January Education Newsletter

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
 

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!

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 

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!

March 12th
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