vented patients - page 2
Hey guys I need your help. My dad was placed on a vent yesterday and his last words prior to being intubated was help... I want to help him so bad but I just don't know how. i've never worked with... Read More
Jan 6, '07Joined: Jan '05; Posts: 4,765; Likes: 2,554I am supposed to do a sedation vacation daily, but the timing is up to me and has nothing to do with the RT. We also have to have DVT/PUD prophalaxis, HOB >30, and oral care Q2hrs.
Sometimes, I just can't do a sedation vacation though. Some pts cannot tolerate it.
If the pt is on propofol, I will do the sed vacation when I change the tubing, seems like a perfect opportunity.
Jan 6, '07Joined: Jan '07; Posts: 2; Likes: 2I am sorry to hear about your father, and you are both in my prayers.
I just wanted to say that I was a patient who went into respiratory failure and was put on a ventilator in a coma for about a week. I was aware of much of what went on, could hear things, etc., but quite confused.
So PLEASE talk to your father and tell him what is going on. He hears you, and he is probably talking to you in his mind (I was, and couldn't understand later when they said they couldn't hear me.) If you explain some of the apparatus, it may help him relax. The more positive and loving the people are around him, the more he can relax and get better. Keep telling him you love him--he is telling you, too!Last edit by rodeosweetheart on Jan 6, '07
Jan 6, '07Occupation: cardiology R.N. Specialty: 25 year(s) of experience in cardiac med-surg ; From: CA ; Joined: May '03; Posts: 8,489; Likes: 147wishing your father a return to wellness
Jan 6, '07Joined: Sep '05; Posts: 74; Likes: 1Thanks guys for all your help. They are doing mouth care.. and they are backing down on the sedation acctually the nurse backed him down and before she could tell us what she did I had asked a question and she started to answer that and he started thrusting his head violently to get the tube out and I though I was gonna throw up lol and then she explained it. He calmed down when we told him to and he squeezed the nurses hand with his right hand and when she said with his left he didn't and when she asked if he could he shook his head no and then started real violent again and she turned the sedation up. I forget the name its milky white and they change the tubing really frequently. The vent is giving him 800cc and breathing 10 times a minute I don't know if thats really important but thats what they told us. the doctors said they think he is giving up but I don't know.. its not his nature to give up. Everything else is better its just he keeps retaining co2 his last blood gas prior to intubation and on cpap was a co2 level of 85.. I don't know... I guess its just a waiting game.. but I now know how families feel when they see their members laying so helpless like this.. I used to think itshelping them why are you so upset (I kinda understood but nothing like I do now) I don't know
Jan 6, '07Occupation: RN Specialty: Pediatrics (Burn ICU, CVICU) ; Joined: Oct '05; Posts: 405; Likes: 169Quote from GardenDoveThey will probably do a sedation vacation each AM, you might want to be there when they do that. The nurse will turn off the propofol prior to RT assessing the pt for weaning potential when they are unsedated. We do it early where I work when RT arrives. This would be your opportunity to interact with him.
We also do not do sedation vacations for our vented pt's. We do however do vec holidays if they are on vecuronium. We do not use propofol for sedation either.
Jan 7, '07Occupation: Pediatric RN, ICU coordinator Specialty: 4 year(s) of experience in PICU, surgical post-op ; From: CA ; Joined: Dec '06; Posts: 424; Likes: 187Quote from GardenDoveDo you work in the adult world or peds?It's part of our ventilator bundle protocol
- Elevation of the Head of the Bed
- Daily "Sedation Vacations" and Assessment of Readiness to Extubate
- Peptic Ulcer Disease Prophylaxis
- Deep Venous Thrombosis Prophylaxis
Jan 7, '07Joined: Jun '06; Posts: 175; Likes: 5I have a question for nurses who work with intubated patients. I realize that sedation is used, but I heard of having to "paralize" someone. What would typically be used and why?
Jan 7, '07Occupation: PICCs/outpatient infusion, ER Specialty: ER, ICU, Infusion ; Joined: Feb '03; Posts: 1,047; Likes: 445Quote from jetscreamer101i have a question for nurses who work with intubated patients. i realize that sedation is used, but i heard of having to "paralize" someone. what would typically be used and why?
this would mean to give a patient a chemical paralytic (such as norcuron, pavulon) to keep them from moving.
it is not a substitution for sedation, as the paralytic has absolutely no sedating properties. the patient is otherwise awake/alert, just unable to respond/move. of course, the patient is also mechanically ventilated since all muscles are paralyzed, including the respiratory ones.
it is commonly given with a sedative (diprivan, versed), and often a pain reliever (morphine).
there are a couple of good reasons to do this. sometimes, when a new trauma comes in but the patient cannot be controlled, they will be sedated/paralyzed/intubated, so they will be able to hold still for tests. it is imparative to find major traumatic injuries as quickly as possible, to treat and limit damage. if the patient won't hold still for xrays/ct scans, those tests can't be done. and sometimes, if a major spinal fracrue is found, the patient will be kept paralyzed until surgery is performed, to make sure the patient doesn't do more damage due to the inability to keep still.
i worked at one hospital where it was common to give a paralytic for bronchs, since the patients were always vented for them.
we would also sometimes paralyze patients with severe head injuries if we were having a hard time controlling icps. less frequently, we would every so often have to paralyze someone with severe chest/lung trauma in order to improve oxygenation.
took care of a patient once who had been in category #1. he had been in an mva, with +loc. came in through the er. wouldn't cooperate, so they give him norcuron to keep him still for xrays and ct. everything came out negative, but he came to icu because he was now ventilated. we got him extubated failry quickly. then he told us that he had been awake the whole time. they hadn't given him anything for sedation, just the paralytic. the whole time he was lying there, thinking he was permanatly paralyzed because he couldn't move. he said it had been terrifying. that happened several years ago, and it still sticks in my mind because it made such an impression. they always, always, always need something to sedate them when given a paralytic.
Jan 8, '07Joined: Oct '06; Posts: 1,256; Likes: 66Quote from AliRaeadultDo you work in the adult world or peds?
Jan 8, '07Occupation: RN Manager (Retired) Specialty: 10 year(s) of experience in ICU, CM, Geriatrics, Management ; From: US ; Joined: Sep '03; Posts: 3,325; Likes: 722Elevation of the Head of the Bed
Daily "Sedation Vacations" and Assessment of Readiness to Extubate
Peptic Ulcer Disease Prophylaxis
Deep Venous Thrombosis Prophylaxis
T & P (small changes are OK) -- Lotion on back & all pressure points -- q 2 hrs
Mouth Care q 2 hrs
Jan 11, '07Joined: Sep '05; Posts: 74; Likes: 1ok! 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??
Jan 11, '07Joined: Feb '04; Posts: 737; Likes: 866Do 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.