[Burnt2]

They discuss this in the AACN CCRN core material in some detail. They cite the fact mentioned above that only 20% of saline is suctioned out, the rest goes to the distal/lower lobes where it is essentially irretrievable, with potential increases in VAP, atelectesis, etc.

Any pulmonologist worth his salt will tell you it's not a good idea. It's a little different to lavage a bronched patient.


That article was fascinating - especially "mucus is not miscible with saline -- even with vigorous shaking, so the intention of thinning mucus to ease removal completely lacks supporting evidence."

[Super RT]

As an RT, allow me to comment on this topic.

I am reading a lot of different arguments from various posters about this, so let me clear up a few things.

1. VAP happens to patients ON the vent (hence Ventilator Acquired Pneumonia). If the seal was perfect, there would be no such thing. Maybe it would become PVAP (Post-Ventilator Acquired Pneumonia)

2. In a Critical Care Unit, never, ever give an intubated patient something to drink, ice, ect. Would you give them liquid tylenol orally? NO. You would give it through an NG, OG, or g-tube, Right? So don't put ice or drinks in there either.

3. the trachea is flexible. There is never a perfect seal. Anytime you turn the patient, you run the risk of a little leak. It might be a huge leak, but it may be big enough for liquids to get around. Can you imagine the damage a Coke or the flouride in water would do the the delicate tissue of the lungs!! Honestly, you don't want it to be so tight that nothing can get around it. This kind of pressure on the trachea can cause necrosis, pressure sores, weakening, fistulas, etc.

4. The secretions that pool in the back of the throat are not just from the mouth! They drain down from the sinuses and up from the airway. Just because you have an ET tube in your airway doesn't mean the mucocilliary elevator stops to function. It is just not as easy to get the secretions out.

5. The majority of trach patients I have seen have bad lungs, not bad vocal cords. They can protect their airways just fine, they just can't keep it from collapsing.

I think I hit upon all the major parts.

Please if your patient's mouth is dry, swab it out with a cold, wet mouth swab while suctioning out any fluid that pools.

There is my 2cents

[OkieICU_RN]

That was well said Super RT!! I couldn't agree more. Thanks for commenting.

[loafin']

Originally Posted by Super RT

As an RT, allow me to comment on this topic.

I am reading a lot of different arguments from various posters about this, so let me clear up a few things.

1. VAP happens to patients ON the vent (hence Ventilator Acquired Pneumonia). If the seal was perfect, there would be no such thing. Maybe it would become PVAP (Post-Ventilator Acquired Pneumonia)

2. In a Critical Care Unit, never, ever give an intubated patient something to drink, ice, ect. Would you give them liquid tylenol orally? NO. You would give it through an NG, OG, or g-tube, Right? So don't put ice or drinks in there either.

3. the trachea is flexible. There is never a perfect seal. Anytime you turn the patient, you run the risk of a little leak. It might be a huge leak, but it may be big enough for liquids to get around. Can you imagine the damage a Coke or the flouride in water would do the the delicate tissue of the lungs!! Honestly, you don't want it to be so tight that nothing can get around it. This kind of pressure on the trachea can cause necrosis, pressure sores, weakening, fistulas, etc.

4. The secretions that pool in the back of the throat are not just from the mouth! They drain down from the sinuses and up from the airway. Just because you have an ET tube in your airway doesn't mean the mucocilliary elevator stops to function. It is just not as easy to get the secretions out.

5. The majority of trach patients I have seen have bad lungs, not bad vocal cords. They can protect their airways just fine, they just can't keep it from collapsing.

I think I hit upon all the major parts.

Please if your patient's mouth is dry, swab it out with a cold, wet mouth swab while suctioning out any fluid that pools.

There is my 2cents

Well SuperRT, I just happen to be a RRT and a RN.
This has gotten way off topic, it's supposed to be about whether to give ice to an intubated patient. Nobody has mentioned giving a patient all the ice they could hold. As I stated in previous posts that if the patient is alert enough to ask for ice then they will be extubated soon. Giving a few ice chips is no different than the toothettes we use to do oral care Q2hrs, they have about the same amount of liquid.

[Super RT]

Originally Posted by loafin'

Well SuperRT, I just happen to be a RRT and a RN.
This has gotten way off topic, it's supposed to be about whether to give ice to an intubated patient. Nobody has mentioned giving a patient all the ice they could hold. As I stated in previous posts that if the patient is alert enough to ask for ice then they will be extubated soon. Giving a few ice chips is no different than the toothettes we use to do oral care Q2hrs, they have about the same amount of liquid.

If your patient is soon to be extubated, why not wait the 30 min or so until the tube is out? Use your toothettes until they can protect their airway on their own, since they have the same amount of liquid anyway.