HAND HYGIENE
Wash hands before direct contact. 40% of infections are transmitted by the hands of hospital staff
Use sterlium or alcohol based hand rub in between procedure
RECORDING OF VITAL SIGNS
Record vital signs (Assess for hypotension, tachycardia, tachypnoea)
Observe respiratory pattern and auscultate lung sounds
Observe for breathing pattern in relation to ventilatory cycle
Assess for changes in mental status and LOC
Continuous pulse oximetry
Observe ABG for abrupt changes or deterioration as required
ENDOTRACHEAL TUBE CARE
Introduce an oropharyngeal airway
Maintain inflation of the cuff at 15 to 20 mmHg
Institute Endotracheal suctioning as appropriate
Administer humidified oxygen before suctioning to loosen secretions
Change Endotracheal tapes every 24 hours
Inspect the skin and oral mucosa
Stop feeding during 30 to 60 minutes before suctioning and chest physiotherapy
Observe the type, color and amount of secretion,notify the changes
Avoid drawing of arterial blood sample immediately after suctioning
Watch for side effects: hypoxemia, bradycardia, and hypotension
ORAL HYGIENE
Provide careful oral hygiene
Apply lubricant to lips to prevent drying, cracking and excoriation
Rotate the ET tube from one corner of mouth to the other side at least every 24 hours
ARTERIAL BLOOD GAS ANALYSIS
ABG reflects oxygenation adequacy of gas exchange in the lungs and acid base status
Avoid taking sample immediately after suctioning, nebulisations and baging
While drawing blood prevent entry of air in syringe
Send immediately ABG sample to laboratory
MAINTAIN NUTRITIONAL NEED
Basal energy expenditure calculation (Harris Benedict Equation)
Men: 66.477 + (13.75 multiply W) + (5 multiply H) – (6.76 multiply A) Kcal/Day
Female: 65.51 + (9.56 multiply W) + (1.58 multiply H) – (4.68 multiply A) Kcal/Day
(W = weight of Pt., H = Height of Pt., A = Age of Pt.)
High protein, high fat and low carbohydrates diet can be beneficial
Add mineral supplements to the diet expecially magnesium and phosphorus. These are essential for energy production and respiratory muscle function
POSITIONING
Turn and reposition the patient every 2nd hourly
Positioning prevents complications such as pneumonia and atelectasis
PERSONAL HYGIENE
Frequent oral hygiene must be done
Eye care to be given every 4th hourly to prevent corneal ulcers and dryness of conjunctiva
Provide skin care
Provide catheter care using sterile technique
ALLAYING ANXIETY AND FEAR
Explain all the procedures to the patient and relatives to win their confidence
Talk and clear the doubts of patient and attainders. Never ignore their feelings.
Use therapeutic touch
Encourage the family members to visit the patient as per hospital policy
CARE OF VENTILATOR CIRCUIT
Keep the water level in humidifier in normal limit
Humidification during mechanical ventilation required to prevent hypothermia, inspissations of airway secretions, destructions of airway epithelium and atelectasis
A heated humidifier should be set to deliver an inspired gas temperature of 33 -/+ 2 Degree Celcius
The temperature of inspired gas should not exceed 37 degree celcius at the airway threshold
Sterile water should be used only
Condensation from the patient circuit should be considered infectious waste and should never be drained back in to the humidification reservoir
Change the circuit when it is visibly soiled or mechanically malfunctioning
Bacterial filters should not be used for more than 48 hours
Use universal precautions when involved in circuit changes
CARE OF VENTILATOR ALARMS
Never Shut Alarms Off – Alarm system must be activated and function at all time. It is acceptable to silence alarms for a preset delay while suctioning and during oxygen flush before suctioning
If equipment failure is suspected and unable to determine the cause of alarm, manually ventilate the patient with resuscitation bag until the problem is corrected
VENTILATOR CARE BUNDLE
According to IHI ‘bundle’ is a group of evidence – based care components for a given disease that, when executed together, may result in better outcomes than if implemented individually.
It includes:
DVT Prophylaxis (unfractioned heparin, elastic stockings, pneumatic compression, elevation of affected extremity, gentle foot and leg exercise, fluid administration)
GI prophylaxis (H2 blocker/proton pump inhibitor)
Head of bed elevated to 30 to 45
Daily sedation vacation/daily spontaneous breathing trial
Skin safety (manage pressure, adequate nutrition, wound assessment and wound care)
Fall prophylaxis
ROLE OF NURSE IN CARE OF MECHANICALLY VENTILATED PATIENT PDF
