No Oxygen or Suction in dining room...normal?

  1. 0
    Hi, I'm new to LTC and wondered if your facility has oxygen and/or suction either IN the dining room or very close by?
    I realize we can perform the Heimlich for FOOD choking; I am more concerned about LIQUID choking if they aren't able to cough the liquid out on their own and then pass out.

    Also very concerned about aspiration / resp. distress. Do you see this a lot where you work?
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  3. 18 Comments so far...

  4. 0
    I've not worked LTC but in the facilities I had clinical rotations health code prevented storing or using suction equipment in the dining area, especially since there is an aeresolization risk. Depending on the patient, some who required oxygen dined in their room. While more ambulatory patients using portable tanks or concentrators were able to go to the dining area. No "invasive" treatments or assessment were permitted in the dining area (MDI, nebulizer, labs, fingersticks, etc.)

    If there was a choking or aspiration incident (and anyone at risk had a swallow study with proper recommendations from the SLP and dietician) the patient was removed (if possible) from the dining area for treatment/assessment.
  5. 3
    I've worked in multiple LTC facilities and have never seen an oxygen hookup or suction machine in any of the dining rooms.

    In my experience, the majority of elders are silent aspirators. Food particles and liquids are silently seeping into the lungs. The telltale signs include drooling, runny nose, fatigue while eating, throat clearing during the meal, and taking an unusually long time to eat the meal.

    Most LTC facilities have in-house speech language pathologists on staff Monday through Friday, so residents at risk are usually screened for swallowing difficulties and placed on modified texture diets or, in the worst cases, placed on NPO status.
  6. 1
    There are suction machines and oxygen on crash carts. In an emergency case of choking/aspiration/respiratory distress, shouldn't you just bring the crash cart over?
    SleeepyRN likes this.
  7. 0
    Not all LTC even utilize crash carts as generally ACLS is not required and there is not an MD on site. Some have a CPR board and call 911 and O2 is only available for patients with specific MD order unlike the hospital environment. Aspiration, chest pain, respiratory distress = call 911.

    When I worked EMS we had about a dozen LTC in the area, never once was a crash cart present on a CPR in progress as that was what ALS/medics were for, they brought in the monitor & drugs while EMT/BLS brought the O2, suction & stretcher.
  8. 0
    All the LTC I worked at did not have a crash cart. I never utilized my acls in this setting. We did not have suction or oxygen without an order. Choking wasnt a problem during the entire 2yrs I worked LTC. These guys see therapy so often that at the first signs of difficulty there was a diet change.
  9. 0
    It makes sense that there is no suction in the dining area, for hygienic purposes... In my facility, we are under strict orders not to perform any form of CPR on the residents, even if choking, even if they do not have a DNR order, we just call 911. I don't know if this is unusual or not, but for me, it takes some of the pressure off. I've worked there for 3 years and i haven't had to call 911 for choking. There is always a lot of coughing at meal time, but like someone said, the elderly usually are silent aspirators. If you've got a good staff working alongside you, your residents would be evaluated properly at admission and at any sign of change or difficulties during mealtime.
  10. 0
    "In my facility, we are under strict orders not to perform any form of CPR on the residents, even if choking, even if they do not have a DNR order, we just call 911"

    Annie - do you worry at all that not doing CPR may put you in a legally risky position if there is not a DNR order? Is this common in LTC? Not that I disagree with it, but I would worry someone would sue me for not performing up to RN standards. I think it would be good to not do CPR on all nursing home residents honestly, but I would worry that family would not feel that way.
  11. 1
    Quote from JustBeachyNurse
    Not all LTC even utilize crash carts as generally ACLS is not required and there is not an MD on site. Some have a CPR board and call 911 and O2 is only available for patients with specific MD order unlike the hospital environment. Aspiration, chest pain, respiratory distress = call 911.

    When I worked EMS we had about a dozen LTC in the area, never once was a crash cart present on a CPR in progress as that was what ALS/medics were for, they brought in the monitor & drugs while EMT/BLS brought the O2, suction & stretcher.
    Hmm... Every facility I have worked in has had a crash cart. We aren't expected to perform ACLS, but BLS is expected for non-DNR patients until emergency services arrived.
    RainRN1 likes this.
  12. 1
    Despite my objections, we have a suction machine in the dining rooms.
    The Heimlich maneuver is the standard of care for someone who is choking....suctioning is NOT. You can't suction liquids out of someone who is coughing.
    We have a crash cart on each unit....3 AEDs for the building. All the nurses are required to be CPR certified. We start CPR unless there is a valid DNR order in the chart.
    We have nurses now who can insert PICC lines in the facility.
    If the 3 midnight rule changes, we'll all be getting sicker patients.
    I would NEVER go to a facility that only called 911 and let me die waiting for the ambulance because the staff didn't start CPR.
    RainRN1 likes this.


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