vented patients

LisaRn21 · Jan 11, 2007

ok! So I have some new questions!! I am just not understanding and you guys have helped out so much!

So last night my dad coded his left lung collapsed from a pneumo they inserted a chest tube and it reinflated. They also told us they want to place a trach cause he was a hard intubation and its more comfortable. The nurse told us it is normal for people to require chest tubes when they are on a vent because of the positive pressure and she also said most patients get trachs if they are vented for more than 2 weeks which is gonna happen in my dad's case.. they aren't even gonna try and ween him for a couple more days to a week... I was just wondering if anyone has heard of this.. I"m not really understanding what the difference is if the he has a endo tube or a trach... why take the endo out if its placed and working properly... I understand a trach is more comfortable and stable (if it pops out you pop it back in) but why not just keep him sedated and resting as llong as the endo is working? any thoughts??

Creamsoda, ASN, RN · Jan 11, 2007

Do you guys routinely sedate your patients continously? Is it just a standing order? We rarely run propofol infusions...used to be more common, but our intensivists dont like to so we have prn orders for versed and fentanyl ivp if needed. Its been my experience that not all vented patients need sedation around the clock. I guess theyve been finding long term negative side effects with propofol.

And to the original poster, we usually do mouthcare q 2 hrs. We use pink sponge mouthswabs that can fit in the mouth around the tube and ties, and suction the mouth for secretions as well. Some ppl are sedated, but not all so they may be aware and able to comunicate via writing if they are alert enough. What often helps is explaining to your dad when you there what happened, what the plan is and why he is intubated. This should help to re-orient him. I could only imagin how scary it would be to be in a sedation infusion and intubated what a person would be thinking. I try to only restrain my patients just so they cant reach the tube, but enough so they can still move there arms a bit and not feel totally trapped.

Cher

nursejohio, ASN, RN · Jan 11, 2007

Our ICU trachs pts after 7-10 days usually. If it looks like the pt will be a slow wean off the vent, trachs are usually the best option. Sedation can be decreased or turned off without worrying about the pt extubating themselves (especially if it was hard to intubate the first time) ET tubes can also cause breakdown if they're left in long term.

TiffyRN, BSN, PhD · Jan 11, 2007

It's been a long time since I worked with adults but when I worked on a floor that had long term vents trachs were a good thing. The patients are far more comfortable and easier to manage with trachs. I know I've been told in our NICU world that trachs make infants easier to wean from support. Something about decreased dead space. Also long term intubation can damage the vocal cords. It was not uncommon for us to have patients who were trached for just a few weeks then the trach is plugged and if the patient tolerates it, it is removed and the hole closes off quickly.

Of course if any patient is requiring ventilation for a prolonged period of time please consider that these are the patients who are at high risk to be vented long term. So your father may be in for a long haul. I'm sure he was very ill and I hope he is starting to make a turn around.

LisaRn21 · Jan 12, 2007

Thanks for all your help guys... now they are gonna place the trach tomorrow... the doctor didn't seem hopeful in being able to do it .. Seeing as my dad has a huge fat short neck...he's 348lbs and has lost most of his muscle tone in the past three years so its all like loose skin... he kept saying his neck could occlude the site if he moves his head certain ways and stuff. Then they wanted to do it under general anethesia the ent doc wanted to and then anethesiologist wanted to do a local since he was high risk... I"m concerned about the general only because he's having the lung issues and he just had the collapsed lung yesterday.. and everyone keeps saying he'll be fine but then the docs look nervous and worried.. heh I don't know.. I jsut want to slap them :lol2: so hopefully tomorrow goes ok and if soo I will be returning to work on monday thanks guys for all your help this stuff is just so new to me.. I never dealt with it vents and trachs and all that I'm learning a lot though haha might end up switching to icu or special care!! :lol2:

Havin' A Party!, ASN, RN · Jan 14, 2007

Trachs provide less trauma to the vocal folds (cords) and the nasal tract.

Good luck!

pghfoxfan · Jan 14, 2007

I have a terrible phobia of being on a ventilator and not being able to move(either by paralysis or restraints). Please tell me that it is standard of care that the patient is to be kept somewhat sedated, especially in long term situations. I understand that when being weaned the patient needs to be awake to take deep breaths and understand the weaning process.

nuangel1, BSN, RN · Jan 15, 2007

everyb intubated pt is different.i worked icu for 12 yrs now er .i have seen some pts do well very awake able to turn ,write messages in no distress and not agitated but i agree its not the norm .most pts do require prn if not continuous meds ie morphine fentanyl versed diprivan ativan the combos of meds very .its usually something for pain and the something for anxiety .we did not have routine sedation vacations perse .ie daily at 1 time but each pt was lightened pwriodically to make sure the neuros were intact but if pt was not weaning and became agitated and/or fighting tube we would resedate.i wish the op and her father much goodluck.the trach is better for him at this point so he doesn't have damage to vocal cords /throat.also the ett makes the pt more likely to develop sinusitis.

CritterLover, BSN, RN · Jan 15, 2007

also, there less of an instance of pneumonia with trachs vs etts.

[color=#483d8b]

[color=#483d8b]wishing the best for your dad and your family.