Intubated Pt's Using Bedside Comodes - page 4

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. Visit  littleneoRN profile page
    0
    Trying to picture being awake enough to walk and not grossly uncomfortable and freaking out about being intubated.
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  3. Visit  GreyGull profile page
    0
    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.
  4. Visit  littleneoRN profile page
    0
    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...
  5. Visit  ErinS profile page
    2
    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.
  6. Visit  NickiLaughs profile page
    0
    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.
  7. Visit  tryingtohaveitall profile page
    0
    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.
  8. Visit  ICURN2011 profile page
    0
    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)
  9. Visit  ChicagoICUNurse profile page
    0
    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.
  10. Visit  GreyGull profile page
    0
    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
  11. Visit  ChicagoICUNurse profile page
    0
    @GreyGull--thanks for the links!

    I agree about the tube holders, too.


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