Ice for a vented patient???

oMerMero · Jul 25, 2007

I just have to wonder if the family is not telling the truth. Perhaps they saw someone doing oral care and thought the nurse put ice in the mouth, or maybe they really believe the patient needs ice so they are going to make up a story to try to get you to do. I just do not want to believe nurses and doctors are giving ice to an intubated patient. When the ice melts to water, where is the water going to go?

OkieICU_RN · Jul 25, 2007

Yes, my point exactly. And let me clarify.....the nurse before me was still there and said she gave him 1 or 2 ice chips and he did fine with it. She is the one that told me the anesthesiologist gave the patient ice earlier.

allnurses Guide · Jul 25, 2007

I have given small amounts of ice to awake intubated patients for very short periods of time, in the unit that I worked it was considered acceptable as part of mouth care. This was only allowed for very short periods and certainly not long enough for the ice to melt or cause aspiration problems. The pateints were not permitted to suck the ice until it dissappeard just enough to have something cool and moist within their mouth for comfort.

iLovemyJackRT · Jul 25, 2007

I agree with you, I am not comfortable giving ice chips to intubated patients whatsoever....don't feel to bad, i don't know any nurses on my floor who would either.

loafin' · Jul 26, 2007

Why not give ice? The airway is protected and pt's can't aspirate unless the et tube cuff blows or et tube comes out. On any intubated pt there are secretions setting on top of the et tube and that's one reason we tell them to cough as we extubate as not to aspirate the secretions.

stressgal, RN · Jul 26, 2007

I will never forget a frequent flyer COPDer who was intubated, unsedated, sitting on the side of bed, drinking soda through a straw (her family had provided).

I FREAKED OUT, but she was able to handle liquids while intubated. The cuff was inflated, airway protected, swallow intact. This was not her first time with an ET tube and she had the right to decide for herself. I did talk the family and patient out of carbonated beverages, made me feel a bit better. LOL!

deeDawntee, RN · Jul 26, 2007

HOLY MOLEY!!

You've got to be kidding me? I have never heard of such a thing!! At my institution, if a person was that active, they would be extubated and on a bipap if they needed it for support. I can't imagine that ever happening where I work (unless of course they were a trached quad).

I can see where it could be done, but it is a little freaky!!!

SICU Queen · Jul 26, 2007

I will get a cup of ice water and use a swab in the patient's mouth; it gives the same effect and provides mouth care at the same time.

Honestly, one tiny piece of ice is no more water in the mouth than doing mouth care with a swab. It just seems so wrong to give ice to an intubated patient though!!

danamobile · Aug 14, 2007

Why not give ice? The airway is protected and pt's can't aspirate unless the et tube cuff blows or et tube comes out. On any intubated pt there are secretions setting on top of the et tube and that's one reason we tell them to cough as we extubate as not to aspirate the secretions.

when a patient coughs, or when we make them cough during suctioning, it makes the seal where the cuff is located not be a seal any longer, this is why the vent alarms when your patient is coughing--well the change in pressure and/or volumes. secretions sometimes get coughed into the mouth as well.so no, you are not entirely correct by saying they cannot aspirate. a lot of folks have swallowing difficulties and have no reflexive gag if they aspirate fluid into the lungs. the cuff is not 100% airtight and patients cough/made to cough many times a day. not all secretions and/or fluid can be suctioned off of the cuff with the VAC or suctioning to the back of the throat either. as well, you need swallowing to make sure that any trickling fluids go down the esophagus rather than to the lungs which is something you cannot guarantee as for the aforementioned. its pretty difficult to swallow with an ETT in your mouth, as well if your mouth is dry, and sedation/analgesics.with that, i say no to ice and venting. i say no to any npo status unless specifically ordered. i introduce all fluids if ordered them from npo from very thick and work my way to thin. apriration only leads to longer stays. if we dont prevent it, ppl will always just think ice is ok.and ice melts the second the temperature is not freezing, so it melts pretty much instataneously in the mouth. and it is much different than giving mouthcare! i dont know about what others do, but i squeeze out swabs before i give them to prevent dripping of water, and if i brush teeth, i use the yaunker int he back of the thraot to prevent it rolling to the back of the mouth!

Nurseboy1 · Aug 15, 2007

One of the RTs on my unit told me that patients who were trached for example could not eat or drink while on the vent. He explained that the cuff inflated in the trachea could cause compression of the esophagus and lead to difficulty swallowing and increase the potential for aspiration.

In that same vein I would not allow one of my intubated patients ice or liquids. Especially if a larger tube such as an 8.0 is in and thrown in an OG/NG or oral airway/bite block and I really don't see how drinking would be all that comfortable.

loafin' · Aug 15, 2007

when a patient coughs, or when we make them cough during suctioning, it makes the seal where the cuff is located not be a seal any longer, this is why the vent alarms when your patient is coughing--well the change in pressure and/or volumes. secretions sometimes get coughed into the mouth as well.so no, you are not entirely correct by saying they cannot aspirate. a lot of folks have swallowing difficulties and have no reflexive gag if they aspirate fluid into the lungs. the cuff is not 100% airtight and patients cough/made to cough many times a day. not all secretions and/or fluid can be suctioned off of the cuff with the VAC or suctioning to the back of the throat either. as well, you need swallowing to make sure that any trickling fluids go down the esophagus rather than to the lungs which is something you cannot guarantee as for the aforementioned. its pretty difficult to swallow with an ETT in your mouth, as well if your mouth is dry, and sedation/analgesics.with that, i say no to ice and venting. i say no to any npo status unless specifically ordered. i introduce all fluids if ordered them from npo from very thick and work my way to thin. apriration only leads to longer stays. if we dont prevent it, ppl will always just think ice is ok.and ice melts the second the temperature is not freezing, so it melts pretty much instataneously in the mouth. and it is much different than giving mouthcare! i dont know about what others do, but i squeeze out swabs before i give them to prevent dripping of water, and if i brush teeth, i use the yaunker int he back of the thraot to prevent it rolling to the back of the mouth!

Where is your info coming from? When we suction the vent alarms high pressure, it has nothing to do with losing the cuff seal. No, it's not easy to swallow with an ET tube in your mouth. Where do you think the natural oral secretions that a patient produces goes? Either they swallow it or it sets on top of the ET tube. If there were any validity to what you're saying about the cuff not sealing then every single ventilated patient would have VAP. As far as aspirating we make them aspirate every time we lavage. I will agree some patients occasionally aspirate but so do you and I. The last time you took a drink of soda and aspirated how long did you make yourself npo. We're talking about a little ice not a big mac and coke. If the patient is that awake and alert they will surely be extubated shortly, a little ice won't hurt.