Eye Care (Adult Critical Care)

8/19/2019 Eye Care (Adult Critical Care)

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Title of Guideline –

Eye Care within Adults Critical Care Critical

Date First Issued: 2009 Latest Re-Issue Date:

2012

Version: 1 Reiew Date: 2015

Author and !o" Title:

Anne Illsley,

Service Improvement Sister, Critical Care

Local Contactincludin# $o" title andE%t& 'o&

Service ImprovementSister ext 59820

Docu(ent Deriation:

No specific Guielines for eye care !it"inCritical Care

Consultation)rocess:

Critical Care Cross#o!n $olicies anGuielines Group%

Critical Care&irectorate

Ratified "y:

Critical Care Cross #o!n $olices anGuielines Group

Distri"ution:

City Critical Care

C 'loor Critical Care()C Campus

* 'loor Critical Care()C Campus

)eical +i"&epenency -nit

)lans for trainin# on*i(+le(entin##uideline:

#rainin continuous

)lans for audit of #uideline:

Auit ientifie%

#"is uieline "as .een reistere !it" t"e #rust% +o!ever, clinicaluielines are uielines only% #"e interpretation an application ofclinical uielines !ill remain t"e responsi.ility of t"e iniviualclinician% If in ou.t contact a senior colleaue or expert% Caution is

avise !"en usin t"e uielines after t"e revie! ate%


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EYE CARE WITHIN ADULT CRITICAL CARE

ANNE ILLSLEY SERVICE IMPROVEMENT SISTER, CRITICAL

CARE

1

Eye Care ,ithin Adult Critical Care

General Eye Care Guidelines refer also to './ Trust 'ursin#+ractice #uidelines: eye care +ac0a#e1

Introduction

*ye care is reconise as a .asic nursin proceure essential for critically ill patients toprevent complications suc" as eye infection or in/ury% It is one of t"e most important, yet

simple to perform nursin interventions% All patients in acute care settins !"o "aveimpaire or compromise protective mec"anisms are at ris of eye in/ury or infection urint"eir stay in +ospital ris, 20023%

-nconscious, seate an 4 or paralyse patients an patients !it" a reuce Glaso!Coma Score are "i" ris roups !"o are epenent on eye care to maintain t"e interityof t"e ocular surface ris, 20023%

#"ere is evience t"at eye care is a nelecte area of patient care in t"e critically ill, as"ealt" professionals are mainly concerne !it" t"e sta.ilisation of vital .oy systemsSures",$%,)ercieca,'%,)orton,A%,#ullo,A%%, 2000 &a!son,20053 6 eye care is often seen

as a relatively minor pro.lem ris, 20023%

*ye complications can rane from mil infections to serious corneal in/ury an ulceration%$ermanent amae may occur from ulceration, vascularisation an scarrin of t"e cornearis, 20003%

$arin an Coo 20003 arue t"at preventative measures in eye care s"oul .e simple,7uic an effective in preventin complications !"ilst .ein accepta.le to .ot" patients anstaff%

Implementation of *ye Care Guielines "ave .een s"o!n to reuce eye surface isease&a!son, 2005 osen.er, %% an *isen, :%A%, 20083% #o ensure effectiveness ancompliance !it" t"e uieline, trainin met"os !ill nee to .e evelope proviineucation to t"e multiisciplinary team is a vital part of any successful c"ane proramme#"urston an ;in, 200


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Inclusion Criteria:

#"is Guieline is to .e use for all patients amitte onto Ault Critical Care !it"inNottin"am -niversity +ospitals%

Ris0 Factors

is factors for t"e Critically Ill Ault inclue=

*xposure an ryin of t"e ocular surface

Inae7uate .linin an ryin of t"e ocular surface

Infecte respiratory tract secretions

'lui mal>istri.ution +i" flo! oxyen an ne.ulisers

Increase ocular pressure

$ositive pressure ventilation

Nursin t"e patient in t"e prone position

Seation 4 paralysin aents impair normal 4 protective mec"anisms an eye

closure &ecrease resistance to infection

Lid Closure

*ye lis offer mec"anical an p"ysical protection%

Critically ill patients fre7uently "ave poor eyeli closure an a reuce a.ility to use t"eprotective .lin reflex ue to t"e effects of seation an muscle relaxants use to ena.leot"er aspects of care &a!son,20053%

