mouth care for vent patient

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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

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Specializes in Cardiac.

I brush their teeth once a shift, and swab/suction them the other times during my shift. We get a little bundle with one toothbrush (hooked up to suction) and 2 swab/sponges that we use per shift.

The certain harm that your teacher speaks of it pts not getting mouth care done. There is no harm in brushing teeth, and certainly nothing greater than a pt getting VAP because mouth care wasn't done...

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Specializes in icu/er.

the only harm that i can foresee and have actually have seen is accidental manipulation of the ett while trying to brush all the teeth and gums and there has been times when there has been a possible airleak to the ett cuff or the cuff was not occluding the entire trachea and some possible aspiration may have occured. just make sure the ett is secured well and the cuff pressures are ok, and other pressures that would indicate a cuff leak.

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Specializes in SICU.

We use an oral care kit by Sage that has a toothbrush that suction can run through, therefore greatly reducing any fluids going where they don't belong... the kit also includes a long, thin, flexible catheter that easily slides around to the back of the throat to get at all those pooled secretions.

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Specializes in icu/er.

our hospitals to cheap for that cool space-age stuff. nothing but mouth swabs, h2o2/h20 and wall sxn for us.

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thank you for your replies I really appreciate

I read lots of materials regarding oral care for a vent patient and tell now there is no standared protcol....what I found regarding contraindicating brushing the teeth is when chlorhexidine in use.

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Specializes in SICU, MICU, CICU, NeuroICU.
The certain harm that your teacher speaks of it pts not getting mouth care done. There is no harm in brushing teeth, and certainly nothing greater than a pt getting VAP because mouth care wasn't done...

I agree 100%

the only harm that i can foresee and have actually have seen is accidental manipulation of the ett while trying to brush all the teeth and gums.

Good point.

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first of all i am proud to see you here

and about what is harm in using toothbrush i think it the bleeding it will cause

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Specializes in Cardiac.

You shouldn't be brushing so hard that it causes bleeding!

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http://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..

regards

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While the literature supports using CHG in CV-Surgery patients, it also doesn't suggest that any harm is done to other patient populations. I think the key is following the VAP Bundle and if your hospital doesn't have one, get one!

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We brush the teeth on ventilated pts once a shift. One hour after brushing their teeth we coat the mouth with chlorhexidine gel. The reason we wait is because the chlorhexidine stops the effect of the flour in the toothpaste.

A study made in several ICU's in Denmark showed an reduction of up to 50% in VAP following the introduction of chlorhexidine as a part of the rutine.

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