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Vap Prevention

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Submitted By bwhite41
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Ventilator associated pneumonia (VAP) is a pneumonia occurring approximately 48 hours after a patient is intubated and placed on a mechanical ventilator. VAP is of major concern as it is directly caused by the use of a medical device. This pneumonia occurs when secretions from the oropharyngeal area move into the lungs (VAP, 2006). VAP accounts for 6 of every 10 deaths attributed to healthcare-associated infections (Doyle, Fletcher, Carter, Blunt, & Young, 2011). VAP extends the time a patient is in the intensive care unit by approximately a week and increases cost by $10000 per episode (Doyle et al., 2011). BioMed Central, a peer research group, performed a quantitative research study on VAP and the PneuX System addresses issues surrounding the prevention of VAP. This device incorporates and proprietary endotracheal tube and tracheal cuff seal monitor which is not used with traditional endotracheal intubation.

When selecting the sample study, each patient was over the age of 18 years and intubation was required within their plan of care. PneuX System was implemented only of patients expected to be intubated over 24 hours (Doyle et al., 2011). For all patients included in the study, the PneuX System was used and intubation time was at least 48 hours. All patients intubated using the PneuX System were included in study results.

First to review VAP and the role the PneuX system plays in VAP prevention. Often when placed on a ventilator a patient is sedated. Bacteria in the surrounding environment and within the patient’s mouth continue to multiply (Grammatikos, 2006). Due to sedation, the patient does not have the ability to cough or otherwise clear the airway. Bacteria can bypass an improperly filled endotracheal tube cuff or can freely enter the lung through the tube itself. Continued sedation allows the bacteria to continually move down into the lower lung fields and colonize. The Pneu system contains a proprietary tube and monitoring device. The monitoring device performs constant monitoring of tracheal wall pressure at the site of the cuff. This allows prevention of secretions to descend past the cuff. There is also a small suction port located just above the cuff to allow for the removal of collected secretions to prevent these from entering the lungs when the cuff is deflated at extubation. A more flexible endotracheal tube allows for custom fitting to the patient’s anatomy for better fit.

The peer research firm, BioMed Central, performed a quantitative study at Queen Elizabeth Hospital, Norfolk UK. All equipment used in this study was done so using the manufacturers’ supplied instructions. Protocols for the prevention of VAP were used during the study. Patients were continually positioned at 30-45 degrees in the semi-fowlers position, intermittent suctioning was performed at 4 hourly intervals, oral care was performed, and the cuff pressure was maintained by the PneuX System using the tracheal seal monitor (Doyle et al., 2011). Alternate methods of preventing VAP were not performed during the study period other than those previously addressed. The study included 53 patients who combined for a total of 306 days of intubation. No episodes of VAP were seen when the PneuX System was used. One patient, who had initially been intubated using the PneuX System was extubated, went into respiratory failure and required reintubation. A conventional endotracheal tube was used in the reintubation with VAP developing after 48 hours (Doyle et al., 2011).

The study implies adherence to a VAP protocol and proper use of evolving endotracheal intubation technology, occurrences of VAP can be greatly reduced along with a decline in the number of intubation days thus leading to improved patient outcomes. The study demonstrated the successful avoidance of VAP when intubation using the PneuX System occurred. The PneuX System proprietary tube has increased flexibility when compared to a traditional endotracheal tube (Venner, 2014). An atraumatic boot-tip compared to a beveled traditional tip also reduces the risk of injury during insertion. The PneuX System has a unique low volume low pressure cuff for eliminating secretions from bypassing the cuff and causing aspiration without the high pressure cuff which can cause ischemia (Venner, 2014). With the secretions safely allowed to build up above the cuff, infrequent suctioning can be performed thus decreasing suction related injuries.

When nurses review the research that is performed for their area of nursing, they better understand how their practice can evolve to make better outcomes for patients. Every nurse should feel a sense of duty to themselves to better educate how. Evolving patient care using evolving technology is a requirement for the modern nurse. Not doing this is borderline negligence to patients. A nurse who does not continue educating themselves is merely passively caring for patients rather than actively making a difference in others’ lives.

References
Doyle, A., Fletcher, A., Carter, J., Blunt, M., & Young, P. (2011). The incidence of ventilator-associated pneumonia using the PneuX System with or without elective endotracheal tube exchange: A pilot study. Retrieved from http:// www.biomedcentral.com/1756-0500/4/92
Grammatikos, A., Siempos II, Michalopoulos, A., & Falagas, M. (2006). Optimal duration of the antimicrobial treatment of ventilator-acquired pneumonia. Retrieved from DOI: 10.1586/14787210.6.6.861
Ventilator-associated Pneumonia. (2006). Retrieved from http://www.cdc.gov/VAP/data.html
Venner Medical (2014), Retrieved from http://www.vennermedical.de/?page_id=3068&lang=en…...

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