January Education Newsletter | Cardiovascular Intensive Care Unit

JoAnna Bentsen

March 19, 2024

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Portex Trach Conversion

Coming January 31st, VUMC will transition all standard Shiley tracheostomy tubes to Portex tracheostomy tubes.

IDENTIFYING SIZE: Numbered on the tube. Color identifier aids in matching trach to inner cannula size.
INNER CANNULA: is disposable and changed q12 and prn.
CUFF: is high volume low pressure to reduce leaks.

Standard of Care for patients with Tracheostomy's

Assessment:
- Confirm placement by auscultating the chest and visualizing moisture exchange in the tube.
- Confirm size by visualizing tube number and color.
Documentation:
- Document type (Portex) and size. securement (trach ties or sutures), trach care, interventions, and the presence of safety equipment.
Interventions:
- Suction: q4h or as needed. be mindful to prevent trauma with in-line suction and the amount of negative pressure.
- Trach Care: performed q12 hours includes changing the inner cannula, trach ties, and cleaning around the trach
Safety and Emergency Equipment:
- Trach Emergency Bag: ambu-bag, CO2 detector, 6.0ett, red rubber, yankauer
- Trach of the SAME Size
- Extra Inner cannula
- Obturator and Wedge taped to the head of bed (HOB) with trach algorithm
- Suction Set up x2

What's a wedge?

The disconnection wedge is used to help disconnect the trach from the Ambu Bag if it gets stuck.

Keep with the Obturator at the HOB

Link to Product Page: Search 'Portex' for more resources!

What's the current best practice for post-arrest temperature management?

New data from 2023 means new recommendations from the American Heart Association (AHA). The new guidelines reflect one key point in management for post-arrest patients who are not following commands.

- Aggressive temperature management, we are trying to PREVENT fevers here. If your patient is getting towards 37.5, you should begin temperature management with the artic sun pads.
** Temperature management = normothermia is our goal. Set the pads to a temperature of 37**

All other management should be directed per our normothermia protocol.

Interested in the full AHA guidelines article? Full link is on the website in the Blog section!

Link to the TTM Protocol on the Website

Impella Documentation and I/0 Recording

Documentation: For patients with Impella, there are two places you are documenting this device.
#1- LDA TAB: Start a 'Mechanical Circulatory Support' LDA with the date of insertion.
What's Documented Here?: Depth via CM markings, dressing changes, maintenance of site, and assessment.

#2:Device Tab: Hourly numbers are recorded here

Documenting Purge Volume:

Current State: Nurses are documenting Impella purge volume in the device tab AND the I/O tab.
Why is this a problem?: eStar pulls purge volume from the device tab and calculates it into your patients I/O status (see below)

If you are documenting the purge in both places, patients are getting double volume which can be >250 mL a shift.

While we are working on a fix the ask is that you document in ONLY one place- you may document purge from the I/O tab OR the device tab but DONT document in both places!

CVICU Procedure & Emergency Management Course!

March 12th
Sign up in Learning Exchange!!

1. Portex trach conversion is 1/31, information is on the product page.
2. If your patient is post-arrest our goal is to aggressively prevent fevers. You should be using the Arctic Sun to maintain normothermia!
3. Impella Devices should be documented in the device tab and started under an LDA
4. Chart purge volume in the I/O tab under the purge medication OR the device tab, but not both!
5. Emergency Management Class is March 12th
6. The first competency skills day is January 30th!

CVICU INQUIRER | January 2024
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