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Oral Care Protocols With Specialty Training Lead to Safe Oral Care Practices and Reduce Iatrogenic Bleeding in Extracorporeal Membrane Oxygenation Patients
- Source :
- Dimensions of Critical Care Nursing. 37:285-293
- Publication Year :
- 2018
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2018.
-
Abstract
- INTRODUCTION Oral care, using either a mouth rinse, gel, toothbrush, or combination of them, together with aspiration of secretions, may reduce the risk of ventilator-acquired pneumonia in intubated patents. Oral care procedure in patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) may cause bleeding due to the systemic anticoagulation required. PURPOSE The aim of this study was to investigate the rate of bleeding episodes during oral care in patients supported by VV-ECMO. METHODS A retrospective observational study was performed. All patients admitted to an Italian ECMO center during 2014 were included in the study. RESULTS Data from 14 patients were analyzed. The median intensive care unit length of stay was 39.0 days (interquartile range, 27.3-83.3 days), and median days on VV-ECMO was 19.5 (10.3-46.0). There were 440 ECMO days, with 1320 oral care maneuvers. In 7 patients, bleeding episodes occurred: 2 with orotracheal intubation and 5 initially managed with orotracheal intubation, thereafter via Translaryngeal tracheostomy tube (according to Fantoni's technique). In 61 oral care procedures (4.6%), bleeding was detected during or after the maneuver, whereas the total numbers of days with at least 1 bleeding episode were 35 (8%).The presence or absence of bleeding during ECMO days was statistically significant for international normalized ratio (1.01 [0.95-1.11] vs 1.13 [1.03-1.25], P < .0001), platelets (163 000 [93 500-229 000] vs 61 000 [91 00-100 000], P < .0001), and mouth care score (6 [5-7] vs 8 [7-9], P < .001). CONCLUSION Oral care can cause bleeding in patients on VV-ECMO. Implementation of protocols for daily oral care in patients on ECMO may reduce risks. As recommended by the literature, this category of patients should be treated in selected centers distinguished by a regular volume of ECMO activity and the presence of dedicated ECMO specialist nurses.
- Subjects :
- Adult
Male
medicine.medical_treatment
Iatrogenic Disease
Nursing assessment
Specialty
Hemorrhage
Emergency Nursing
Critical Care Nursing
law.invention
03 medical and health sciences
Extracorporeal Membrane Oxygenation
0302 clinical medicine
Risk Factors
Interquartile range
law
Extracorporeal membrane oxygenation
medicine
Humans
Nursing Assessment
Retrospective Studies
business.industry
Pneumonia, Ventilator-Associated
030208 emergency & critical care medicine
Retrospective cohort study
Length of Stay
Middle Aged
medicine.disease
Intensive care unit
Pneumonia
surgical procedures, operative
Italy
030228 respiratory system
Dental Care for Chronically Ill
Anesthesia
Female
Toothbrush
oral care, nursing, bleeding, ecmo
business
Subjects
Details
- ISSN :
- 07304625
- Volume :
- 37
- Database :
- OpenAIRE
- Journal :
- Dimensions of Critical Care Nursing
- Accession number :
- edsair.doi.dedup.....9dc03ce6cc1d2fbe3b2a4238322ed7b0