Ice for a vented patient???

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Am I the only person who will not give ice to their intubated patient?? I had just come on shift earlier this week and a family member asked for ice for the patient who was on a vent. I said no, can't have any, on a vent, potential for aspiration, la...la...la.

They said the nurse before gave it. I said that I am not comfortable with it and wouldn't do it. The nurse before me said that the ANESTHESIOLOGIST gave it to the patient when he was in to do a procedure (not the intubation) and said it was ok for him to have "a little".

This has happened to me more than once. Am I crazy for not allowing this?:uhoh3:

Specializes in PULMONARY/CRITICAL CARE.
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.

If the cuff pressure is high enough to hinder swallowing then the patient has tracheal malacia and/or the trachea in necrosing. Ask your RT if

he/she has ever heard of a chronic home ventilator patient who's trached and eats solid foods and drinks liquids at every meal.

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Very interesting to see different perspectives on the ice while on a vent question.

I think I will take a poll of RT's and see what they think about it too. I think I'll ask some speech therapists too.

Loafin': I see what you are saying about home trached/vented patients, but they are long term, completely awake and aware, no recent trauma, or catastrophic event that bought them the tube in the first place. And, most likely the VAST majority of them worked with speech therapy before being given the go ahead to Cokes and Big Macs. And in my experience with long term trachs, they generally don't have a cuffed trach at all or early on after being trached, when speech therapy starts working with them, they will let the cuff down to work with swallowing.

One place I worked had a policy that anyone intubated longer than 72 hours had to have a swallow eval after extubation before being allowed to eat/drink.

I understand what other said about cleaning out the mouth and the sponges, etc. And that swallowing or aspirating a little H2O isn't that big of a deal. I guess my point is that generally people fight the urge to swallow when they have a build up of oral secretions in their mouth. Which is why they need to get frequent oral suctioning, oropharyngeal suctioning and complete oral care frequently. I feel like I am somehow enabling frequent swallowing if I give my patient ice/water and increasing the chance of aspiration.

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Specializes in GSICU, med/surg.

In reply:

When we suction the vent alarms high pressure, it has nothing to do with losing the cuff seal.

-the high pressure alarms off because suctioning causes them to cough, when you cough, the 'seal' IS indeed broken

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.

- OR into the lungs. thats why its important to routinely suction your patients and prevent oral flora overgrowth and promote a clean mouth.

If there were any validity to what you're saying about the cuff not sealing then every single ventilated patient would have VAP.

- i never said it does not seal, but its not always a perfect seal, aka when coughing. why do you think vap occurs so often? i would like to hear more of what you have to say.

As far as aspirating we make them aspirate every time we lavage.

- its actually against our hospital's policy to do this to patients, because you are aspirating for them, and there are studies that show it does not actually loosten secretions. if i am able to find this, i will post it for you.

I will agree some patients occasionally aspirate but so do you and I.

- yes of course

The last time you took a drink of soda and aspirated how long did you make yourself npo.

- if i told myself to be npo, i wouldnt be following a strict doctors order. if it says npo, that means NOTHING to me. i prefer doing things by best practice. i am accountable for my actions, and i knowingly will not aspirate my patient when i could have prevented it the entire time.

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.

- ice is still more than nothing. call me strict, but people lose their licenses for not following through with doctors orders... even if its not about an order, its about safety! ... and things run in different ways in different hospitals. here, we keep our patients npo for at least 4 hrs post extubation d/t aspiration risk, as well, nearly 100% of them get swallowing assessments prior to initiation of food and remain NPO.

feel free to comment if i remain to be misunderstood. i dont mind ellaborating further.

oh. as well, the way i was taught in school was research based. all care needs rationale to apply best care possible based on data that proves that you're actually doing a good thing! (or if not)

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Specializes in ER/SICU.

When pts are coughing or bucking the vent the most likely cause for the alarm is increased airway pressures. When you are suctioning most likely alarm is for disconnect, if not using an inline suction cath, if you are then it could be several different things but most likely you are making them cough and increase airway pressures is the reason

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Specializes in GSICU, med/surg.

agreed!

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Specializes in Cardiac.

- its actually against our hospital's policy to do this to patients, because you are aspirating for them, and there are studies that show it does not actually loosten secretions. if i am able to find this, i will post it for you.

I don't agree with this. All this week I have had patients with such thick secretions, that they won't even suction out without lavage. Nothing comes out. But when you lavage, tons comes out-and it's not just all the saline. It makes no sense that the saline wouldn't help loosen secretions. Study or not, I've got experience to tell me that it helps...

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Specializes in GSICU, med/surg.

you m ay feel that way, but i wont go against hospital policy and risk losing my license

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Specializes in Cardiac.

Well, it's not against my hospital policy here, so I'm ok doing it...

Plus, it's more important for me to be able to clear my patient's airway.

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Specializes in GSICU, med/surg.

i can understand why people would want to do it, but have you ever had or seen a time where the suction cannister wouldnt go down after putting water down and then they were just choking? ive seen an emergency bronch after that happened. all in all, i dont like the thought of apsirating a patient for them. im all for prevention :) we can all make our own educated decisions. best practice is my policy.

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Specializes in Cardiac.
i can understand why people would want to do it, but have you ever had or seen a time where the suction cannister wouldnt go down after putting water down and then they were just choking? ive seen an emergency bronch after that happened. all in all, i dont like the thought of apsirating a patient for them. im all for prevention :) we can all make our own educated decisions. best practice is my policy.

No, I actually haven't seen a time when the saline won't go down. I use about 1/2 of a saline bullet at a time, sometimes less.

About prevention...my patient had bloody mucus coming up his tube. Very difficult to suction even with lavage. His situation had nothing to do with prevention on my part. When I suction alone, nothing comes up, when I suction with saline, lots comes up and my pts RR drops back down and the vent stops alarming.

So without the lavage, I'd have a real hard time on my hands....and so would the patient.

If it's against policy, then it's against policy. I wouldn't do it. But, I can't agree that the saline doesn't help loosen secretions, when I know it does.

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Specializes in GSICU, med/surg.
No, I actually haven't seen a time when the saline won't go down. I use about 1/2 of a saline bullet at a time, sometimes less.

About prevention...my patient had bloody mucus coming up his tube. Very difficult to suction even with lavage. His situation had nothing to do with prevention on my part. When I suction alone, nothing comes up, when I suction with saline, lots comes up and my pts RR drops back down and the vent stops alarming.

So without the lavage, I'd have a real hard time on my hands....and so would the patient.

If it's against policy, then it's against policy. I wouldn't do it. But, I can't agree that the saline doesn't help loosen secretions, when I know it does.

sorry i didnt mean the saline, i meant the actual suction tubing. if he had that much crap coming out of his lungs maybe he needed to be bronched in a more controlled and very sedated situation, who knows.this is a web page i found, it has some interesting points although its on neonates, there is some reference to adults, and the conversation in general. i hope you have a peek :)http://www.medscape.com/viewarticle/552862

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Specializes in Cardiac.
if he had that much crap coming out of his lungs maybe he needed to be bronched in a more controlled and very sedated situation,

Actually we do bronchs in the room, using the same sedation. And we knew why he was bleeding, so a bronch would be pretty useless. He just needed frequent suctioning, and lavage was the only way to go...

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