oh boy, do we ever have the proptcols for vap. it's the "boogey of the month" at my facility. the rules are HOB at 30 degrees at all times unless contraindicated, mouth care with special little swabs and biotene mouthwash that attach to suction tubing, special little yankauers with sleeves over them special little Y connectors for the yankauer tubing and in line suction tubing, all this comes in a package with the set up and enough products for q 4 hour oral care for 24 hours the set up needs to be changed q 24 hours. little toothbrushes that attach to the suction tubing as teeth must be brushed q 24 hours. oh yeah, and if the HOB is less than 30 degrees, like say, when you are repositioning your pt you must sub glottal suction with yet another special attachment. the other part of the "bundle" is PUD prophylaxis, DVT prophylaxis, q day wake up unless contraindicated and q day RSBI. i like the packets with the mouthcare products, it keeps everything you need in one self contained, clutter free location and i like the special yankauers, the sleeve on them keeps them clean. PUD and DVT prophylaxis we do anyway and HOB 30 degrees, why not? often contraindicated d/t hemodynamic instability in my pt population though. the only thing i really have a problem with is the subglottal suction every time the HOB is under 30 degrees. think about how many times you reposition a pt in a shift. it's unreal to think you are going to sub glottal suction every time. sorry my vap rant. i tried to find a pic of the products we use, but no luck. hope this is informative.