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 pretend to be an ICU nurse or know... Read More

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    Need to get to 15 post

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    to be able to PM
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    Quote from GraduateNurse89
    wow never would think a pt intubated could get out of bed and walk the hallways!
    Here is an example:

    University of California San Francisco

    http://www.ucsfcme.com/2011/slides/M...bilization.pdf
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    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.
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    I agree. If they are strong enough to walk, but just cannot be weaned from the vent (paralyzed hemi-diaphram or whatever) - trach 'em!
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    Trauma centers with TBIs, SCIs and extensive facial injuries are very, very different and you know they will need a lengthy rehab and a trach to manage secretions. These patients are appropriate for a trach in 7 days or even during their first day in the hospital if they are in the OR. However, not every patient with a paralyzed hemi-diaphram needs a trach.

    I can not imagine what the LTC facilities or the acute hospitals would be like if we trached every COPD, sepsis and ARDS patient. We've got too many patients now waiting for beds in the subacutes and SNFs. We feel lucky to have the ability to put an aggressive plan in place for some patients. I think the patients feel that way also. Sometimes the success of the patients depend on a "can do" attitude and a multidisciplinary effort.

    But then, this is nothing new and it has been done for at least the 40 years I've been around the ICUs.

    I'm not trying to being argumentative but showing there are other ways out there to get a patient on their feet again. We have the technology and the professionals who specialize in this so we might as well make good use of them if there is a benefit for the patient. Of course, not every patient will be a candidate for this. Just because you've never seen it might just mean your unit might have a different concept of success and a save or they have an adequate step down unit for all the trachs and vents.
    NRSKarenRN likes this.
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    Trying to picture being awake enough to walk and not grossly uncomfortable and freaking out about being intubated.
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    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.
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    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...
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    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.
    NRSKarenRN and GreyGull like this.


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