70 Purpose-built Catheters for Minimally Invasive Surfactant Therapy – Experience from a Canadian Tertiary Level Neonatal Intensive Care Unit
Authors: Bhattacharya Soume , Harthy Talib Al , Lepore Natasha , DaSilva Orlando , Miller Michael 
Published: September 2023

Abstract

Background
Surfactant delivery via a thin endotracheal catheter during spontaneous breathing (a technique called minimally invasive surfactant therapy [MIST]), is an increasingly popular alternative to intubation and surfactant administration. Procedural details among different centres vary, with marked differences in the choice of catheter to instill surfactant. Studies report use of feeding catheters, multiaccess catheters and vascular catheters for this purpose. Recently, purpose-built catheters for MIST received regulatory approval in Canada and became available for use. Procedural differences and user experiences between such catheters have not been described.

Objectives
The aim of this study was to describe procedural success, procedural adverse effects and user experience pertaining to two different types of purpose-build catheters (BLEScath™ and Surfcath™) for surfactant administration.

Design/Methods
This was a retrospective review of prospectively collected data at a tertiary care neonatal intensive care unit (NICU) in Southwestern Ontario. Neonates who received MIST using purpose-built catheters between January 1, 2021 and March 31, 2022 were included. Two types of purpose-built catheters were used in this time period: Surfcath™ and BLEScath™. Relevant baseline characteristics and data on procedural details (premedication, type of catheter) were collected. The procedural success, number of attempts and adverse effects among neonates who received MIST via Surfcath™ and those who received surfactant via BLEScath™ were compared, using chi-square tests or Fisher’s tests, as appropriate. User experience was described using an ease-of-use scale. Descriptive reports of user experience were collected and explored for themes/patterns. P-values &lt;0.05 were considered statistically significant.

Results
37 neonates met eligibility criteria; 22 received MIST via Surfcath™, whereas 15 received MIST via BLEScath™. Success rates were 91% in SurfCath™ and 93% in BLES-Cath (P&gt; 0.994). Failed attempts were lower in Surfcath™ (23%) compared with BLEScath™ (33%), but the difference was not statistically significant (p=0.708). Upon analyzing ease-of-use by operators, we found that 90% of operators found Surfcath™ very easy or relatively easy to use, compared with 43% of users reflecting the same degree of use with BLEScath™ (P=.021). Users described difficulty in ‘maneuvering’ the BLEScath™ and reported it to be ‘pliable/ flimsy’. There was no difference in adverse events between groups.

Conclusion
This is the first study in Canada to report the experience of MIST with purpose-built catheters. Overall success rate was equally high for both catheters. Users subjectively reported higher ease of use with SurfCath™. Commercially available purpose-built catheters should facilitate universal adaptation of the MIST method. Our reports regarding operator experience may help with optimizing future product design to improve ease-of-use.