I have a few questions about the VAP Bundle and trach tubes

hello, hello!!!!!!!!!!!!

How does the deep vein thrombosis prophylaxis help with VAP prevention? Is it also used as a prophylactic for people at risk for pneumonia, who aren't on vents?

Is the rationale behind a Peptic Ulcer Prophylaxis because of the possibility of regurgitating gastric acid into the trachea? Is there any evidence that one agent is better than the other? I could not find info on this.

The ETT is inserted into the mouth, then down the trach and a balloon hold it in place? How long do patients typically keep this in for?

A tracheotomy is a procedure performed in surgery for long-term trach patients?
I believe you are speaking of 3 common protocols for hospitalized patients, particularly critical patients:1) VAP = ventilator-associated pneumonia2) PPI use/peptic ulcer prophylaxis3) DVT prophylaxisCritically ill, immobile patients are at risk for all of these (or at least #2 & #3, if not on a vent).VAP prophylaxis typically includes keeping the HOB inclined at least 30 degrees, use of an oral chlorhexidine solution for swabbing the oral cavity, and encouraging coughing/deep breathing.Stress/peptic ulcer prophylaxis includes daily PPI administration.Risk of DVTs related to immobility and/or other circulatory compromise can be mitigated by use of SCDs or other compression hosiery and/or daily SQ Heparin.These 3 protocols each address a risk of a different side effect of critical illness and immobility. The maintenance of skin integrity is another important protocol for critically ill, immobile patients.In my experience, if after 2-3 weeks of intubation the patient still cannot be weaned off the vent and requires an artificial airway then it's time for a tracheotomy.I'm not sure of your background -- hope this helps to answer your questions.

[color=#0e774a]try looking through this power point. it might answer some of your questions. [color=#0e774a] [color=#0e774a]www.flpic.com/vap_prevention_cjl_10-08.ppt[color=#767676]

Quote from bounceybounce The ETT is inserted into the mouth, then down the trach and a balloon hold it in place?

GreyGull, very nice explanation. There's nothing to add.

Just one more thing, ET tubes can only be used for about 10 days. The thin tissue lining the trachea can be injured or infarcted by the cuff, even if cuff pressures are not high. As you can imagine a tracheal erosion is a bad thing. If the patient looks like they will continue to need the vent tracheostomy is done at that time.

Quote from nurse2033Just one more thing, ET tubes can only be used for about 10 days. The thin tissue lining the trachea can be injured or infarcted by the cuff, even if cuff pressures are not high. As you can imagine a tracheal erosion is a bad thing. If the patient looks like they will continue to need the vent tracheostomy is done at that time.

I agree Grey Gull -- in my ICU 2-3 weeks is common before a trach is performed. Every effort is made to wean them from the vent in that time, but we still see a lot of trachs.