31/23) was completed to quantify the number of heated circuits utilized based on the number of documented days per modality of respiratory support for invasive mechanical ventilation (IMV), noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), and heated tracheostomy collar (HTC). Number of days per modality was used to calculate the number of circuits based on AARC CPG and MIFU frequency of replacement. MIFU for the NIV, HFNC, and infant invasive MV circuits we utilize recommend changing every 7 d. Replacement for HTC and adult MV circuits is recommended every 14 d. Change within modality was analyzed with 2-tailed Wilcoxon matched pair signed rank test. Variation between modalities was analyzed with Kruskal-Wallis followed by Dunn’s multiple comparisons test. Results: There were 1,501 admissions (401 used > 1 respiratory support modality). 59% (891) of the admissions were ≤ 7 d. HFNC was the most used modality during all admissions (1,052, 70%) followed by IMV (569, 38%), NIV (322, 21%), and HTC (69, 5%). A shift from AARC CPG to MIFU frequency of replacement would result in a 62% increase in the total number of circuits (2,688 vs. 4,362). IMV, NIV, HFNC, and HTC will increase 111%, 60%, 23%, and 48% respectively (P < .001 for each modality) (Figure 1). HFNC modality had the lowest impact when compared to other modalities (P < .01) with no statistically significant difference among the others. The most ordered circuit would change from HFNC to IMV when switching from AARC CPG to MIFU guidelines. Conclusions: Change in practice to replace circuits per MIFU will increase the number of circuits utilized for all modalities with a heated circuit, with the greatest impact on IMV. The implications extend beyond cost including procurement, tracking, documentation, and staffing.