mouth care for vent patient - page 2
hi every body, I want to ask about the best mouth care can be delivered for a vent patient, specifically teeth brushing...my instructor said it is better not to use the brush for those patient... Read More
Jan 9, '08Joined: Jul '06; Posts: 10; Likes: 4I don't see any harm in it. My hospital policy is oral care is required and documented every 4 hours to prevent VAP. We also have the neat toothbrush kit that connects to suction.
Jan 9, '08Occupation: Physician Informatics Specialty: 16 year(s) of experience in cardiac/critical care/ informatics ; Joined: Jun '05; Posts: 3,071; Likes: 909Quote from fatomaBrushing teeth while on the vent is done bid and basic mouth care is done q2 hours, this is part of protocol to fight VAP.hi every body,
I want to ask about the best mouth care can be delivered for a vent patient, specifically teeth brushing...my instructor said it is better not to use the brush for those patient beacause it leads to a certain harm...any idea what kind of harm it could be..
any help will be appreciated
So your instructor may be a little behind the times.
Mar 19, '08Specialty: 1 year(s) of experience in LTC ; Joined: Mar '08; Posts: 62; Likes: 17The toothbrush could actually scratch gums and that leaves your patient wide open for different bacteria to enter his body (ex: vre, mrsa,staph) and thats just a few, your best bet is to use the mouth swabs they offer dipped in either paroxide or lemon glycerin
Mar 19, '08Occupation: Physician Informatics Specialty: 16 year(s) of experience in cardiac/critical care/ informatics ; Joined: Jun '05; Posts: 3,071; Likes: 909Not according to evidence based practice and the literature out there.
Mar 20, '08Joined: Mar '01; Posts: 2,730; Likes: 605Quote from RN1980Same here!our hospitals to cheap for that cool space-age stuff. nothing but mouth swabs, h2o2/h20 and wall sxn for us.
mouth care on Vent patients should be done every two hours to help prevent VAP
Mar 20, '08Occupation: Registered Nurse Specialty: 5 year(s) of experience in Intensive Care ; From: AU ; Joined: Oct '03; Posts: 68; Likes: 27Teeth cleaned TDS (so once a shift) and mouth/eye care 2nd hrly
Normally, I will clean teeth just prior to changing tapes. We have kiddies toothbrushes (nice and soft, and small enough to fit into a mouth already full due to an ETT) and toothpaste, and we brush gently. Then irrigate the mouth with a yankeur sucker and syringe with an irrigation nozzle.
I'm liking the sounds of the toothbrush hooked up to suction, sounds very cool!
Mouth care is 2nd hrly swabs with H2O/Sodi Bic, lanolin to lips and suctioning of oropharynx. Of course, thats just a minimun, if pts need it more/less frequently, alter care accordingly
Mar 20, '08Joined: May '05; Posts: 13; Likes: 20i had a long term neuro pt who actually bit her tongue nearly in half--make sure you assess that mouth before you grab the toothbrush and suction!! I prefer swabs (more gentle than a brush) q2.
Mar 21, '08Occupation: ICU RN Specialty: 4 year(s) of experience in Med-Surg, ICU ; Joined: Nov '07; Posts: 15; Likes: 7Quote from cardiacRN2006Sometimes it doesn't take much to cause bleeding in the end-stage liver pt or the pt with DIC. On these pt's, I just use the swabs, gently.You shouldn't be brushing so hard that it causes bleeding!
Mar 22, '08Joined: Jan '05; Posts: 4,765; Likes: 2,554I think people have more critical thinking skills than to use a toothbrush on DIC pts...Last edit by cardiacRN2006 on Apr 25, '08 : Reason: remove unnecessary content
Mar 22, '08Joined: Mar '08; Posts: 3,791; Likes: 3,445Most important thing is prevention of VAP. I am not sure why everyone is inventing their own protocol - use the CDC VAP prevention bundle.
There is just so much literature out there about best EBP for intubated patients, there's not really any excuse for confusion.
Mar 26, '08Occupation: icu Specialty: 15 year(s) of experience in critical care ; Joined: Jan '04; Posts: 162; Likes: 22Quote from fatomahttp://www.lhsc.on.ca/critcare/ucicu/procs/oralcare.htm
this website includes guidelines for oral care for intubated patient to prevent VAP...besides of course head of bed elevation and hand washing.
another issue her is the chlorhexidine which is recommened only for cardiac patient, not all intubated patients which I have just known and I am worried about it b/c all our ICU patients we use chlorheidine..
the article is gone
I was curious to read it because we just implemented the chlorhexidine and some of us have had concerns.
Mar 28, '08Occupation: SICU Joined: Jan '08; Posts: 6Many patients in ICUs are prescribed Heparin to prevent DVTs and therefore I believe the harm could come from small cuts or abrasions caused during mouth care with a bristle toothbrush. Where I work we only use green tipped sponge swabs to clean the patient's mouths.
Mar 31, '08Joined: Mar '08; Posts: 13; Likes: 6the harm could be refering to bacteria in the blood stream leading to endocarditis. However the likelihood of that is about nill. It usually only occurs with deep oral care such as a dental procedure. the AACN and many comericial products recommend tooth brushing. Pull up the AACN guidlines for oral care q 2 hours . Tooth brushing is right at the top of the list. It decreases Ventilator Associated Pneumonia and length of stay and ventilated days of care. Studied and proven. BRUSH YOUR TEETH- Your mom was right.