[ELKMNin06]

Originally Posted by Christie RN2006

At my facility the protocol is HOB at least at 30 degrees. We suction them and clean their mouths at least every 2 hours. All vent patients get a special kit every 24 hours with mouth swabs, biotene mouthwash, and these special toothbrushes and mouth swabs with suction in them. Also we are now doing only OG tubes if they are vented because inserting an NG introduces whatever bacteria that was in their nose to their ETT. We also do Peptic Ulcer Disease Prophylaxis and DVT prophylaxis unless it is contraindicated.

I used to work in Ohio and we had that same protocol in the MSICU. HEre in phoenix we do mouth care qshift. We have those green swabbies but we aren't required to use them. Even vented pts. get mouth care qshift. We have these new tube things that hang on the side of the bed that we are supposed to keep our yanker in. We are supposed to change it q24hrs. We keep HOB up 30.

[OkieICU_RN]

We use the same 24hr kits described above, performing oropharyngeal suctioning at least q 12 hrs and routine oral care at least q 4 hrs. Suctioning with yankaur prior to lowering HOB.

Another part of our VAP bundle is daily sedation vacation and daily weaning attempts. We have cut and dry parameters to perform the sedation vacation, only contraindicated in a few specific circumstances: significant hemodynamic instability (not just 1 low BP reading), PEEP must be less than 10, FiO2 less than 60%, ICP can't be increased. Might not perform if we have a severe trauma requiring multiple surgeries every couple of days and needs to stay on Vec or something. We can either decrease sedation by 50% or turn off. If pt doesn't need it, we discontinue it.

Turning q 2 hrs of course and continuous lateral rotation therapy if not contraindicated.

Our bundle also specifies the need for a speech therapy eval prior to starting liquids/foods/oral meds if pt has been intubated >48 hrs.

All our patients coming directly from surgery to ICU and pts intubated in our hospital all are done with an ETT that has the continous subglottic suction.

[neuro23]

Pretty much the same in our Neuro ICU in Edmonton ... HOB @ 30, OG vs NGTs, oral care: cleaning the tongue and teeth (where possible) with a toothbrush + toothpaste Q12h + mouthcare Q2H using toothettes with chlorhexidine mouthwash & suction. We also started using EVAC tubes (which sxn secretions above the cuff) about 5/52 ago. The Q2H mouthcare is also important in maintaining long-term patency of the EVAC tubes.

[Flockone]

Neuro ICU nurses: What do you think about increased VAP
due to the patients lying flat for multiple CATT scans and repeated angios possibly causing aspiration??

[neuro23]

Originally Posted by Flockone

Neuro ICU nurses: What do you think about increased VAP
due to the patients lying flat for multiple CATT scans and repeated angios possibly causing aspiration??

Honestly, I'd never thought of that. I don't think most vented patients could be positioned lying at 30 degrees in a CT scanner because the head wouldn't be centred in the gantry. I'm sure a 30 degree position would be possible in our angio suite (biplanar with 3D reconstruction). I also think the incidence of VAP may be decreased by suctioning and cleansing the oral cavity before transferring the patient to the CT or angio table. If a patient with an ETT must remain supine (for whatever reason), maybe placing a couple of throat packs (or any easily removable absorbent swab) might help -- might need McGill forceps. Great point though!

Neuro.