A CLINICAL EXEMPLAR OF A PATIENT WITH SEVERE HEMORRHAGIC MUCOSITIS FOLLOWING A HEMATOPOIETIC STEM CELL TRANSPLANT AND USE OF THE ENDOTRACHEAL TUBE WITH SUBGLOTTIC SUCTION

2.50
Hdl Handle:
http://hdl.handle.net/10755/164724
Category:
Abstract
Type:
Presentation
Title:
A CLINICAL EXEMPLAR OF A PATIENT WITH SEVERE HEMORRHAGIC MUCOSITIS FOLLOWING A HEMATOPOIETIC STEM CELL TRANSPLANT AND USE OF THE ENDOTRACHEAL TUBE WITH SUBGLOTTIC SUCTION
Author(s):
Melvin, Mary; Douglas, Tracy; Tasony, Lou Ann; Kornet, John; Murter, Allison; Shelton, Brenda
Author Details:
Mary Melvin, RN, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA, email: mmelvin1@jhmi.edu, Tracy Douglas, MSN, RN, OCN; Lou Ann Tasony, BSN, RN; John Kornet, AA, RN; Allison Murter, MSN, RN; Brenda Shelton, MS, RN, CCRN, AOCN
Abstract:
Mucositis occurs in 80-100% of patients undergoing hematopoetic stem cell transplant (HSCT). Mucositis ranges from pain and erythema to hemorrhagic ulceration and edema so severe that patients cannot effectively clear their secretions. Patients may require intubation to protect their airway. These patients are at high risk for aspiration and ventilator-associated pneumonia (VAP) due to immunosuppression, damaged mucosa, excessive secretions, and oral bleeding. Studies describe VAP as a common and fatal complication of mechanical ventilation. Evidence-based guidelines suggest continuous subglottic suction is effective in preventing aspiration and VAP. Applying evidence-based guidelines, continuous subglottic suction via specialized endotracheal tubes (ET) was implemented on the HSCT unit. One patient using this device demonstrated exemplary results. This patientÆs care and nursing management of the subglottic ET tube are presented. The multidisciplinary team began evaluation of ET tubes with subglottic suction in July 2006. Staff evaluated ease of insertion, clinical effects on ventilation and cuff pressures, and the amount and type of drainage from the subglottic port. This exemplar patient had severe mucositis and excessive oral bleeding. Although thorough mouth care is essential for prevention of pneumonia, it is often difficult to perform effectively in a patient with severe mucositis. Over 500mL of bloody drainage was removed by the continuous suction port over the 19 days the patient was intubated. The patient did not develop pneumonia and was successfully weaned as the mucositis resolved despite the patients high risk for aspiration of blood and secretions. This project demonstrates successful implementation of evidence- based guidelines to improve outcomes for high risk critically ill oncology patients. Secretions that were suctioned from the subglottic port could not have been removed by suction through standard ET tubes and oral care measures. Previous experience with such patients demonstrates a high incidence of aspiration, often with fatal outcomes. Statistics show that VAP continues to have a high mortality rate. As direct care givers, nurses can make an impact on patient outcomes. Oncology providers involved in the care of mechanically ventilated patents should consider this therapy to prevent pneumonia in critically ill patents with mucositis requiring intubation.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2007
Conference Name:
32nd Annual Oncology Nursing Society Congress
Conference Host:
Oncology Nursing Society
Conference Location:
Las Vegas, Nevada, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleA CLINICAL EXEMPLAR OF A PATIENT WITH SEVERE HEMORRHAGIC MUCOSITIS FOLLOWING A HEMATOPOIETIC STEM CELL TRANSPLANT AND USE OF THE ENDOTRACHEAL TUBE WITH SUBGLOTTIC SUCTIONen_GB
dc.contributor.authorMelvin, Maryen_US
dc.contributor.authorDouglas, Tracyen_US
dc.contributor.authorTasony, Lou Annen_US
dc.contributor.authorKornet, Johnen_US
dc.contributor.authorMurter, Allisonen_US
dc.contributor.authorShelton, Brendaen_US
dc.author.detailsMary Melvin, RN, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA, email: mmelvin1@jhmi.edu, Tracy Douglas, MSN, RN, OCN; Lou Ann Tasony, BSN, RN; John Kornet, AA, RN; Allison Murter, MSN, RN; Brenda Shelton, MS, RN, CCRN, AOCNen_US
dc.identifier.urihttp://hdl.handle.net/10755/164724-
dc.description.abstractMucositis occurs in 80-100% of patients undergoing hematopoetic stem cell transplant (HSCT). Mucositis ranges from pain and erythema to hemorrhagic ulceration and edema so severe that patients cannot effectively clear their secretions. Patients may require intubation to protect their airway. These patients are at high risk for aspiration and ventilator-associated pneumonia (VAP) due to immunosuppression, damaged mucosa, excessive secretions, and oral bleeding. Studies describe VAP as a common and fatal complication of mechanical ventilation. Evidence-based guidelines suggest continuous subglottic suction is effective in preventing aspiration and VAP. Applying evidence-based guidelines, continuous subglottic suction via specialized endotracheal tubes (ET) was implemented on the HSCT unit. One patient using this device demonstrated exemplary results. This patientÆs care and nursing management of the subglottic ET tube are presented. The multidisciplinary team began evaluation of ET tubes with subglottic suction in July 2006. Staff evaluated ease of insertion, clinical effects on ventilation and cuff pressures, and the amount and type of drainage from the subglottic port. This exemplar patient had severe mucositis and excessive oral bleeding. Although thorough mouth care is essential for prevention of pneumonia, it is often difficult to perform effectively in a patient with severe mucositis. Over 500mL of bloody drainage was removed by the continuous suction port over the 19 days the patient was intubated. The patient did not develop pneumonia and was successfully weaned as the mucositis resolved despite the patients high risk for aspiration of blood and secretions. This project demonstrates successful implementation of evidence- based guidelines to improve outcomes for high risk critically ill oncology patients. Secretions that were suctioned from the subglottic port could not have been removed by suction through standard ET tubes and oral care measures. Previous experience with such patients demonstrates a high incidence of aspiration, often with fatal outcomes. Statistics show that VAP continues to have a high mortality rate. As direct care givers, nurses can make an impact on patient outcomes. Oncology providers involved in the care of mechanically ventilated patents should consider this therapy to prevent pneumonia in critically ill patents with mucositis requiring intubation.en_GB
dc.date.available2011-10-27T12:05:49Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T12:05:49Z-
dc.conference.date2007en_US
dc.conference.name32nd Annual Oncology Nursing Society Congressen_US
dc.conference.hostOncology Nursing Societyen_US
dc.conference.locationLas Vegas, Nevada, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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