Patient Care for Esophagogastric Balloon Tamponade Tubes

It has been repeatedly stated that oral care is important in the prevention of ventilator-associated pneumonia (VAP). Endotracheal intubation predisposes patients to developing VAP. The tube acts as a conduit from the mouth to the lungs – a perfect track for bacteria to descend upon. Khezeri, et al. (2014) suggest that “the presence of an endotracheal tube (ETT) inhibits normal coughing, normal swallowing, and the protection of the trachea contact by epiglottis closure.” In addition, an endotracheal tube keeps the patients mouth open – leading to dryness. Bacteria are not washed away by saliva. Also, Landgraf, et al. (2017) mention that the presence of an endotracheal tube in the mouth causes “changes in the oral epithelium” which “might indicate risk for infection in intensive care patients

Once on scene, paramedics began to treat the unconscious Villella for his injuries. As part of their treatment, the paramedics inserted an endotracheal tube into his trachea, in an attempt to secure his airway (Brody & Acker, 2010). While in

Although when it happens, there can be a devastating impact on patients as well as to the multidisciplinary theatre team involved. Consequently, the DAS has produced a consensus set of guidelines for managing failed intubations in adult and paediatric patients, but there are as yet no such nationally-agreed guidelines in obstetrics, therefore each obstetric unit should have their own flowchart with regards to management of failed intubation (Brien and Conlon, 2013). Furthermore, in light of the latest DAS guidelines, several aspects of clinical anaesthetic practise have changed over recent years (Frerk at al, 2015). Amongst the changes are the use of new drugs such as rocuronium and suggamadex and using electronic video-laryngoscopes (Frerk et al, 2015). Further work had also looked at extending the period of apnoea without causing desaturation by optimising the preoxygenation process and adequate patient positioning (Frerk et al, 2015). As a result, updated guidelines for difficult intubations in adult patients were published in 2015; these guidelines provide a flowchart to be used when endotracheal intubation proves difficult or impossible and focus on the central importance of oxygenation while reducing the amount of airway interventions in order to minimize trauma to the delicate airway (Frerk et al, 2015). The main message of the revised guidelines is

This study focuses on methods to confirm proper tube placement. Through a cross sectional study, the research concluded that over seventy eight percent of critical care health workers use multiple methods to confirm tube placement. Some of the more common methods include looking at the gastric aspirate’s pH, observing the patient for signs or respiratory distress, and capnography. Auscultation of the air bolus was not included in the study because it was deemed “unreliable”. However, a small separate study was done and about eighty eight percent of critical care health workers claimed they also used an air bolus auscultation as a method of confirming placement. So, what is the reasoning for health care workers to continue doing this if it is unreliable? It has been hypothesized that this method requires the least amount of supplies and the nurses can do it quickly and easily. This research study along with many others concludes that air bolus auscultation is not an accurate method because the sounds nurses are used to hearing that “confirm” proper tube placement in the gastrointestinal tract are the same as sounds heard in the lungs and other areas of the

On arrival to UKMC the patient received a Glasgow Coma Score of 3, which is an indication that intubation is needed. Bipap therapy was attempted but failed, due to respiratory failure. This was confirmed by arterial blood gases. After being assessed by the team at UKMC, the patient was intubated for respiratory failure, as well as shock of an unclear etiology. Rapid sequence intubation drugs, Etomidate and Succinylcholine where administered prior to intubation. A 7.5 endotracheal tube was used

The key concept underpinning the role of the anaesthetic nurse in an unanticipated difficult intubation as part of the multidisciplinary theatre team is essential; as a lead provider of compassionate anaesthetic care (Fynes et al, 2014), as a communicator, have the courage to advocate, be competent and committed (DOH, 2012). These are very important for enhancing patient anaesthetic care and improving patient safety (NPSA, 2010). And above, to improve the knowledge and skills by continuous training is vital in the event of a difficult intubation in adults, pregnant women and children (Brien and Conlon, 2013; Clark and Nolan, 2010). The incident confirms that to improve airway management, especially in the event of a difficult intubation planning, training and practising (such as in simulation centres) for the unanticipated difficult airway for the anaesthetist, anaesthetic nurse and theatre staff as a whole, is vital and it highlighted that our practice around managing the airway needs to be improved and constantly updated (Mellanby, Podmore and McNarry, 2014), and that is why I have applied to take part in the new airway simulation training

Throughout my clinical rotation, the only concern for this patient was pain management and discomfort from the chest tube site. The patient was given Ketorolac for a pain of 4/10 using the numeric pain sale. The patient was also at risk for pneumonia and pressure ulcers from immobility and not coughing/deep breathing. Nursing interventions were getting the patient up to the chair and using the incentive spirometer ten-times per hour. Another concern was SOB and fatigue with activities.

One of the most important things to maintain a trauma patients airway is ensuring that you have adequate help around (Stephens, 2011). This is important because there are many different tasks that must be delegated in maintaining this persons airway. Some of these processes include opening the airway, suctioning the airway, inserting the proper adjunct, and maintaining

A.W., a 52-year-old woman disabled from severe emphysema, was walking at a mall when she suddenly grabbed her right side and gasped, “Oh, something just popped.” A.W. whispered to her walking companion, “I can’t get any air.” Her companion yelled for someone to call 911 and helped her to the nearest bench. By the time the rescue unit arrived, A.W. was stuporous and in severe respiratory distress. She was intubated, an IV of lactated Ringer’s (LR) to KVO (keep vein open) was started, and she was transported to the nearest emergency department (ED).

Throughout the placement of a chest tube, the patient should be assessed for complications of chest tube drainage and for re-expansion of the lung. A nurse should assess the lungs and the thorax for tracheal deviation, nonsymmetrical movement of the chest, emphysema, changes in the pattern of breathing, adventitious lung sounds, and presence of a pneumothorax (tympany).

Second, instead of using normal saline valves that are not sterile, ensure the procedure is performed with sterile equipment and sterile normal saline. This can reduce the potential sources of infection and allow the use for those patients who require this action, for an example, a patient with tenacious secretions. In conclusion the practice of normal saline installation has the potential to cause more harm that benefits, however risk can be reduced by sterile procedures and adding adequate humidification and hydration hence making this practice safe to utilize on patients who can benefit greatly from

You will have a bandage (dressing) around the area where the VAD tube exits your abdomen. The dressing consists of a drain sponge, gauze, and adhesive tape. Your VAD coordinator may help you order the supplies you need to change your dressing.

2. Remeasure length of tube every shift to ensure it has not moved. Replace anything securing the tube (like tape) every 2 days.

Surgery normally consists either of saphenofemoral ligation (where a cut is made at the top of the groin above the main varicose vein) or short saphenous ligation, with or without stripping, and phlebectomies (removal of the vein). Alternatively, varicose veins can be treated by sclerotherapy, an injection treatment which shrinks the blood vessel, although this has been associated with a high recurrence rate.

Scrub the site of the puncture with a alcohol pad. Use a circular scrubbing motion, from inside to outside only. Cover a wide area around the selected site, 3 to 4 inches. This may have to be repeated depending on the cleanliness of the patient. Cleansing the site prevents chemical or microbial contamination of specimen and patient. Do not touch this area again. Let the area air dry. Do not blow on or fan the area. The alcohol should be allowed to dry to avoid hemolysis and/or burning sensation when the venipuncture is performed. It is better to use syringes if veins are small. butterfly collection sets are also available and useful if multiple tubes are needed. If a syringe is used, move the plunger up and down in the barrel once or