As a healthcare provider, you know that caring for patients following an accident or illness is a major responsibility. While your treatment regime will depend on their diagnosis, a major focus of your care must be directed toward protecting your patients from acquiring healthcare-associated infections (HAIs) during their stay. And some of the most vulnerable patients are those dependent upon ventilators.
According to the CDC, about one in 25 patients will suffer from at least one form of HAI on any given day. And out of the more than 700,000 infections that occurred in 2011, 157,000 of them involved pneumonia, which is always a concern for ventilator-dependent patients.
American Nurse Today, the official journal of the American Nurses Association, identifies the top 10 care essentials for ventilator patients. But for the sake of brevity, we’ll focus on three essentials that can ensure your ventilator patients remain safe while under your care.
1. Reducing Infection
The staggering rate of HAIs each year means that preventing infection should be your primary goal in patient care. The last thing a recovering patient needs is to be burdened with additional infection, especially when it is preventable. Here are American Nurse Today’s suggestions for reducing the chance of infection among patients on vents:
- If the patient’s condition allows, keep the head elevated 30 degrees to 45 degrees to help prevent ventilator-associated pneumonia.
- If the patient is able to take breaths on his or her own, and his or her vitals are within normal range, provide sedation “vacations” to ready your patient for extubation.
- Provide prophylactic care for peptic ulcers and deep vein thrombosis.
- Perform daily oral care with chlorhexidine.
2. Check the Settings and Modes
It is essential that the ventilator settings and modes are continually checked, to ensure proper oxygenation and to prevent complications. The following settings should be monitored closely:
- Respiratory rate – manually count your patient’s respirations, because he or she may be overriding the vent and taking breaths on his or her own
- Fraction of inspired oxygen (FiO2) – which is expressed as a percentage
- Tidal volume – the amount of air inhaled with each breath (TV or VT)
- Peak inspiratory pressure (PIP) – which is the amount of pressure needed to provide each breath and, when elevated (above 30 cm H2O), can indicate serious complications (pneumothorax or pulmonary edema)
3. The Importance of Suctioning
As in any situation requiring airway support, effective suctioning is a critical component in preventing ventilator complications. Even a ventilator can be ineffective if the tube is clogged or the tracheostomy is not maintained. But suctioning must be applied following proper guidelines, which include:
- Suctioning only as needed
- Hyperoxygenating the patient prior to suctioning to prevent oxygen desaturation
- Avoiding instilling normal saline into the tube to loosen secretions
- Using the lowest level of suction pressure to remove secretions
- Keeping your suctioning time to a minimum
The care you provide your patients can have tremendous impact on their overall recovery. And reducing the time on the ventilator, through effective preventive measures and diligent monitoring, will only improve their outcomes. There is much you can do to keep your ventilator patients safe, so follow these guidelines to enhance the prognoses of these vulnerable individuals.