mouth care/intubated patient

LindaMarie76 · Apr 18, 2005

In the past months our hospital has become very aggressive in the fight against VAP (ventilator acquired pneumonia). We have recently acquired a new pre-packaged suction set that is more involved than the previous one. For the patients with the dried secretions and beefy-appearing tongues, more deliberate nursing care is required.

For dried secretions, a wet saline pad helps to remove.

For beefy tongues protruding from the oral cavity, I will apply a wet saline gauze for short periods of time. We keep the lips moistened with a vaseline-type substance.

I think a protocol is in the works.

Linda

Hi,
I'm currently a tech in an ICU and will graduate and take my boards this summer. I'm looking forward to starting my job in a MICU/SICU/CCU Level II trauma center after boards.
Can you share with me what interventions you use to care for patients' mouths who are intubated? Where I currently work, I don't see a standard being used. Some nurses use hydrogen peroxide, some mouthwash, and some just water. We have the prepackaged toothbrushes/sponges that attach to suction, and sometimes I use them. But as a tech, I'll admit that they don't always work to remove dried fluids on the mouth and teeth. I've noticed that some patients' tongues become brown and beefy looking. Seems that some patients' mouths can tolerate the tube more than others. I'm sure some of this relates to their illness/medications, frequent cleaning, and current dental status.
Thanks in advance for your help!
Classicaldreams

pricklypear · Apr 18, 2005

If the patients you work with have "brown, beefy" tongues, they are NOT getting anything near adequate oral care! Our protocol is AT LEAST q 2h. I do it hourly with vent checks. We use a product called Peroximint ( I think that's what it's called) It is H2o2, water and a minty scent. We also have the toothbrushes attached to suction, and we use them at least BID. We also have a product in a tube that's a mouth moisturizer. I usually load that up on a swab and apply it after oral care. Good for you for noticing the importance of something like oral care for intubated patients!!! You're going to be a GREAT NURSE!!

By the way, since we really started enforcing our protocol, and educating staff and family, our patients have gotten better faster, with less complications!

classicaldreams · Apr 19, 2005

If the patients you work with have "brown, beefy" tongues, they are NOT getting anything near adequate oral care! Our protocol is AT LEAST q 2h. I do it hourly with vent checks. We use a product called Peroximint ( I think that's what it's called) It is H2o2, water and a minty scent. We also have the toothbrushes attached to suction, and we use them at least BID. We also have a product in a tube that's a mouth moisturizer. I usually load that up on a swab and apply it after oral care. Good for you for noticing the importance of something like oral care for intubated patients!!! You're going to be a GREAT NURSE!!
By the way, since we really started enforcing our protocol, and educating staff and family, our patients have gotten better faster, with less complications!

LIndaMarie and Pricklypear,

Thank you for your responses. I'll look up Peroximint. Since our unit is not consistent in care, perhaps something like this is needed. I've found it really difficult to clean some mouths as the exudate is hard and thick. There had been mention of VAP a few months ago and the toothbrush/sponges were pushed, but perhaps old habits die hard and the nurses aren't doing the care like they should.

And pricklypear, thank you for the compliment!

Classicaldreams

pricklypear · Apr 19, 2005

Believe me, it is really hard to get old dogs to do new tricks!! There was a lot of whining at first, but as time has gone by and nurses have seen the benefits, it's become sort of a status thing - whose patient gets the best oral care. It's just a matter of getting everybody to incorporate it into their routine. And as to the mouths with the hard, thick stuff, work on them frequently over the shift. Sometimes it takes several hours of moisturizing and swabbing to get the stuff out without hurting the patient. You deserved the compliment, keep up the good work!!

