Published May 19, 2005
Just wondering if anyone has an establised oral care protocol esp for vented pts...Trying to make some changes in our unit and lower VAP...Most nurses use the pink swabs.."Toothettes" and they don't really do well...Also wondering if anyone has any evidence based research on the subject..Thanks! :)
We use swabs - ours are green. We use either a H2O2 solution, or a product called peroximint with the swabs. We also use toothbrushes attached to suction. Our protocol is q2h, preferably more often.
We use green swabs as well with a q 2hr protocol for oral care (more if needed)...I work in the MICU with a lot of vented pts......sounds like ours is pretty much like picklypear's....Our green swab packets have the peroximent and are attached to suction we also have toothbrushes with suction and a lip moisturizer .....You can really tell a difference when you use the green q2 hrs then lip moisturizer after.. ..We use the pink swabs usually for awake pts who want to wet their mouths if they're NPO...We just dip it in some water....we don't use the pink for oral care.....
you do know this is not lip moisturizer,it is oral moisturizer.:rotfl: we thought the same thing until a rep from the company came and demoed the product line we are currently using.i hate this stuff.it makes a nasty film in the patients mouth. i use vaseline on their lips,it works better.but i use the packet with the swabs for oral care.it has a tropical fruit flavor to it i am told.we do oral care q2hrs with swabs,we brush at 0800 and 2000.our vap is very low compared to national average,we also keep head of beds up greater than 30 degrees,this also helps with the secretions.
we use green swabs as well with a q 2hr protocol for oral care (more if needed)...i work in the micu with a lot of vented pts......sounds like ours is pretty much like picklypear's....our green swab packets have the peroximent and are attached to suction we also have toothbrushes with suction and a lip moisturizer .....you can really tell a difference when you use the green q2 hrs then lip moisturizer after.. ..we use the pink swabs usually for awake pts who want to wet their mouths if they're npo...we just dip it in some water....we don't use the pink for oral care.....
We use the sage program q 4 hours, with moistened toothette the alternating q4h, so the pt gets one or the other q2h.
The suction appliances make all the difference in the world.
Green swabs q2hours and prn brushing thier teeth bid, this protocol was developed by a bunch of nurses and is evidence based. However I don't have thier data.
Surgical Hrt RN
we use sage products, which are great! the sage rep had some great studies and research about reducing vap, by doing oral care a minimum of every 4 hours. i do it at least every 2 hours if not every hour. this is also what i instruct my orientees to do. the rep said that they saw a decrease in vap with oral care every 4 hours, but the numbers were even better with oral care every 2. hospitals are cheap and don't want to spend the money for the every 2 hour kits, at least the one i work at. so they purchased the q 4, the bare minimum. so i just grab another kit when i need it and do it every 2! :rotfl:
Check out aacn's oral care protocol for prevention of VAP. The latest edition of Critical Care Nurse has a CEU article about this.
On our unit some of the nurses did a research study using a peridex protocol for all intubated pts, we use chlorhexidine gluconate q12h, if they have teeth brush as usual followed by using the solution (which comes from pharmacy). the research they have does show a decreased in our units VAP rates.
The American Journal of Critical Care for Sept 2005 has a great article with study-based parameters in it; the basic finding was that, generally, oral care is not done frequently/consistently enough to prevent VAP. We read it as a unit and discussed it at our AM meeting.
I'm a dental hygienist and also a pre-nursing student. I have to admit that only being able to use toothette swabs on patients will probably drive me crazy in my future nursing career!
dorimar, BSN, RN
We use the sage product as well and it is WONDERFULL!
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