Intubated Pt's Using Bedside Comodes - page 3

Ok...a few days ago an ICU nurse, at my facility, stated that stable intubated patients on the Unit use bedside comodes. My first thought was you are joking, right?! No, she was serious! I don't... Read More

  1. by   littleneoRN
    Trying to picture being awake enough to walk and not grossly uncomfortable and freaking out about being intubated.
  2. by   GreyGull
    Quote from littleneoRN
    Trying to picture being awake enough to walk and not grossly uncomfortable and freaking out about being intubated.
    Do you keep all of your patients totally snowed and do no sedation vacations, weaning protocols (meds and vent), neuro checks, orientation etc? On modern ventilators, many patients are comfortable enough to not require much sedation once the initial event is over and they have stabilized. Even if trached, a patient can not go to a subacute on Propofol. The patient's comfort level and weaning success are proportional to the expertise of the care providers at the bedside.
  3. by   littleneoRN
    Well, I work in the NICU, so it's all different. Our patients receive fairly small amounts of sedation while ventilated, but they aren't up at the commode either. We RARELY use drips for sedation. A little prn Ativan, Fentanyl, Morphine, Versed...that's about it. Some kids have no sedation at all. I don't do adult ICU, so I'm not an expert there. But being awake enough be to oriented isn't the same as awake enough to be upright and walking... I was kind of just joking though...because my imagination of what it feels like to have a tube in my throat isn't very...good...
  4. by   ErinS
    In my hospital system it is an EXPECTATION that pt's in the ICU that are recovering get up to the chair and ambulate as soon as possible. This is based on best practice. Our ICU's are also well staffed- 1 to 2 pt's per nurse with many RTs, CNAs, and PTs available for support. Intubation does not provide an exception to the rule. This has really decreased length of stay and improved outcomes. It may be a pain in the a$$ to ambulate a ventilated pt, but worth it when they walk back into the ICU in a few months fully recovered thanks to your hard work.
  5. by   NickiLaughs
    I think it's fantastic. I've never had the opportunity to have a stable enough pt on a vent to do it, or seen it, but I would love to.
  6. by   tryingtohaveitall
    In my 21 years in the PICU, I have seen us do this once with a very stable CF patient who was doing a slow wean.
  7. by   ICURN2011
    We have a few chronic vent patients in our ICU and they sit on chairs-so a bedside commode could be a possibility. We are starting a new initiative to mobilize these patients sooner to prevent complications (pressure sores, muscle deconditioning etc)
  8. by   ChicagoICUNurse
    Are we talking orally intubated patient? It seems a little interested to me. I have used a cardiac chair for a "stable" orally intubated ICU patient on several occasions.

    I must admit that I didn't read all the thread responses, but one thing pops into my mind regarding the airway. So if the patients extubates themself on the commode, what's the plan to handle that situation?? Then again, I work in neuro ICU and these patients are tubed for a reason.
  9. by   GreyGull
    Quote from ChicagoICUNurse
    Are we talking orally intubated patient? It seems a little interested to me. I have used a cardiac chair for a "stable" orally intubated ICU patient on several occasions.

    I must admit that I didn't read all the thread responses, but one thing pops into my mind regarding the airway. So if the patients extubates themself on the commode, what's the plan to handle that situation?? Then again, I work in neuro ICU and these patients are tubed for a reason.
    This truly is nothing that new and has been around for over 30 years that I've been in the ICUs. Commonsense should tell you this is not going to be practical to walk a patient who is immobile due to a TBI or CVA. Those patients may be trached and go to a subacute until they can go to an Acute rehab (if possible) where they may or may not walk again. Very, very different scenario than from a COPD exacerbation or ARDS recovery. This also is not something where a patient just graps his EVD and ventilator and trots over to the toilet. It takes a team effort with all disciplines. Sometimes just having a patient be weight bearing for a few seconds during that move to the cardiac chair can make a big difference in strengthening.

    Of course you must be comfortable with airways and know how to test for security. I don't trust all the new commercial holders which we use in neuro ICU so there is nothing tight around the neck. I prefer over the ear with old fashioned tape the same as we did over 30 years ago without problems for moving patients. The patient must also be able to cooperate enough to where they are no longer in restraints and can understand the words "don't pull it out". These patients are also not on sedation or paralytics or HFOV to where if they did lose the tube, there is time to calmly get the patient back to bed or even give them a trial off the ventilator while the RRT and RN stands by to re-intubate if necessary. If you panic, the patient panics and increases their work of breathing. I recommend this only be done in an ICU with experienced and confident health care providers who can convey that confidence to the patient.

    I sometimes find it safer than some of the scary moves on IFT ambulances or to CT Scan with 2 trees of pumps, a couple of chest tubes, a ventilator and a patient that just barely meets the size requirements for the sled.


    I posted this link earlier.

    UCSF

    http://www.ucsfcme.com/2011/slides/M...bilization.pdf

    Johns Hopkins

    http://www.hopkinsmedicine.org/dome/0711/top_story.cfm

    Indepth detail and more references.

    http://www.medscape.com/viewarticle/704498
    Last edit by GreyGull on Aug 11, '11
  10. by   ChicagoICUNurse
    @GreyGull--thanks for the links!

    I agree about the tube holders, too.
  11. by   wildnursebrendan
    Quote from SionainnRN
    I work in a Trauma ICU and standard practice is to trach 7 days after intubation, or if we know they are going to be intubated longer than a week to do the trach right away. I have never, ever seen someone ambulated while intubated or on a bedside commode! It's hard enough getting them into a cardiac chair and that's with using a slide board. We have PT/OT ordered right away, but ambulating usually starts once they are transferred out of our unit.
    I'm just a CNA but I believe in our ICU the max time intubated before requiring a trach is 14 days. It's not uncommon to have vented patients up out of bed. We bring in a PT, an RT, the RN and I, and PT basically takes charge making sure we don't push them further than we should. They can appropriately use the call light and are off propofol. Sometimes we will walk them with PT and RT present. There is just our CCU and the Med/Surg floors, so we don't transfer them out. They stay ICU status.
  12. by   SICUmurseCCRN
    in SICU most of our pts are critically ill and when they are no longer critical we extubate them. i have seen a few pts intubated out of bed in the chair but they are mostly trach to vent. i would guess in MICU they would do this more as they tend to have pts intubated for longer periods of time. even some of our neuro pts who do not move much if any but are trach to vent still and cleared by neurosurgery we will get them out of bed in the chair but again these are all stable pts where the potential to lose an airway is very low.
  13. by   mcubed45
    Quote from burn out
    Yes physical therapy is vital early in patients that have been extubated because they are weak as kittens. However, how do you get active rom out of someone that is sedated and how do they bear weight? I really don't want to reseach something I think is ludicrous.
    You don't keep them snowed.

    There's tons of research showing the long term neurological deficits associated with prolonged sedation in the ICU. A lof of us were trained with the mentality that we're helping our patients by letting them sleep through their critical illness. In a lot of cases, it's quite the opposite. Over sedation leads to more vent days, longer hospital stays, and more complications. We also don't see the neurological damage we cause because the memory and cognitive problems don't become evident until long after we've extubated and downgraded our patients.

    The goal should always be to get the patient off all sedation/analgesia as long as it's safe to do so. That means spontaneous awakening trials every shift at a minimum.

    It can be really difficult to change your unit's culture, but all the evidence shows that we need to change. If your unit isn't already a part of the SCCM ICU Liberation Collaborative, I'd encourage you to explore the work being done and consider adopting some of the bundles/guidelines.

    ICU Liberation |
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