ICU trachelostomy of 600lbs

[Matthew89]

I have a patient who weighs 600lbs actually even more who just got a fresh tracheostomy. The senior nurse wanted to fully turn him to bathe and said it was OK if it dislodged as long as we have an extra trache. He was vent dependent too as well. I didn't want too because my preceptor stated we don't fully turn after a new trache is placed for atleast 6 hours due to risk of bleeding and dislodgement ( This was their policy ib their previous hospital). We don't have any policies. Does anyone have these kind of policies on not turning especially for newly trached patients? My senior nurse was mad cause I didn't want to do it. Thank you.

[SFANURSE2011, MSN, RN]

Turning patients and doing progressive mobility is actually very beneficial for patient care and outcomes. Does anyone want to turn a 600 lb bariatric patient? Probably not, but we do a lot for patient care. A physician ordered proning on a 580 lbs who was 5 ft 3. Needless to say it was done but with caution and needed equipment to help facilitate patient care. 

[offlabel]

A policy probably doesn't (and shouldn't) address this issue. Policies are very general guidelines for generic care of a certain category patient. Sooner or later, common sense has to prevail in any given situation. There is a reason why first trach changes are done by the surgeon and the stay sutures are clearly marked and readily accessible in case of need. And the time you'd need them would be an absolute s**t show in this patient. 

Glad common sense prevailed in this case.