Intubated Pt's Using Bedside Comodes - page 2

Ok...a few days ago an ICU nurse, at my facility, stated that stable intubated patients on the Unit use bedside comodes. My first thought was you are joking, right?! No, she was serious! I don't... Read More

  1. by   GreyGull
    Quote from NtannRN
    Grey gull, it's not laziness, I think ambulating an intubated pt has fallen out of favor, esp.when you dont even have the time to get yourself to the bathroom. From my stand point, we barely have the staff to get through the day, our cna's get pulled according to the# of pt's, not by the acuity. So when our pt population drops regardless if they're on something like hypothermic protocol, we have to reduce our staff, I cannot walk an intubated pt when theres only 2 of us for the floor.
    First, don't be ridiculous with thinking I am referring to ambulating patients on a hypothermia protocol. I made a statement about sitting patients up in a bedside chair and yes, maybe ambulating a patient if it helps them gain strength to get off a ventilator. Taking the easy way out and just letting a patient lie there to get a trach attitude is a **** poor patient advocate attitude. Cry me a river because we all have rough shifts with layoffs and increased patient loads but one less patient with a ventilator and trach is one less patient that is the long term troll no one wants to care for until they are warehoused in some nursing home or sub acute. Amazing how a patient can sometimes become less than a human when attached to technology or they become part of the trach and peg club.

    Now, have you ever heard of getting a PT consult from the physician and having them arrange the ambulation with RT? Most hospitals are finding creative ways to use their multidisciplinary teams to reduce patient hospital stays and offer the patient something other than a life in a subacute. We get the PT involved with the patient while they are in the ICU especially if we suspect a patient will be a difficult wean but may still be capable of getting off the vent without a trach.
  2. by   burn out
    Please show me the research that intubated/sedated patients on vents that are put in chairs result in less trachs than those kept in beds turned q2h and the hob up.
  3. by   GreyGull
    Quote from burn out
    Please show me the research that intubated/sedated patients on vents that are put in chairs result in less trachs than those kept in beds turned q2h and the hob up.
    Just go to any reliable medical search engine and type in "mechanical ventilation out of bed". Add the word "pulmonary", "COPD" or "neuromuscular complications" and you will find more articles.

    YOU passively turning a patient does very little to strength the muscles they need to support being off a ventilator.

    You will also find articles that Phyical Therapy consults as soon as possible in the ICU also promotes quicker recovery times and less time in a SNF from the neuromuscular complications.

    Ever work on an acute rehab floor with stroke, TBI or quad patients who where initially mechanically ventilated straight from an ICU for vent and trach weaning? Straight from the ICU, these patients are put through an aggressive program and not just turning q2. The sooner some PT was initiated in the ICU, the easier it is to get them accepted into acute rehab with the 3 hour requirement. Ever hear the terms "endurance", "core strengthening" or "accessory muscles". Ever look at the metabolic studies done in your ICU? Oxygen and metabolic energy cost? How about some of the basic priniciples of pulmonary rehab being introduced earlier?

    Sometimes healthy people take for granted all the muscles it takes hold your head upright, sit in a chair or just to breathe.
  4. by   burn out
    Yes physical therapy is vital early in patients that have been extubated because they are weak as kittens. However, how do you get active rom out of someone that is sedated and how do they bear weight? I really don't want to reseach something I think is ludicrous.
  5. by   GraduateNurse89
    wow never would think a pt intubated could get out of bed and walk the hallways!
  6. by   GraduateNurse89
    sounds crazy to me
  7. by   GraduateNurse89
    sorry for the post spamming
  8. by   GraduateNurse89
    Need to get to 15 post
  9. by   GraduateNurse89
    to be able to PM
  10. by   GreyGull
    Quote from GraduateNurse89
    wow never would think a pt intubated could get out of bed and walk the hallways!
    Here is an example:

    University of California San Francisco
  11. by   SionainnRN
    I work in a Trauma ICU and standard practice is to trach 7 days after intubation, or if we know they are going to be intubated longer than a week to do the trach right away. I have never, ever seen someone ambulated while intubated or on a bedside commode! It's hard enough getting them into a cardiac chair and that's with using a slide board. We have PT/OT ordered right away, but ambulating usually starts once they are transferred out of our unit.
  12. by   Biffbradford
    I agree. If they are strong enough to walk, but just cannot be weaned from the vent (paralyzed hemi-diaphram or whatever) - trach 'em!
  13. by   GreyGull
    Trauma centers with TBIs, SCIs and extensive facial injuries are very, very different and you know they will need a lengthy rehab and a trach to manage secretions. These patients are appropriate for a trach in 7 days or even during their first day in the hospital if they are in the OR. However, not every patient with a paralyzed hemi-diaphram needs a trach.

    I can not imagine what the LTC facilities or the acute hospitals would be like if we trached every COPD, sepsis and ARDS patient. We've got too many patients now waiting for beds in the subacutes and SNFs. We feel lucky to have the ability to put an aggressive plan in place for some patients. I think the patients feel that way also. Sometimes the success of the patients depend on a "can do" attitude and a multidisciplinary effort.

    But then, this is nothing new and it has been done for at least the 40 years I've been around the ICUs.

    I'm not trying to being argumentative but showing there are other ways out there to get a patient on their feet again. We have the technology and the professionals who specialize in this so we might as well make good use of them if there is a benefit for the patient. Of course, not every patient will be a candidate for this. Just because you've never seen it might just mean your unit might have a different concept of success and a save or they have an adequate step down unit for all the trachs and vents.