vented patients

Hi!

I understand your concerns. I take care of vented patients everyday. If the patient is properly sedated and has something for pain, the patient usually does not even remember the time they were intubated. I say this with certainty because when my vented patients are extubated and they are off they vent, I ask them. Most remember nothing at all.

The purpose of the restraints is this: Even though the patient is sedated, they are not paralyzed and thus can still move. It is to inadvertantly prevent self- extubation before the patient is ready.

Mouth care is important, we do it q2hrs. Turning may not be possible depending on the stability of the patient.

Hope this helps some,

Avery

how do you do mouth care? I was doing it when he was on the cpap cause his mouth was exposed but now the tube and the ties and all that are in the way... do you just go around it?

Yes, we have the green little sponge things. It is still possible to do mouth care. We have this chlorohexadine rinse we do once per shift to prevent vent acquired pneumonia and then every two hours use the stuff that comes in the kit with the green sponges. Are the nurses not doing mouth care? What state are you in?

Avery

no they are well they were doing it when he had the cpap on..but they placed the tube last night and shortley after we left... so I am not sure if they are or aren't I would imagine they are.. I'm in pa

They will probably do a sedation vacation each AM, you might want to be there when they do that. The nurse will turn off the propofol prior to RT assessing the pt for weaning potential when they are unsedated. We do it early where I work when RT arrives. This would be your opportunity to interact with him.

We do the sedation vacation too - but be aware, he may not have a clue what the heck is going on when he does arouse. Don't expect too much from him. It is a chance for him to know you are all there and that things are okay. He may be interactive, more likely for him it will be like waking up in a very strange hotel instead of his own bed, and he will be trying to piece it all together. First thing is trying to take that hose out of his mouth that doesn't belong there, hence the restraints. Many patients do re-orient to their environment much more quickly when family is there to help them realize what is going on and it is all okay.

It is much harder mentally/emotionally to have a family member/loved one so sick. I take care of these patients every day with no problem, but when it was my dad I nearly fainted in the room first time in to see him. My thoughts and prayers will be with you!

They will probably do a sedation vacation each AM

I've never heard of this as a routine thing. Is this unique to the adult world? I work PICU, and the only time we cut our sedation is if we really think we're going to go for it.

I've never heard of this as a routine thing. Is this unique to the adult world? I work PICU, and the only time we cut our sedation is if we really think we're going to go for it.

It's part of our ventilator bundle protocol

• Elevation of the Head of the Bed
  
• Daily "Sedation Vacations" and Assessment of Readiness to Extubate
  
• Peptic Ulcer Disease Prophylaxis
  
• Deep Venous Thrombosis Prophylaxis

Institute for Healthcare Improvement: Implement the Ventilator Bundle

I've never heard of this as a routine thing. Is this unique to the adult world? I work PICU, and the only time we cut our sedation is if we really think we're going to go for it.

We are required to do a wake up assessment at least every shift. This is to assess that the patient will still follow commands and has had no neuro change since the last wake up assessment. See if the nod and track, etc. Typical neuro exam. It can also tell weaning potential. Does the pt breath 40 times a minute? Tidal volumes 200 on a 250lb man? Now sometimes the patient is not stable enough to be woken up q shift. I always make sure I have an MD order if I don't do a wake up assess. As for mouthcare, we use the Sage mouthcare kits and brush twice a shift with deep above the cuff suctioning. we also use the wash and mouth moisturizer q 2 hours to prevent VAP. And prn also ofcourse. HOB greater than 30 degrees, Protonix and DVT protocol. We also have rotation beds that we try to make sure our larger or more unstable patients are on.

I have asked many of my patients if they remember anything that happened. Usually, no. If they do remember something it is very vauge.

I hope your Dad gets better. Good Luck.

my dad was on a vent for 9 days, he does not remember any of it. I was there for 4 times when he went on sedation vacation, and it was painful to watch but I am glad I was there because he became upset and start biting the mouthpiece. He opened his eyes and the minute he would, I would lean real close and tell him " You are ok, you are ok, everything is fine" then he would calm down." I hated seeing him so terrified and upset. He remembers nothing of it tho. I cant imagine how upset he was when there wasnt a farmiliar face when he was "brought up" i was able to talk to him tell him what was going on, point out pictures my kids had drawn and tell him that he was getting better.

tough times, but everything turned out ok

best wishes for you and your family

it is a paradoxical phenomenon but even when vented pts appear disoriented and agitated, there is no recollection afterwards.

and not only is po care doable, it is mandatory-esp given the high risks of vap.

i would clearly share your concerns with your father's nurse.

best of everything.

leslie