Aspiration of pharyngeal or gastric materials into the lungs is a big threat for a lot of sufferers within the ICU. This will result in the event of aspiration pneumonia, which might trigger critical issues.
The American Affiliation of Crucial Care Nurses (AACN)just lately up to date a Apply Alert referred to as Prevention of Aspiration in Adults. By implementing these measures nurses can use to maintain sufferers’ airways clear, cut back the chance of aspiration, and stop subsequent pneumonia, with a purpose towards enhancing affected person outcomes and decreasing hospital prices.
Among the AACN apply suggestions:
- Elevate affected person’s head of mattress between 30 and 45 levels: Mendacity supine will increase reflux and potential for aspiration. Barring any contraindications, sufferers who’re at excessive threat for aspiration, comparable to these with a feeding tube or who’re ventilated, ought to have the top of the mattress elevated to lower this threat.
- Scale back using sedatives when attainable: When a affected person is sedated, they might be much less prone to clear their very own airway by coughing or gagging. Limiting using sedatives will permit these reflexes to remain intact.
- Examine feeding tube placement each 4 hours: Even when correctly positioned, the place of the feeding tube can change over time. It can be crucial that nurses repeatedly assess the place the top of the feeding tube is situated. If it strikes too excessive, the affected person is at a better threat for aspiration.
- Assess for indicators of feeding intolerance each 4 hours in tube-fed sufferers: Frequently checking gastric residuals (the quantity of a tube feeding that has not been digested), gastric distention, and complaints of gastric ache are all good indicators of how effectively a affected person is tolerating feedings. Intolerance can result in vomiting and attainable aspiration.
- Keep away from bolus feedings: There are not any particular suggestions, however it seems from a small examine that sufferers at excessive threat for aspiration are much less prone to aspirate when receiving steady feedings versus receiving a bigger meals bolus over a brief time frame.
- Contemplate swallow research for just lately extubated sufferers: When sufferers are intubated, they expertise some lower in swallowing skill. Sufferers who’ve been intubated for longer than 2 days ought to have a proper analysis of their swallowing perform.
- Hold endotracheal cuff pressures at correct ranges and suction secretions from the hypopharynx: It is suggested that cuff pressures be saved between 20 and 30 cm H2O to forestall secretions from leaking into the decrease airways, whereas nonetheless minimizing injury to the trachea. Earlier than the cuff is deflated, the affected person ought to be suctioned to take away secretions from the hypopharynx in order that they aren’t aspirated.
Moreover, nurses are affected person advocates. Though they aren’t instantly accountable for a affected person previous to admission, vital care nurses ought to acknowledge the significance of and advocate for the absolute best remedy of their sufferers earlier than they arrive within the ICU. A latest article, Aspiration Pneumonitis and Pneumonia, discusses the worth of suctioning to take away aspirate when stabilizing sufferers’ airways within the area and within the ER, in order to keep away from the event of aspiration pneumonia days later.
Nurses ought to at all times keep abreast of the latest pointers and proposals in order that they’re sure to supply the very best high quality care for his or her sufferers. Decreasing the prevalence of aspiration pneumonia will result in shorter hospital stays, much less use of antibiotics, and a lower in mortality for his or her sufferers.
Editor’s Observe: This weblog was initially revealed in Might 2016. It has been re-published with extra up-to-date content material.