Con/unctival oeema can prevent ae7uate closure if t"e con/unctiva prolapses .eyon t"eeyelis, t"is can cause corneal ryin an efective epit"elial repair 6 t"is is as a result of t"e averse effects of .ot" ventilatory support an t"e rus use to facilitate it ris,

200?3% #"is can .e exacer.ate if t"e enotrac"eal tape securin t"e enotrac"eal tu.e issecure too ti"tly% @enous return is compromise leain to venous conestion an apotential increase in ocular pressure &a!son, 20053%

A constant flo! of t"e preocular tear film into t"e lacriminal sac, aie .y t"e .lin reflex,"elps in flus"in out contaminatin microranisms% #ears prevent .acterial a"erence analso ill t"e oranisms &ua, 19983% Aministration of artificial tears, suc" as "ypromelloseeye rops can .e aministere to reuce ryness an irritation an prevent furt"er complications%

:i closure "as s"o!n to .e of reat importance, as any corneal exposure !ill lea to

epit"elial ryin increasin t"e ris of eratitis an epit"elial erosion Sures" et al%, 20003


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It is vital to assess an maintain li closure in patients%


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#apin lis close is unpopular !it" nursin staff as t"ere is a potential ris of amae to t"eeyeli, repeate application an removal of micropore tape can cause excoriation of t"e li

sin% #"e appearance of tape across t"e patients eyes is also t"ou"t to increase relativesstress levels 'arrell an ay, 199B Sures" et al%,20003 An alternative is t"e &onalson eye patc" !"ic" uses a @elcro system to ac"ieve closure%"en t"e lis cannot .e oppose, for example ue to riiity follo!in .urns or in/ury or!"en oeematous, polyacrylamie el patc"es of "i" !ater content or polyet"ylenecovers i%e% clin !rap can .e use% #"ese provie ae7uate cover an conserve moistureon t"e ocular surface% &ua,19983

Sures" et al, 2000 avocate t"e use of lu.ricants in patients .ut t"ere is no evience tosuest fre7uency or t"e most effective solutions &a!son,20053% $olyet"ylene covers!"en compare to lu.ricants "ave .een s"o!n to .e more effective in reucin t"e

incience of eye surface isease Cortese, &%, Capp,:%, )c;inley,S% 1995 Sures",$% et al2000 ;oroloff et al,20003, .ut lu.rication an li closure toet"er "ave not .een compare!it" polyet"ylene covers%5D of Intensive Care -nits use Geliperm routinely in eye care !it" 25D usin ocular lu.ricants ;in an +ealy, 200B3 Geliperm !as oriinally esine as a !oun ressinan t"ere is no evience to support its use in eye care% +o!ever, t"e lu.ricant :acrilu.e"as .een s"o!n to .e effective :enart, S%% an Garrity, %A%,2000, *Era,&%G%,:e!is,G%,+ealy,)%,Coom.es,A% 20053%

#"e met"o of treatment in Nottin"am -niversity +ospitals !ill .e .ase upon t"epatientsF li position%

:i positionin !ill .e rae%

GRADE LID )23ITI2'G8A&* 1 :I&S A$$S*&

G8A&* 2 +I#* ' *H* @ISI:* CN9-NC#I@A3

G8A&* B CN*A @ISI:*

$atients assesse as Grae 1 an 2 !ill "ave :acrilu.e applie to t"e eye%Grae B !ill "ave :acrilu.e applie an eliperm to cover t"e eye area%

Infection

*arly etection of infection is important% :i s!ellin an con/unctival s!ellin an renessare important sins% &isc"are an crustin of t"e eyeli marins s"oul .e vie!e !it"suspicion% *arly sins of corneal involvement inclue loss of t"e normal s"ine or lustre,corneal "aEiness an localise !"ite infiltrates &ua, 19983%


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Infecte respiratory tract secretions are no!n to .e a source of ocular contaminationurin suction proceures% If t"e patient is re7uirin open rat"er t"an close suctionintec"ni7ues suctionin of respiratory tract secretions s"oul .e performe to t"e sie of t"e


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patient rat"er t"an over t"e top of t"e "ea% Care s"oul .e taen !"en isconnectinpatients from t"e ventilator an "i" flo! t>pieces t"at spray from t"e tu.in oes not o

over t"e patients face% At all times t"e eyes s"oul .e ae7uately covere an s"iele%

