trach'd patient and npo

[apma77]

does one still need to follow npo guidelines (g tube feeds) even thogh the airway is essentailly secured if the patient has a cuffed trach?

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[militarymd]

does one still need to follow npo guidelines (g tube feeds) even thogh the airway is essentailly secured if the patient has a cuffed trach?

you should.

 

[apma77]

why? whats your rationale military?

 

[Trisomy13]

why? whats your rationale military?

My guess would be that there is no guarantee that the cuffed trach will remain there or do it's job in preventing aspiration even if it does stay in place. More of the "better safe than sorry" approach, especially since it is a simple matter of making someone NPO. I don't know much though

 

[Noyac]

If the feeding tube is transpyloric, I don't worry so much. I will hold the feedings for only 1 hr.

 

[Tenesma]

cuffed trach patients aspirate all the time - don't you see that crap yellow stuff they can't expectorate properly cause their cords aren't being used... that crap yellow stuff comes usually from above the cords - dripping down slowly...

so don't be fooled into thinking that a cuffed trach protects the airway from regurgitated stuff....

i mean look at how many intubated patients aspirate!!!! and those cuffs are usually more inflated than the trach patients...

ICU 101: nothing can prevent aspiration...

 

[militarymd]

ICU 101: nothing can prevent aspiration...

bingo...and that applies to regular patients....I always find it extremely amusing that, once the ETT is placed, everyone breathes a sign of relief and think that the patient won't aspirate.

The fact that patients don't aspirate in the OR has little to do with the "cuffed" ETT.....it is due to the fact that patients rarely aspirate ...period.

 

[TIVA]

ICU 101: nothing can prevent aspiration...[/QUOTE]


Well ... actually elevating the head of the bed does prevent aspiration.

But that's not to argue against your point.

 

[SilverStreak]

ICU 101: nothing can prevent aspiration...

Well ... actually elevating the head of the bed does prevent aspiration.

But that's not to argue against your point.[/QUOTE]

I think the point is that there are things we do to decrease the incidence of aspiration, but it can still occur in the ICU. We usually still place an NGT with an intubated patient to deflate the stomach, but nothing is foolproof.

As far as elevating the HOB for example...the guilelines are to elevate the HOB to 30 for aspiration precaution/prevention. There are numerous problems with this and reasons why aspiration still does occur. 1. The nurse lies the patient flat to turn them, forgets to pause the tube feeding. 2. The HOB is only actually at 15 or 20 and not 30, guessing the degree of elevation by eyeball has been documented to not be accurate. 3. A vented pt is nauseated and aspirates. Any number of things can happen to cause aspiration even when we document on our prevention sheets that the HOB is at 30 degrees everyday, people don't always take these things into account when a patient does aspirate.

 

[Tenesma]

i think some of you guys forget that aspiration also includes aspirating oral/nasal secretions (which can be just as full of yuck)

30 degress doesn't prevent that

 

[Laryngospasm]

ICU 101: nothing can prevent aspiration...

Death can prevent aspiration