[Nurseboy1]

One of the RTs on my unit told me that patients who were trached for example could not eat or drink while on the vent. He explained that the cuff inflated in the trachea could cause compression of the esophagus and lead to difficulty swallowing and increase the potential for aspiration.

In that same vein I would not allow one of my intubated patients ice or liquids. Especially if a larger tube such as an 8.0 is in and thrown in an OG/NG or oral airway/bite block and I really don't see how drinking would be all that comfortable.

[loafin']

Originally Posted by danamobile

when a patient coughs, or when we make them cough during suctioning, it makes the seal where the cuff is located not be a seal any longer, this is why the vent alarms when your patient is coughing--well the change in pressure and/or volumes. secretions sometimes get coughed into the mouth as well.so no, you are not entirely correct by saying they cannot aspirate. a lot of folks have swallowing difficulties and have no reflexive gag if they aspirate fluid into the lungs. the cuff is not 100% airtight and patients cough/made to cough many times a day. not all secretions and/or fluid can be suctioned off of the cuff with the VAC or suctioning to the back of the throat either. as well, you need swallowing to make sure that any trickling fluids go down the esophagus rather than to the lungs which is something you cannot guarantee as for the aforementioned. its pretty difficult to swallow with an ETT in your mouth, as well if your mouth is dry, and sedation/analgesics.with that, i say no to ice and venting. i say no to any npo status unless specifically ordered. i introduce all fluids if ordered them from npo from very thick and work my way to thin. apriration only leads to longer stays. if we dont prevent it, ppl will always just think ice is ok.and ice melts the second the temperature is not freezing, so it melts pretty much instataneously in the mouth. and it is much different than giving mouthcare! i dont know about what others do, but i squeeze out swabs before i give them to prevent dripping of water, and if i brush teeth, i use the yaunker int he back of the thraot to prevent it rolling to the back of the mouth!

Where is your info coming from? When we suction the vent alarms high pressure, it has nothing to do with losing the cuff seal. No, it's not easy to swallow with an ET tube in your mouth. Where do you think the natural oral secretions that a patient produces goes? Either they swallow it or it sets on top of the ET tube. If there were any validity to what you're saying about the cuff not sealing then every single ventilated patient would have VAP. As far as aspirating we make them aspirate every time we lavage. I will agree some patients occasionally aspirate but so do you and I. The last time you took a drink of soda and aspirated how long did you make yourself npo. We're talking about a little ice not a big mac and coke. If the patient is that awake and alert they will surely be extubated shortly, a little ice won't hurt.

[loafin']

Originally Posted by Nurseboy1

One of the RTs on my unit told me that patients who were trached for example could not eat or drink while on the vent. He explained that the cuff inflated in the trachea could cause compression of the esophagus and lead to difficulty swallowing and increase the potential for aspiration.

In that same vein I would not allow one of my intubated patients ice or liquids. Especially if a larger tube such as an 8.0 is in and thrown in an OG/NG or oral airway/bite block and I really don't see how drinking would be all that comfortable.

If the cuff pressure is high enough to hinder swallowing then the patient has tracheal malacia and/or the trachea in necrosing. Ask your RT if
he/she has ever heard of a chronic home ventilator patient who's trached and eats solid foods and drinks liquids at every meal.

[OkieICU_RN]

Very interesting to see different perspectives on the ice while on a vent question.

I think I will take a poll of RT's and see what they think about it too. I think I'll ask some speech therapists too.

Loafin': I see what you are saying about home trached/vented patients, but they are long term, completely awake and aware, no recent trauma, or catastrophic event that bought them the tube in the first place. And, most likely the VAST majority of them worked with speech therapy before being given the go ahead to Cokes and Big Macs. And in my experience with long term trachs, they generally don't have a cuffed trach at all or early on after being trached, when speech therapy starts working with them, they will let the cuff down to work with swallowing.

One place I worked had a policy that anyone intubated longer than 72 hours had to have a swallow eval after extubation before being allowed to eat/drink.

I understand what other said about cleaning out the mouth and the sponges, etc. And that swallowing or aspirating a little H2O isn't that big of a deal. I guess my point is that generally people fight the urge to swallow when they have a build up of oral secretions in their mouth. Which is why they need to get frequent oral suctioning, oropharyngeal suctioning and complete oral care frequently. I feel like I am somehow enabling frequent swallowing if I give my patient ice/water and increasing the chance of aspiration.

[danamobile]

In reply:

When we suction the vent alarms high pressure, it has nothing to do with losing the cuff seal.
-the high pressure alarms off because suctioning causes them to cough, when you cough, the 'seal' IS indeed broken

No, it's not easy to swallow with an ET tube in your mouth. Where do you think the natural oral secretions that a patient produces goes? Either they swallow it or it sets on top of the ET tube.
- OR into the lungs. thats why its important to routinely suction your patients and prevent oral flora overgrowth and promote a clean mouth.

If there were any validity to what you're saying about the cuff not sealing then every single ventilated patient would have VAP.
- i never said it does not seal, but its not always a perfect seal, aka when coughing. why do you think vap occurs so often? i would like to hear more of what you have to say.

As far as aspirating we make them aspirate every time we lavage.
- its actually against our hospital's policy to do this to patients, because you are aspirating for them, and there are studies that show it does not actually loosten secretions. if i am able to find this, i will post it for you.

I will agree some patients occasionally aspirate but so do you and I.
- yes of course
The last time you took a drink of soda and aspirated how long did you make yourself npo.
- if i told myself to be npo, i wouldnt be following a strict doctors order. if it says npo, that means NOTHING to me. i prefer doing things by best practice. i am accountable for my actions, and i knowingly will not aspirate my patient when i could have prevented it the entire time.

We're talking about a little ice not a big mac and coke. If the patient is that awake and alert they will surely be extubated shortly, a little ice won't hurt.
- ice is still more than nothing. call me strict, but people lose their licenses for not following through with doctors orders... even if its not about an order, its about safety! ... and things run in different ways in different hospitals. here, we keep our patients npo for at least 4 hrs post extubation d/t aspiration risk, as well, nearly 100% of them get swallowing assessments prior to initiation of food and remain NPO.

feel free to comment if i remain to be misunderstood. i dont mind ellaborating further.

oh. as well, the way i was taught in school was research based. all care needs rationale to apply best care possible based on data that proves that you're actually doing a good thing! (or if not)

[berry]

When pts are coughing or bucking the vent the most likely cause for the alarm is increased airway pressures. When you are suctioning most likely alarm is for disconnect, if not using an inline suction cath, if you are then it could be several different things but most likely you are making them cough and increase airway pressures is the reason

[danamobile]

agreed!

[cardiacRN2006]

Originally Posted by danamobile

- its actually against our hospital's policy to do this to patients, because you are aspirating for them, and there are studies that show it does not actually loosten secretions. if i am able to find this, i will post it for you.

I don't agree with this. All this week I have had patients with such thick secretions, that they won't even suction out without lavage. Nothing comes out. But when you lavage, tons comes out-and it's not just all the saline. It makes no sense that the saline wouldn't help loosen secretions. Study or not, I've got experience to tell me that it helps...

[danamobile]

you m ay feel that way, but i wont go against hospital policy and risk losing my license

[cardiacRN2006]

Well, it's not against my hospital policy here, so I'm ok doing it...

Plus, it's more important for me to be able to clear my patient's airway.