Ward 118 Royal Infirmary, Edinburgh

Ventilator Bundle Definitions

DVT Prophylaxis
Standards of care
Minihep prescribed as per protocol

Exclusions
uncorrected bleeding disorders
platelet count < 70 x 109/L
APTT > 1.5
INR > 1.5
bleeding or potentially bleeding lesions
(e.g. oesophageal varices, active peptic
ulcer, recent (3 months) GI or
intracranial bleed, intracranial aneurysm
or angioma)
heparin induced thrombocytopenia or
thrombosis
traumatic head injury (review with
neurosurgeons 10 days post injury)
allergy

TEDS on patient

massive leg oedema

severe peripheral arterial disease
severe peripheral neuropathy
major leg deformity
dermatitis
an existing DVT in a leg

Gastric Bleeding Prophylaxis

Standards of care
Ranitidine prescribed IV or oral/NG

Exclusions
Already on proton pump inhibitor

Bed Head Elevation 30o

Standards of care
Ventilated patients elevate bed head 30o

Exclusions
Unstable patient eg high dose inotropes

Sedation
Standards of care
All patients have Ramsay sedation scale
2 to 4

Exclusions
Paralysed
Head Trauma sedated ?ICP problem
Fulminant hepatic failure with ICP bolt
Difficult to ventilate
Coma with no sedation eg overdose

Ramsay Score
1. Anxious, agitated or restless
2. Co-operative, orientated , tranquil
3. Responds to commands
4. BRISK response to glabellar tap or loud noise
5. SLUGGISH

6. No response
Dr Brian Cook
Lead Clinician Nov 05

Ward 118 Royal Infirmary, Edinburgh

VENTILATED CARE BUNDLE AUDIT FORM

DATE____________________
COMPLETE FOR VENTILATED PATIENTS ONLY
Bed DVT
DVT
Gastric
No. Prophylaxis Prophylaxis Prophylaxis
Minihep
TEDS
Yes

No Excl Yes

No Excl Yes

No

30o head
elevation

Excl Yes

No

Sedation
Scale
2 to 4
Excl

Yes

No

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
NB. If no and exclusion are both ticked then Yes is also ticked.
IE. ONLY 1 or 3 BOXES ARE TICKED

Dr Brian Cook
Lead Clinician Nov 05

Excl