Ventilator Associated Pneumonia

[marib]

I am a nursing student, researching information on VAP and techniques used to protect intibated patients. I have come across two articals that discuss "bundle barriers" or strategies used, such as head of bed elevation, ulcer and DVT prophylaxis, and sedition holidays. I am interested in a nurses real life experience with these and other treatments you have used to prevent or treat VAP.

Thanks Mari

[nursprl]

Hi there

The bundle barriers that the articles may pertain to are prophylactic treatments and nursing interventions. Besides elevating the head of the bed, an intubated patient should be turned at least every two hours (prevents skin breakdown and helps w/ movment of secretions). DVT prophylaxix is using ted hoses or SCD and proper body positioning, especially if patient is paralyzed as well as sedated since they are unable to move their limbs to circulate blood. If the patient is going to be NPO and only receiving IV fluids like TPN, then pepcid or zantac should be ordered to prevent gastric buildup and this helps decrease chances of ulcer. In most cases the patient will be receiving tube feeding via NG or NJ tube. The patient should also be suctioned at least every two hours, preferably before and after turning/repositioning, and thorough and proper mouth care at least every 4 hrs. The sedation holiday is temporarily lifting their sedation so you can evaluate their progress and sometimes to allow a little movement. It also allows the patient to have a deeper cough response when you suction them and help clear secretions. Chest physiotherapy may or may not always be ordered; usually only if patient needs extra help in loosening secretions prior to suction, but if you do much of the above, it keep CPT from being ordered and lowers risk of VAP (vent. assoc. pneum.).

I hope this helps.

[dorimar, BSN, RN]

You can go to the IHI site on line (Institue for Health Improvement) as a good source for this and other barrier bundles.

[gr8rnpjt, RN]

I am wondering how they clean the vents between patients. I have had patients develop MRSA pneumonia after being on the vent and I wonder if there is somewhere in the machine that cannot be cleaned, where the bacteria can spread from pt to pt. Not sure who I am asking but I have been wondering about this for a while.