*ye s!a.s A$$*N&I 13 s"oul .e not performe routinely% If an infection is suspecte t"emeical team must .e informe an a s!a. taen%

eferral to an op"t"almoloist s"oul .e mae at t"e first sins of infection%

If a s!a. proves positive antimicro.ial 4 antiviral eye rops s"oul .e commence,follo!in consultation !it" t"e op"t"almoloy an micro.ioloy teams%

Eye In$uries that can occur in the Critically Ill )atient

Corneal exposure, can lea to a.rasions, ulceration, perforation an scarrin%

&amae can .e permanent%

Corneal A.rasion Corneal -lceration

;eratopat"y is a non>inflammatory isease of t"e cornea, usually as a result of

incomplete eye closure it is seconary to corneal ryin%

;eratopat"y

+ypopyon 4 Corneal Clouin


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+ypopyon


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Con/unctival c"emosis also no!n as Jventilator eyeK A ramatic s!ellin of t"e tissue surrounin t"e eye%

Con/uctivall C"emosis

Su.> con/unctival "aemorr"ae

Su.> "aemorr"ae

Infections that can occur in the Critically Ill )atient

Infections

Con/unctivitis ;eratitis


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lep"aritis

Con/unctivitis is t"e inflammation of t"e con/unctiva an can .e cause .y .acteria orviruses% #"ere is reness an isc"are%

;eratitis is inflammation of t"e cornea, symptoms are similar to con/unctivitis !it"excess tear prouction%

lep"aritis is inflammation of t"e eye las" follicles an se.aceous lans% #"ere isreness, s!ellin an rie mucous

'ursin# Cares And Interentions#"e Nurse !ill perform an eye assessment at t"e .einnin of "er s"ift usin t"eGuieline flo! c"arts See Appenix 2 3% All $atients must "ave an eye assessment performe every 12 "ours an

ocumente in t"e nursin careplan%*ac" episoe of eye care must .e ocumente on t"e 2< "our o.servation c"art%

REFERE'CE3

ris, % 20003 *ye care for intensive care patients% *vience .ase practice s"eetsfor "ealt" professionals% ?13 pp1>?Cortese, &%, Capp, :%, )c;inely, S% 19953 )oisture c"am.er versus lu.rication for t"e

prevention of corneal epit"elial .reao!n% American ournal of Critical Care%


12/19

;in, &%%, +ealy, )% 200B3 $revention of eye isease in intensive care 6 a telep"onesurvey% Intensive Care )eicine, 29153 supplement%


13/19

;oroloff,N%, oots,%,:ipman,%,#"omas,$%,icar,C%,Coyer,'% 200:u.e com.ination versus

polyet"ylene4clin !rap to prevent corneal epit"elial.reao!n in t"e semi>consciousintensive care patient% Intensive Care )eicine, B0 pp 112>112?:enart, S%%, Garrity, %A% 20003 *ye care for patients receivin neuromuscular.locin aents or propofol urin mec"anical ventilation% American /ournal of criticalcare% 9B3 pp188>191$arin, %, Coo, S% 20003 A clear vie!= t"e !ay for!ar for eye care on IC-%Intensive Care )eicine, 2? pp155>15?$arin, %, #urner, A%, )oore, *%, Coo, S% 1993 acterial eratitis in t"e critically ill%ritis" ournal of p"t"almoloy, 81123 pp10?0>10?Bosen.er, %%, *isen, :%A% 20083 *ye care in t"e intensive care unit= Narrativerevie! an meta>analysis% B?123 ppB151>B155oyal )arsen N+S #rust 20083 #"e oyal )arsen +ospital )anual of ClinicalNursin $roceures t" *ition= ileylac!ellSures", $%, )ercieca, '%, )orton, A%, #ullo, A%% 20003 *ye care for t"e critically ill%Intensive Care )eicine, 2? pp1?2>1??#"urston, N%, ;in, ;% 200


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2ri#inal Authors

Anne Illsley * 3onya Finucane4 5667Reiewed 'oe("er 5688: Anne Illsley

'e%t Reiew Date 5689


15/19

A))E'DI 8

)R2CED.RE F2R E;E 3,A< C2LLECTI2'

E=.I)>E'T LI3T

-niversal s!a.s, 1 per eye)icro.ioloy form$atient sticer la.el for specimen an formNon>sterile o!n an loves

