NHS Lothian Induction: VAP Bundle, Eye and Mouth Care

In addition to secretion management, you will also need to continue providing your patient with oral care. So that may be that you start off using a toothbrush with a firm head and some toothpaste as you would normally with yourselves. And you may have to combine that with a Yankauer suction because your patient will likely be unable to swallow adequately. So this would remove any of the foaming component of the toothpaste. Afterwards, you can then go in with some water to get rid of the toothpaste and suction in a similar fashion. If your patient is unable to open their mouth adequately or gain access, you may have to find alternative means to do oral care.

So we do have pink oral hygiene sponges. However, do be careful because they’re not always secured on the end. So you want to check that before use. Otherwise, you can use a normal swab to go around the outside of the teeth and into the soft tissues. At least once per shift, you will be applying chlorhexidine products to the mouth for oral care. That is to ensure that you get rid of any excess bacteria that’s in the mouth to reduce the risk of ventilator-associated pneumonia.

As well as general cleanliness, we will be inspecting the mouth on at least a daily basis as well to ensure that the patient is not developing any condition such as oral thrush, that their mouth is remaining nice and moist. We may need to supplement that with some artificial products or some oral hygiene products to ensure that saliva production is there, and the mouth is kept nice and moist. And we also want to check for any areas of pressure damage either to the lip or the interior of the mouth as a result of this endotracheal tube being in situ. So this routine mouth care is part of something that we call the ventilator-associated pneumonia prevention bundle.

The other parts of this include ensuring your patients nursed, if possible, at least at 30 degrees in the bed. Higher if your patient can tolerate it, but should be no lower unless there’s clinical need for that. Other things that we do have to consider as part of this is can we wake our patient at least partially on a daily basis to assist with them using their own respiratory muscles a bit more to reduce the risk of them developing ventilator-associated pneumonia.

And two other components we’d consider is is our patient on DVT prophylaxis because they’re likely to be very immobile at this stage, and do we have some gastric ulcer prevention prescribed such as the PPI to protect the stomach from trauma if we’re using airway manoeuvres on them? As well as oral care, we have to give consideration to the fact that the patient is at increased risk of eye issues. They don’t have the usual blink reflex if they’re unconscious or heavily sedated, so we must perform eye care regularly. Varies from unit to unit, but roughly every two to four hours and depending on what your eye assessment tells you.

So commonly used things to clean the eyes with is just sterile saline and sterile gauze, but we also use Hypromellose eye drops when patients have got very dry eyes. And we’ll consider using something like Lacrilube if the patient’s perhaps at risk of corneal abrasions. And you can even get little covers for the eyes, which are very effective at preventing particulate matter coming into the patient’s eyes and reducing the risk of corneal abrasion. Every patient will be different, and we would make the assessment based on need.