Single-use versus multiple-use endotracheal suction catheters flushed with chlorhexidine in mechanically ventilated ICU patients: A study protocol of a feasibility randomized controlled trial with an embedded qualitative study.

Background: Endotracheal suction catheters are often used multiple times during endotracheal suctioning procedures in resource-limited intensive care units (ICU). The impact of this practice on mechanically ventilated patients' outcomes remains unclear.

Aim: The aim of this feasibility randomized controlled trial (fRCT) is to assess the feasibility and acceptability of single-use versus multiple-use endotracheal suction catheters flushed with chlorhexidine in mechanically ventilated ICU patients.

Design: This study is a three-armed fRCT with an embedded qualitative study.

Methods: The trial involves three groups. One group includes endotracheal suctioning using a single-use catheter; the second group includes a multiple-use endotracheal suction catheter flushed with chlorhexidine and the control group includes a multiple-use endotracheal suction catheter flushed with normal saline. Sixty adult ICU patients (20 in each group) will be recruited, along with 12-16 ICU nurses delivering the interventions, and 12-16 patients' next-of-kin for semi-structured interviews. The study protocol has been approved by two ethics committees. Study recruitment will be conducted over an 8-month period with an expected start date of 12 April 2024.

Outcome measures: The feasibility outcome measures will be recruitment, retention, and follow-up measures as well as the identification of clinical outcomes such as Ventilator-Associated Pneumonia (VAP) using the modified clinical pulmonary infection score, and ICU length-of-stay.

Relevance to clinical practice: This study will help ICU nurses to understand how different methods of endotracheal suctioning affects patients in ICUs with limited resources. The findings could influence clinical practice and improve patient outcomes.