Tony35NYC · Apr 24, 2005

Hi,
I'm currently a tech in an ICU and will graduate and take my boards this summer. I'm looking forward to starting my job in a MICU/SICU/CCU Level II trauma center after boards.
Can you share with me what interventions you use to care for patients' mouths who are intubated? Where I currently work, I don't see a standard being used. Some nurses use hydrogen peroxide, some mouthwash, and some just water. We have the prepackaged toothbrushes/sponges that attach to suction, and sometimes I use them. But as a tech, I'll admit that they don't always work to remove dried fluids on the mouth and teeth. I've noticed that some patients' tongues become brown and beefy looking. Seems that some patients' mouths can tolerate the tube more than others. I'm sure some of this relates to their illness/medications, frequent cleaning, and current dental status.
Thanks in advance for your help!
Classicaldreams

They had a staff meeting about VAP on my unit not too long ago and we also got a new type of mouth care kit. We use a mild, flavored peroxide solution and a mouth moisturizer with the toothettes/sponges and do a light scrub while suctioning. Our protocol is at least every 2 hours. I like the peroxide because it is good for removing dried up secretions and it takes out the odor, too.

gwenith, BSN, RN · Apr 24, 2005

Okay I MUST work in the sticks because I have never seen the toothbrushes that attach to suction - but then the companies do not always think to export to Australia (small market). Can someone give me some product information pretty please???

We use good 'ol toothpaste and peppermint water. For those without teeth I put the toothpaste on a swab and then rinse and suction. Personally I have found one GOOD rinse is worth about 100 wet swipes. The beefy tongues - yes I agree - wet gauze swabs laid over the tongue.

leslie :-D · Apr 24, 2005

when my mom was on the ventilator, i wasn't too thrilled w/the way her mouth looked- not just her tongue but brown on her teeth as well. they just had regular toothettes but i had to go through several, esp on her tongue to get it clean and took me around 20 minutes. then i put surgilube on her lips and a little to coat her tongue- i don't think she received any mouth care til i had arrived. and she took pride in her appearance so had she known what she looked like, she would have died of shock, rather than her ca.

leslie

hollyster · Apr 24, 2005

One of my pet-peeves is seeing a pt who has not had proper oral care.

Our unit mouth care is every two hours. We use the suction peroximint mouth sponges(they come two to a pack.) I find it helpful to put a wet gauze in the mouth. Provide suctioning and then clean with a mouth sponge. Then dip the sponge into a cup of water and clean again with another mouth sponge,the peroxide should be rinsed out, if it is not it will dry out the mucous membranes. Prevents the brown stuff from ever building up. When I first get a vented pt. I do a mouth sweep to make sure that there is not denture adhesive build up.

This is one of the areas that lawyers are focusing on now. They can use it as the reason for pneumonia or ARDS, even if that was the cause for admission.

Also they use it to prove neglect, if we aren't doing the basics of mouth care what else are we negligent in.

HillaryC, RN, CRNA · Apr 24, 2005

We use a chlorhexidine rinse from the pharmacy. It's ordered as Peridex -- I think that's the brand name. We use it with those green sponge swabs -- it's ordered q8h.

Hi,
I'm currently a tech in an ICU and will graduate and take my boards this summer. I'm looking forward to starting my job in a MICU/SICU/CCU Level II trauma center after boards.
Can you share with me what interventions you use to care for patients' mouths who are intubated? Where I currently work, I don't see a standard being used. Some nurses use hydrogen peroxide, some mouthwash, and some just water. We have the prepackaged toothbrushes/sponges that attach to suction, and sometimes I use them. But as a tech, I'll admit that they don't always work to remove dried fluids on the mouth and teeth. I've noticed that some patients' tongues become brown and beefy looking. Seems that some patients' mouths can tolerate the tube more than others. I'm sure some of this relates to their illness/medications, frequent cleaning, and current dental status.
Thanks in advance for your help!
Classicaldreams

KimberRN1 · Jun 19, 2005

We use the pre-packaged green sponges with periximent with suction...there is a lip moisturizer and also toothbrushes with suction in the oral kit....this comes in a large bag with several of the pre packaged sponges and toothbrushes in it....the pt is charged for one bag, you get the sponges out as needed and it's theirs and left in the room....our protocol is q2hrs but more if needed....It works...if you follow the protocol the pts lips and mouth doesn't get dry, crusted and bleeding... i always use the lip moisturizer after oral care....

bellehill, RN · Jun 19, 2005

We do peridex QID, mouth care with the Sage oral care products Q4h. The only thing I don't like about Sage is the mouth moisturizer is very gritty and the pts don't seem to like it. The Sage kit comes with suction handle, suction sponges and brushes. My big pet peeve...poor oral care. I have been known to do oral care before my assessment (if the pt is stable).