ACTI2' RATI2'ALE1% *xplain proceure to patient *nsure patient unerstans t"e proceure an if

a.le ives consent%

2% as" "ans, an !ear non>sterileo!n an loves

#o minimise t"e ris of cross>infection

B% -n!rap a universal s!a. an "olt"e s!a. parallel to t"e cornea anently ru. t"e con/unctiva in t"e lo!ereyeli% #"e oyal )arsen N+S #rust20083

#o ensure t"at a s!a. of t"e correct site is taen%

#o avoi contamination .y touc"in t"e eyeli

infection

?% Sen t"e s!a. promptly to t"emicro.ioloy &epartment%

#o ensure t"e s!a. is processe 7uicly

% &ocument in t"e micro.ioloy formst"at t"e s!a. "as% .een sent an t"eate of senin

#o ensure t"ere is an accurate recor ept%


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CARE

10

A))E'DI 5

E;E CARE F2R T/E CRITICALL; Ill AD.LTG.IDELI'E A

All $atients !ill "ave a ocumente *ye Assessment .y t"e Nursin Staff at least

every 12 "oursIf there is sus+ected or 0nown forei#n "odies in the eye-s1 infor( the >edical Tea(i((ediately and refer to o+hthal(olo#y&Do not atte(+t re(oal until seen "y o+hthal(olo#y4 await +lan of care followin# reiew.

&oes t"e patient "ave trauma to t"e eye H*S Go to Guideline Dan 4 or surrounin areaL

&oes t"e patient "ave .urns to t"e eyean surrounin area L

NO

Is t"e patient in t"e prone positionL H*S Go to Guideline C NO

Is t"e patient a.le to fully close t"eir eyelisL

H*S N Go to Guideline <

Are t"e patients eyes reene, !it"out isc"areL

H*S N

• Assess eyes ? "ourly Assess eyes ?

"ourly

• Clean as per #rust

Guieline If re7uire

Are t"e $atients

eyes reene,!it" isc"areL

Hes

8efer to meical #eam%

Is t"e patient ventilate, receivin "i" 6 flo! oxyen 8efer to p"t"almoloistt"erapy an 4or t"e patient "as an altere G%C%S% #a0e a con/unctiva s!a.

Aminister prescri.e

YES NO treatment%

.

• Assess eyes ? "ourly Assess eyes ? "ourly

• Clean as per #rust

Guieline

• Apply celluvisc 1D eye

rops to .ot" eyes (&S Apply :acrilu.e noc"te !aitin a fe! minutes after t"e aministration of t"e celluvisc 1Deye rop3


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CARE

11

E;E CARE F2R T/E CRITICALL; Ill AD.LT

G.IDELI'E

• A ne! pac0et of eliperm must .e opene for eac"

application% 1 pac0et can .e use for .ot" eyes3

• #"e pieces re7uire must .e cut !it" sterile scissors%

• #"e unuse eliperm must .e iscare%

• A ne! iece of eli erm must .e a lie to eac" e e t!o "ourl , after cleanin %


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E;E CARE F2R T/E CRITICALL; IllAD.LT

G.IDELI'E C

)R2'ED )ATIE'T3

• Assess eyes 2>< "ourly once prone

• Clean eyes as per #rust Guieline

• Apply lacrilu.e ointment to accessi.le eye

• Apply a melolin ressin to accessi.le eye

• Cover accessi.le eye !it" an eye pa, an secure !it" micro poretape

• n resumin t"e supine position, assess t"e patient 2 "ourly

• Grae li position an assess for corneal c"emosis

• Clean eyes as per #rust Guieline

• Aminister treatment as per assessment finins

• )aintain 2 "ourly assessments for at least 8 "ours after turnin supine

• efer to )eical #eam if sins of infection present

• efer to op"t"almoloist

)atients in the +roned +osition are at ris0 of deelo+in#

co(+lications of the eye due to the raised intraocular +ressure&

$rior to pronin t"e patient t"e Nurse s"oul perform an eye assessment%ot" eyes s"oul .e cleane as per #rust Guieline, lacrilu.e applie to .ot"eyes an t"en .ot" eyes covere !it" eye pas an secure !it" micro poretape%


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E;E CARE F2R T/E CRITICALL; Ill AD.LT

G.IDELI'E D

ALL )ATIE'T3 ,IT/ FRACT.RED 2R

Documents

Eye Care (Adult Critical Care)