Mouth Care Ventilator Pt: ET vs Trach

[gtmoore]

Our hospital policy states that mouth care must be provided to ventilator patients q2hr. There is no differentiation between vent pts with an ET tube vs a trach. My thinking is that trach patients should not need mouth care as often as ET tube pt.

Our policy for trach pts not vented is mouth care q8hr. The primary reason for mouth care is prevention of ventilator-associated pneumonia. Is a vented pt with a trach in as much risk of developing pneumonia as an ET tube pt?

[meandragonbrett]

I would say yes, the are. They are still on the vent and still have secretions. Good and aggressive oral care with CHG is what we do.

[criticalHP, MSN, RN]

If the patient is on a ventilator oral care should be done according to AACN recommendations to prevent VAP. IT should make no difference as to the route of ventialtion (ETT Trach Nasal). I encourage you to check out the AACN website practice alerts on oral care. It doesn't address your specific question with regard to ETT vs trach, but it gives current guidelines with great evidence to back it up. You don't need to be a member to look at the site, but you do need membership to access other databases.

[dorie43rn]

I have to disagree with the previous posts. I thing ETT tubed patients have a far greater risk of VAP then trached patients. I'm not saying that trached paitents shouldn't have aggressive oral care, but I really don't think it needs to be q2hrs unless needed. People live all their lives with trachs. The problems with the ETT is all the germs in the mouth are traveling down the tube. At least with a trach, you have the closed suction protecting it. I bet if you read statistics, Trach patients have fewer problems then ETT paitients.

Dorie

[AdelaideChic]

In the unit i work on, mouth care is strictly at least 3 hourly on any ventilated patients, to protect the mucosa, comfort as well as VAP minimization. We used close suction on both trachy and ETT.

[danamobile]

Patients with ETTs have much greater incidence of VAP due to the direct tubing, and the use of traching a patient decreases VAP if needed long term. HOWEVER, with the amount of secretions, decreased immunity, and antibiotic use on these patients, i think q2h mouthcare is needed on everyone; even if it is 'just' for comfort reasons. I personally would hate a dry mouth...