Eye care on ED intubated patients

[kmoonshine, RN]

Hey ED nurses -

What do you do for eye care on patients who are intubated in the ED? Sometimes we can get the patient up to ICU fast, but there are times when we have the patient for quite some time (whether we are still stabilizing them, or they are an ICU hold). Thanks very much.

[nuangel1, BSN, RN]

nothing other then keeping them moist and closed ie artificial tears if need be.

[Larry77, RN]

Um...how long we talking? I think the longest I've ever had an intubated patient in the ED is 4 hours...never worried about eye care myself...rather keep them alive.

[kmoonshine, RN]

I agree, keeping them alive is a priority.

The other day we intubated a patient who had crashed really fast, right in front of his wife. Once we got him stabalized, I talked with the wife and explained everything (machine breathing for him, won't remember any of this, etc), all while the husband's eyes were half-open. I had tried to close them but they wouldn't stay shut. His eyes were lacrimating and his wife said "it looks like he's crying".

Also, this topic makes me remember one patient who I was bagging up to ICU; he had one glass eye, and as I looked down on the patient, his fake eye was starring right at me. It was very peculiar.

I didn't know if anyone took 5 seconds to gently tape the eyes closed or what is generally done (once the patient is stabilized, of course). I'm a newer nurse, so forgive my question if it sounds ridiculous!

When I bring family in to see their loved one, I try to make them appear as natural and peaceful as possible (cover up the bedding soaked with blood/secretions, place a clean sheet over the patient, put a pillow under their head, etc). Sometimes, this is the last time the family will see their loved one alive - if it were me, I'd rather remember my loved one with eyes closed than with eyes open. Maybe that's just me.

[Larry77, RN]

I'm very careful to cover up any open wounds and even to clean up some supplies but I guess I just never thought about the eyes. However I think taping them closed would be more disturbing than seeing them open a little bit. Now that you bring up this topic I will probably think about it next time :)

BTW I think it is an interesting question not a ridiculous one.

[GilaRRT]

Intubated, sedated, and paralyzed patients are at high risk for corneal injuries. Taping the eyes is not an unreasonable action. This is especially true in an environment that is very dynamic. (ER, moving the patient, transport, etc.)

[meandragonbrett]

We often tape them shut (if they won't close on their own) to protect from corneal injury.

[cardiacRN2006, ADN, RN]

Never had to tape the eyes of my pts shut before. I've also never had them stay open. It seems like they are usually swollen shut enough to stay closed from the edema related to being on a vent.

I've also never had them come over from the ED taped shut either.

[Jen2]

During the "Golden Hour" so to speak, I will take a quick second Before going to scan and tape the eyes shut before I start pulling at monitors and tubes. Once the trauma resuscitaion is complete and before family comes in I will take the tape off.

[lpnstudentin2010, LPN]

in my case, unless you pull my bottom lid way up my right eye will not close. I have a prosthetic eye and my surgeon shortened my right upper lid so that it could be open, now it is always open.

[flightnurse2b, LPN]

We often tape them shut (if they won't close on their own) to protect from corneal injury.

we did this too, and it works well for transport and holding. then usually the ER doc would send them up to CCU/ICU with orders for eye scrub and artificial tears.

[mmutk, BSN, RN, EMT-I]

Never even thought about eye care for intubated pts in the ER