A~WTRAUAN C R ~ C A L CARE VOL 5 NO 1 MARCH 1992

COST AND ENVIRONMENTAL COMPARISONS OF TWO TRACHEAL SUCTlONlNG TECHNIQUES L Mackey, St Vincent's Hospital, Melbourne, Victoria

Environmental considerations in clinical practice have implications for the purchasing of equipment utilised in the delivery of patient care within the intensive care unit. A study was undertaken to compare the cost and the environmental impact 01 the Y-Catheter suctioning technique (YCST) with the Closed Catheter Suctioning Technique (CCST) in mechanically ventilated patients over a 24 hour period.

The study sample consisted of 10 male patients with ages ranging from 17-74 years. Ten patient days were allocated to each group. The trial was a randomised crossover design in which the YCST was used on odd days and the CCST on even days, thus each patient participated in both arms. All equipment used and all waste produced were recorded for each 24 hour period and compared from cost and environmental perspectives. The data were analysed with paired t-tests.

The cost of equipment and disposal were similar for both techniques although there was a trend for lower costs for the YCST.

COSTS: $YCST $1 9.99 f 8.35SD CCST: $24.1 1 f 2.73SD P = 0.10

YCATH CLOSED pVALUE W C HCI residues 268 119 4.01

Latex 114.0 10.4 4.01 co2, H20

This study demonstrates that the YCST, although marginally cheaper, results in greater production of PVC, latex and paper than the CCST. Furthermore the results of this study have implications for the future purchasing of equipment in the lntensive Care Unit, where environmental considerations should form an integral factor.

COST ANALYSIS OF MASK CPAP COMPARED TO OXYGEN ALONE IN THE MANAGEMENT OF ACUTE RESPIRATORY FAILURE DUE TO CARDIOGENIC PULMONARY OEDEMA S Fuller, A Bersten, A Holt lntensive Care Unit, Flinders Medical Centre Adelaide, Soutb Australia

lntensive Care Units (ICU) are being challenged to justify their resource allocation. Therefore, examination of cost effectiveness will be an important corollary to dinical efficacy for any new therapy. We have shown mask CPAP is beneficial in cardienic pulmonary oedema. The following cost analysis now completes the evaluation of mask CPAP in this study.

Thirty-nine patients were randomised to receive oxygen via mask CPAP (19 patients) or oxygen alone (20 patients). Using the South Australian ICU Costing and CaseMix Study, the direct costs of each ICU episode were determined. This involved costing all consumables, pharmaceuticals, investigations, and medical and nursing personnel.

Results:

02 abne: CPAP.02 Total Non- Ventllated

ventilated

Noof Patients 19 20 13 7 Days in ICU 1.2 2.7 1.7 4.6 Episode Cost 922 2,654 1,274 5,216 Daily Cost 768 983 750 1134

PERCENTAGE OF TOTAL COST:

02 alone: CPAP.02 Non- Ventlated

ventilated

Consumables 4 2 6 Pharmaceuticals 2 2 3 Investigations 19 19 17 Medical 36 37 24 Nursing 39 40 50

No mask CPAP patient required mechanical ventilation compared to 7(3%) of the oxygen alone. CPAP demonstrated bwer episode cost then the oxygen alone due to shorter stay, even excluding the ventilated patients. The increase in cost with ventilation is due to both length of stay and nursing intensity.

Concluslon: While the use of mask CPAP will result in a significant increase in ICU admissions, the estimated overall savings will be $90,000 per 100 patients in our Unit.

'CARING' IN INTENSIVE CARE NURSING C Spratt NSW College of Nursing Glebe, NSW

Altruistic caring laid the foundation for contemporary nursing practice. Care as a moral imperative remains of interest to nursing researchers and scholars. If care is seen as central to nursing practice, then it should follow that care is central to lntensive Care Nursing practice. Such a notion of care however has avoided situating care of the physical body as an explicit, visible and essential component of nursing practice. Physical care of the body has been seen as women's work and dirty work - debased and devalued. Those clinicians who were situated at the base of the nursing hierarchical tree, junior student nurses and enrolled nurses, were delegated this dirty work or basic nursing care.

Contemporary scholars in nursing provide evidence that physical care of the body is fundamental to nursing practice. Some argue that caring is nursing's metaparadigm. This paper will suggest that the physical care of the body is central to nurses work and demands, especially in the lntensive Care setting, the practice of intelligent, informed, well educated registered nurses. There should be no place for ancillary non registered nursing staff in a dinical practice setting which considers care and all its connotations, the essence of the skilled intellectual, practice of intensive care nurses.