Seton Healthcare Network
As part of its palliative care program, the Seton Healthcare Network in Austin, Texas, has developed the following guidelines for ventilator withdrawal.
Preparation: Prior to Withdrawal
- Discontinue all medications/tests/treatments not directed toward comfort care.
- Remove unnecessary lines and tubes.
- Maintain one IV access site for administration of analgesia and sedation.
- Determine noninvasive monitoring needs.
- Discontinue unnecessary alarm systems, including internal defibrillator devices or pacemakers.
- Assemble equipment and medication necessary for comfort and pain control.
- Provide quiet atmosphere and unlimited visiting.
- Ensure that caregivers who are uncomfortable with the process can withdraw from the case.
- Notify the chaplain.
Withdrawal
- The attending physician and chaplain are encouraged to be present.
- Raise head of bed, if possible.
- Clear the airways of secretions if necessary for patient comfort.
- Administer and maintain appropriate levels of sedation/analgesia for signs of dyspnea and distress.
- Reduce ventilator settings to provide minimal support or remove the patient from the ventilator.
- Extubate the patient and, if indicated, place on oxygen as a comfort measure.
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