Oral Care Protocols With Specialty Training Lead to Safe Oral Care Practices and Reduce Iatrogenic Bleeding in Extracorporeal Membrane Oxygenation Patients.

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.

Higiene oral ao paciente dependente hospitalizado: percepções de uma equipe de enfermagem / Higiene oral al paciente dependiente hospitalizado: percepciones de un equipo de enfermería / Oral hygiene to a hospitalized dependent patient: perce ptions of a nursing team

Objective: To discuss the perceptions of the nursing team about oral hygiene of hospitalized dependent patients.Method: this is a descriptive and qualitative study, performed in the medical and surgical clinics of a hospital in the country side of Bahia, between March and July of 2006. The data were collected through a semi-structured interview, applied to seventeen participants and complemented by structured observation.Result:after an analysis of thematic content,emerged three categories that say: oral hygiene is an important care to patients; oral hygiene avoids discomfort of the team providing care; and oral hygiene may be delegated to the family.Conclusion: In studied context, there is no protocol to administer oral hygiene; the oral odors define their periodicity, oral hygiene is performed by family members; and the nurses do not participate directly in such care.

Objetivo: Discutir a percepção da equipe de enfermagem sobre a higiene oral de pacientes dependentes hospitalizados.Método: Estudo descritivo, qualitativo, realizado nas clínicas médica e cirúrgica de um hospital do interior da Bahia, no período de março a julho de 2006, dados obtidos através da entrevista semiestruturada aplicada a dezessete participantes,complementados pela observação estruturada.Resultado:Após a análise de conteúdo temática emergiram três categorias que revelam: a higiene oral como cuidado importante para o paciente; a higiene oral evita o desconforto da equipe na prestação de outros cuidados; e a higiene oral pode ser delegada para a família.Conclusão: No contexto estudado não existe protocolo para realização desse cuidado, os odores advindos da boca do paciente definem sua periodicidade,a higiene oral é realizada por familiares e as enfermeiras não participam diretamente deste cuidado.

Objetivo: Discutir la percepción del equipo de enfermería sobre la higiene oral de los pacientes dependientes hospitalizados.Método:estudio descriptivo y cualitativo, realizado en las clínicas médicas y quirúrgicas de un hospital del interior de Bahia, entre marzo y julio de 2006. Los datos fueron obtenidos através de entrevista semiestructurada aplicada a diecisiete participantes, complementados por la observación estructurada.Resultados:de los discursos surgieron tres categorías: La higiene oral como un cuidado importante para el paciente; la higiene oral evita el malestar del equipo en la prestación de otros cuidados; y la higiene oral puede ser delegada a la familia.Conclusión:en el contexto estudiado no existe un protocolo para la realización dese cuidado, los olores procedentes de la boca del paciente establecen su tiempo, la higiene oral se realiza por la familia y las enfermeras no participan directamente en este cuidado.

Pediatric dental rehabilitation procedures in the OR.

Children with significant baby bottle tooth decay and children who are challenged by significant physical and emotional limitations are candidates for dental rehabilitaion procedures with general anesthesia. Rehabilitation of children's primary teeth is important to prevent pain, infection, and tooth loss. To provide skilled care for children undergoing dental rehabilitation procedures, perioperative nurses must understand normal dentition, tooth anatomy, and caries prevention and formation and be able to meet children's developmental and emotional needs. Perioperative nurses also must collaborate with dentists to maintain appropriate supply inventories that are unique to dental rehabilitation procedures.