Checklist for Implementing VAP Prevention Best Practices

Mike Hewitt, RRT-NPS, FAARC, FCCM, director of respiratory, pulmonary, sleep and neurology at Peninsula Regional Medical Center in Salisbury, Md. Offers the following checklist:

1. All ICU patients shall be assessed upon admission, PRN and before discharge out of the ICU by the ICU therapists. Included in their assessment will be a current chest X-ray, cough ability and quality, oxygenation, secretions and patient mobility. A transfer report must be called to the receiving therapist on all patients leaving the ICU by the ICU therapist.

2. Patients who have atelectasis and/or consolidation shall be placed “bad” lung up to facilitate expansion and mobilization of secretions in the affected lung during delivery of their respiratory treatments.

3. Patients with a bilateral process shall be positioned appropriately positions as determined by the respiratory therapist  during their therapy.

4. Perform deep breathing and coughing therapy.

5. Evaluate trach suctioning every four hours and as needed.

6. Reassess patients every 72 hours to determine appropriateness of current therapies.

7. At these 72-hour intervals, the therapy must be discontinued, modified, or reordered as is. The therapy may be modified be-fore the 72-hour mandatory assessment period when indicated for changes in status. Appropriate documentation is required and will support whichever course of action is taken.

8. Assessments shall be performed between the mandatory 72 hour assessments as appropriate for monitoring the patient’s status.

9. Changes to therapy must be communicated to the primary team and the notification documented, including the name of the party notified.

Patient Entry Criteria to ICU:

— Post operative laparotomy or thoracotomy

— Two or more rib fractures

— Prolonged bed rest (anticipated more than three days)

— Chest tube in place

— Pre-existing airway disease

— Older than 65 years)

— Any patient with IS ? 15 cc/kg/IBW

Patients shall remain on q4 therapy for as long as they meet any aspect of the entry criteria listed above. For patients that are 65 years of age or older, at least one additional component of the entry criteria must be met to continue q4 therapy.

Exiting Criteria from ICU:

—  More than five  days post-operative laparotomy or thoracotomy with none of the entry criteria present

—  Patient freely mobile

—  IS ? 15 cc/kg/IBW x 24 hours

—  No active respiratory process

—  No other evident factors placing the patient at risk for pulmonary complications

—  More than 72 hours post ICU discharge and absence of active or evident pulmonary complication

Once a patient meets the exit criteria, their treatments shall be changed to PRN and they shall receive a pulmonary assessment q12 until discharge. This assessment shall be documented.

Clinicians Share VAP Prevention Strategies.

Chest Tubes

1- What are chest tubes used for?

2- Where exactly is a chest placed?

3- How does the three-chamber system work?

4- Can suction be bad for the patient?

5- What is the difference between exudate and transudate, and why do we care?

6- What is an effusion?

7- How are effusions treated?

8- When should a chest tube for effusions be removed?

9- What is pleurodesis?

10-  How are malignant effusions treated?

11- What is streptokinase used for when it is given through a chest tube?

12- What is empyema?

13- What exactly is an air leak?

14- How can you tell if the chest tube port is out of the chest?

15- How can this be fixed?

16- Are air leaks good or bad?

17- Would that be a bad situation?

18- What is the black button on top of the pleurevac for?

19- What is tube “stripping”?

20- How could I tell if a patient were developing a tension situation in her chest?

21- What is a pulsus paradoxus?

22- Should you ever clamp a chest tube?

23- What if the chest tube gets pulled out by mistake?

24- What is “water seal”?

25- What is subcutaneous emphysema, and what does it have to do with chest tubes?

Continue Reading Complete Tutorial in PDF

Pneumothorax

• Definition

Air accumulation in the pleural space with secondary lung

collapse

• Sources

–Visceral pleura

–Ruptured esophagus

–Chest wall defect

–Gas-forming organisms

• Factors determining gasreabsorption

–Diffusion properties of the gases

–Pressure gradients

–Area of contact

–Permeability of pleural surface

Read Further:

Pneumothorax and Chest Tubes PDF