TY - JOUR
T1 - Oral Care Protocols With Specialty Training Lead to Safe Oral Care Practices and Reduce Iatrogenic Bleeding in Extracorporeal Membrane Oxygenation Patients
AU - Lucchini, Alberto
AU - Bambi, Stefano
AU - de Felippis, Christian
AU - Galazzi, Alessandro
AU - Addis, Grazia
AU - Rona, Roberto
AU - Grasselli, Giacomo
AU - Pesenti, Antonio
AU - Fumagalli, Roberto
AU - Foti, Giuseppe
PY - 2018/11/1
Y1 - 2018/11/1
N2 - 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.
AB - 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.
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U2 - 10.1097/DCC.0000000000000321
DO - 10.1097/DCC.0000000000000321
M3 - Article
C2 - 30273212
AN - SCOPUS:85054058557
VL - 37
SP - 285
EP - 293
JO - Dimensions of Critical Care Nursing
JF - Dimensions of Critical Care Nursing
SN - 0730-4625
IS - 6
ER -