Intubated Pt's Using Bedside Comodes

[EDrunnerRN]

Ok...a few days ago an ICU nurse, at my facility, stated that stable intubated patients on the Unit use bedside comodes. My first thought was you are joking, right?! No, she was serious! I don't pretend to be an ICU nurse or know the aspects of care that pertain to ICU nursing but in the ER I would NEVER place an intubated pt on a bedside comode for obvious reasons, they are not stable. Can any ICU nurses out there back up her statement? For some odd reason, I keep picturing an intubated patient on a bedside comode and find it HILARIOUS! I think I need to see this to believe it!!

[wildnursebrendan]

I work in a Trauma ICU and standard practice is to trach 7 days after intubation, or if we know they are going to be intubated longer than a week to do the trach right away. I have never, ever seen someone ambulated while intubated or on a bedside commode! It's hard enough getting them into a cardiac chair and that's with using a slide board. We have PT/OT ordered right away, but ambulating usually starts once they are transferred out of our unit.

I'm just a CNA but I believe in our ICU the max time intubated before requiring a trach is 14 days. It's not uncommon to have vented patients up out of bed. We bring in a PT, an RT, the RN and I, and PT basically takes charge making sure we don't push them further than we should. They can appropriately use the call light and are off propofol. Sometimes we will walk them with PT and RT present. There is just our CCU and the Med/Surg floors, so we don't transfer them out. They stay ICU status.

[KeepinitrealCCRN]

in SICU most of our pts are critically ill and when they are no longer critical we extubate them. i have seen a few pts intubated out of bed in the chair but they are mostly trach to vent. i would guess in MICU they would do this more as they tend to have pts intubated for longer periods of time. even some of our neuro pts who do not move much if any but are trach to vent still and cleared by neurosurgery we will get them out of bed in the chair but again these are all stable pts where the potential to lose an airway is very low.

[mcubed45]

Yes physical therapy is vital early in patients that have been extubated because they are weak as kittens. However, how do you get active rom out of someone that is sedated and how do they bear weight? I really don't want to reseach something I think is ludicrous.

You don't keep them snowed.

There's tons of research showing the long term neurological deficits associated with prolonged sedation in the ICU. A lof of us were trained with the mentality that we're helping our patients by letting them sleep through their critical illness. In a lot of cases, it's quite the opposite. Over sedation leads to more vent days, longer hospital stays, and more complications. We also don't see the neurological damage we cause because the memory and cognitive problems don't become evident until long after we've extubated and downgraded our patients.

The goal should always be to get the patient off all sedation/analgesia as long as it's safe to do so. That means spontaneous awakening trials every shift at a minimum.

It can be really difficult to change your unit's culture, but all the evidence shows that we need to change. If your unit isn't already a part of the SCCM ICU Liberation Collaborative, I'd encourage you to explore the work being done and consider adopting some of the bundles/guidelines.

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