1. Is Tracheal Culture using Mucous Extractor
Technique as efficacious as Non
Bronchoscopic Broncheoalveolar Lavage in
diagnosing chest infection in ICU patients?
MS CHRISTINA VARGHESE
STAFF NURSE
NEUROSURGERY ICU
JPNA TRAUMA CENTRE, AIIMS
NEW DELHI

2. Introduction
 28.8% of all neurosurgical patients contract
infections inspite of prophylactic antibiotics.
 12.3%of neurosurgical patients develop chest
infections.
 9-27% of all intubated patients develop VAP.

3. Background
 Respiratory secretion culture is used to assess chest
infections of intubated patients.
 Routine procedure followed by the nurses in Neurosurgery
ICU, JPNATC for obtaining respiratory secretion is by
Mucous Extractor.
 Tracheal Culture using Mucous Extractor Technique
(TCMET) is believed to be inferior to the Non
Bronchoscopic BAL (NBBAL).

4. Aims & Objectives
 To assess the efficacy of TCMET in determining the
chest infection.
 To assess the consistency in the results of chest
infection between TCMET and NBBAL.

5. methodology
 Research Approach : Quantitative
 Research Design : Prospective
 Sampling Technique : Purposive sampling technique
(Adult, intubated)
 Sample Size : 30
 Sample Setting :TC3 ICU, JPNATC
 Duration of Study : September-October, 2011

6. Methodology
• Two samples of tracheal aspirate of each patient
were obtained on the same day-
1) TCMET, by Nurses
2) NBBAL, by Doctors
• Both these tracheal aspirate samples from each
patient were sent for culture.

7. Tracheal Culture using Mucous Extractor Technique
(TCMET)

8. Tracheal Culture using Mucous Extractor Technique
(TCMET)

9. Tracheal Culture using Mucous Extractor Technique
(TCMET)

10. Tracheal Culture using Mucous Extractor Technique
(TCMET)

11. Tracheal Culture using Mucous Extractor Technique
(TCMET)

12. Non Bronchoscopic BAL(NBBAL)

13. Articles for NBBAL
On a sterile surface
•Two Suction catheters:16G & 10G
•A pair of gloves
•500mL NS bottle with 100mL NS
•NS for flushing catheter tip
•Sterile blade

14. Preparation of Collection bottle
To To the Suction
Suction Catheter Unit
Apparatus

15. Technique of NBBAL
Cut short larger suction catheter (16G) by 2” from the
distal end

16. Technique of NBBAL
Insert smaller suction
catheter (10G) into larger
catheter.

17. Technique of NBBAL
The tip of the
smaller catheter is
within larger catheter
prior to introduction
into ETT

18. Technique of NBBAL
Introduce & advance this catheter unit till end of ETT

19. Technique of NBBAL
Advance smaller catheter beyond
larger catheter to collect respiratory
secretions

20. Technique of NBBAL
Withdraw smaller suction catheter into the larger catheter

21. Technique of NBBAL
Withdraw the catheter unit from the ETT

22. Technique of NBBAL
Flush smaller catheter
with normal saline to
collect into the collection
bottle

23. Findings
 Of the total of 30 patients, 73.3% (n=22)were
males having an average age of 37 years (19-60 yrs)
and had been intubated for an average of 4.2
days(2-10 days) .

24. Findings
30
27
25
21
20
15
10 9
5 3
0
TCMET NBBAL
Positive Culture Sterile

25. Findings (Gold Standard Test)
NBBAL
(Gold Standard)
POSITIVE NEGATIVE TOTAL
POSITIVE 3 (TP) 6 (FP) 9
TCMET
NEGATIVE 0 (FN) 21 (TN) 21
TOTAL 3 27 30
TP = True Positives TN = True Negatives
FP = False Positives FN = False Negatives

26. rESULT
 The probability that TCMET will show a positive culture
result for an infected patient is 100% (Sensitivity).
 The probability that TCMET will show a negative culture
result for a non infected patient is 77.8% (Specificity).

27. Result (Contd.)
 When a positive culture result is observed, there is 33.3%
that it is infected (Positive Predictive Value).
 When a negative culture result is observed, there is 100%
probability that it is non infected(Negative Predictive
Value).
 80% samples have been correctly diagnosed by TCMET
(Diagnostic Accuracy).

28. TCMET
Diagnostic Accuracy
True Report False Report
20%
80%

29. Conclusions
 TCMET is highly effective in diagnosing chest
infection in ICU patients.
 TCMET is cost effective and a time effective method.
 As TCMET can be done by the nurses, it is
therefore recommended as a SOP in ICU patients.