Novel connector improves inhaler delivery in ICU

The new inhaler connector RTC 24-V demonstrates fewer medication errors when compared with the 22M-22F, as shown in a study. Healthcare professionals in the intensive care unit (ICU) also prefer it in terms of safety and accuracy.

RTC 24-V “was better for patient safety as it reflected more accurate dose delivery and was found to be sturdier when used in the ventilator circuit,” said lead author QinHao Jonathan Ye from SengKang General Hospital, Singapore, Singapore. “It was also found to be well received and much preferred by our ICU healthcare professionals.”

In 2022, a nurse in the ICU found that the Seretide (salmeterol/Fluticasone) Evohaler, a commonly used inhaler, did not change its dose counter when used with the inhaler connector 22M-22F. Healthcare professionals considered this incident a medication safety issue.

Ye and colleagues then initiated education programs for healthcare professionals in the ICU and introduced the inhaler connector RTC 24-V. They weighed the new device against the existing 22M-22F connector in this comparative study.

There was a significant drop in doses, ranging from 15 to 63, in the dose counter of Seretide recorded before initiation and extubation among patients using the RTC 24-V compared with a drop in doses of 0 to 2 among those using 22M-22F. [Proc Singap Healthc 2024;doi:10.1177/20101058241241915]

In the surveys conducted before and after the study, 51 and 33 questionnaires were completed, respectively. After using the inhaler connector RTC 24-V, confidence in the administration of an accurate dose among healthcare professionals increased from 58.8 percent to 84.8 percent.

Likewise, participants expressing no issues that could compromise the safety of patients also increased from 0 percent to 51.5 percent. On the other hand, the number of healthcare professionals raising concerns about disconnections causing infections decreased from 51 percent to 9.1 percent. Notably, most of the respondents (93.3 percent) preferred the new inhaler connector RTC 24-V over the 22M-22F.

“Significantly fewer healthcare professionals found issues with the administration of inhalers using the RTC 24-V, and a great majority of them preferred the RTC 24-V over the existing 22M-22F inhaler connector,” Ye said.

“Usage of the new RTC 24-V not only addressed the patient safety aspect of inaccurate dose reflection and dose delivery, but it has increased the confidence level of healthcare professionals in the administering of metered dose inhalers in the ICU,” Ye added.

Tighter fit

Healthcare professionals in the ICU also found the new RTC 24-V connector to have a better fit to the ventilator circuit. In the past, the 22M-22F connector would be removed once the inhaler was administered. This was done previously because the connection to the ventilatory circuit was loose, and there had been incidents of accidental disconnections.

“With the RTC 24-V connector, it can be left in the inhalation limb of the ventilator circuit and used whenever it’s required,” Ye said. “Despite leaving the connector in the circuit for the entire period of mechanical ventilation, no accidental disconnections were found during the study period.”

In addition, the new inhaler connector is located beyond the Y-piece of the breathing circuit. Because of this, it does not contribute to apparatus dead space of the ventilator circuit. [Paediatr Anaesth 2017;27:1185-1192]

“As the RTC 24V is left in circuit throughout the period of mechanical ventilation, there will be less disconnections which might contribute to decreasing ventilator associated infections as well as making the administration of inhalers easier,” according to Ye and colleagues.

“Together with continued education to all staff on the appropriate use of MDIs and how to use the inhaler connectors, we hope that there will be an improvement in the effectiveness and accuracy of bronchodilator administration in the ICU,” Ye said.