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VAP and trachs
ventilator associated pneumonia and tracheostomy
| Question | Answer |
|---|---|
| ventilator associated pneumonia | occurs 48 hours after endotracheal intubation |
| risk factors for VAP | contaminated respiratory equipment, inadequate hand washing, environmental factors (poor room ventilation, high traffic flow), impaired cough, colonization of oropharynx |
| clinical manifestations of VAP | fever, elevated WBCs, purulent or odorous sputum, crackles or wheezes, pulmonary infiltrates |
| VAP prevention techniques | minimize sedation, early exercise and mobilization, HOB of 30-45 degrees, subglottic secretion drainage, no routine changes of ventilator tubing, strict handwashing and gloves, oral care |
| what are tracheostomies used for | establish a patent airway, bypass an airway obstruction, facilitate secretion removal, permit long-term mechanical ventilation, facilitate weaning from mechanical ventilation |
| pre procedure for tracheostomy | record VS, ensure IV is patent, assess bedside suction, position patient supine, administer analgesics |
| post procedure for tracheostomy | obturator removed but must remain at bedside, cuff (balloon) is inflated, auscultate for air entry, tracheostomy secure and sutured in place |
| precautions to prevent dislodgement | replacement tube at bedside, do not change ties for 24 hours, physician must do first tube change |
| if accidental dislodgement occurs... | call for help immediately |
| Replacing tube if dislodgement occurs | 1) spread opening with hemostat, insert a replacement tube with obturator then remove the obturator 2) insert suction catheter to allow passage of air and guide insertion of replacement tube |
| if tube cannot be replaced... | assess level of respiratory distress position patient in semi-fowlers |
| teach patient to... | assess stoma site, clean inner cannula, suction and change the trach tapes |
| decannulation occurs when | patient is hemodynamically stable, has stable and intact respiratory drive, can adequately exchange air and expectorate |
| after decannulation.. | apply sterile occlusive dressing, monitor for bleeding, assess O2 stats, apply alternate method of O2, instruct pt to splint stoma with fingers when coughing, swallowing or speaking |
Created by:
ebrewer12
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