ot tips for intubated patients

OT Tips and Treatment Ideas for Working with Intubated Patients

As OTs, we love to engage our patients in meaningful and functional activities, and as a result, treating intubated patients in the intensive care unit (ICU) can be challenging. We are creative thinkers, for sure, but every now and then we need a bit of guidance to brainstorm creative solutions for challenging circumstances, like a patient being on a ventilator!

This article will highlight tips and OT treatment ideas for acute care OT practitioners working with intubated patients in the ICU so you can feel more confident and comfortable with this increased challenge. 

What does ‘intubation’ mean? 

Intubation is defined as the process of having a tube inserted into the mouth or nose. There are three different types of intubation:

  • Nasogastric intubation: the process of putting a tube through the nose and through to the stomach to provide food or medication to the patient. 
  • Endotracheal intubation: the process of putting a tube into the nose or mouth into the trachea to help a person breathe. This is then connected to a ventilator. 
  • Fiber-optic intubation: the process of putting a tube into the throat for examination. 

occupational therapy intubation tips

Why are people intubated? 

  • To support breathing in people with conditions such as respiratory failure, pneumonia, COVID-19, heart failure, and severe trauma.
  • During surgery while under anesthetic
  • Helps to prevent a patient from breathing in liquid (aspirating)
  • To provide a safer means for feeding and medication administration

Why is intubation and the ICU setting more challenging? 

  • When a patient is intubated, they are connected to a machine-either a ventilator or a feeding pump-which is more limiting from a mobility point of view. 
  • Many occupational therapists that have limited experience working in the ICU feel a bit apprehensive about working with intubated patients, due to fear of pulling out the tube and not understanding the settings on the machines. 
  • Most (but not all) patients that are intubated are also critically ill, and this can feel scary or restrictive in treatment options for some OTs. 

Let’s change this with showing you some tips and treatment ideas for intubated patients in the ICU. 

5 tips for working with intubated patients in the ICU

  • Always take note of whether your patient is intubated and keep track of where the tubes are. Some OTs have accidentally pulled out NG tubes while helping a patient to reposition or transfer, and this can result in some drama. To avoid this, just be cognizant of where the tubes are and place them in a way that they are easy for you to see. 
  • If you want to assist your patient in a transfer rather be safe than sorry, and check with the nurses if the tube can be disconnected. Patients with endotracheal intubation can be tricky to transfer as they have to stay connected to the ventilator. Do not attempt this if you are unsure how, and rather practice doing it with another health care practitioner first to build up your confidence.  A patient with nasogastric intubation is a bit easier to assist in transferring, as there is a point where the tube can be safely disconnected. Always check with the patient’s nurse or doctor.  
  • Sometimes, when patients are being weaned off of a ventilator, they go onto different settings at different times. Check the chart or speak to the nurse or doctor so you can schedule your OT session accordingly. 
  • Keep an eye on the vital signs monitor to ensure that your intervention is not pushing a patient past their limit. 
  • Position your patient and the machines in such a way that the tube is not taut and the patient is comfortable. You always want to have some slack in the tube to reduce the risk of it being pulled.

OT tips for intubated patients

OT treatment ideas for intubated patients in the ICU

As with any patient, we will first compile an occupational profile during the evaluation, either with our patient or with help from their family if possible.

Our therapy treatments will then target independence in activities that are client-centered and meaningful to the patient. We know that intubation can make therapy feel more restrictive, so here are some ideas:

  • Grooming tasks: Patients in the ICU are often weak, have a decreased attention span, are disoriented to the time of day, and learn to become reliant on nurses in all tasks. Grooming tasks are a simple ADL activity you can do as an opportunity to strengthen their upper limb, have them attend to a task and sequence its steps, as well as use it as an opportunity to orient them to the time of day and increase their active engagement in the unit. It is always a good idea to educate nurses as well on the patient’s current level of engagement in the task and encourage the nurse to allow the patient to actively engage in the task first before being assisted. 
  • Mobilization: Intubated patients in the ICU tend to spend prolonged periods of time lying in bed, which puts them at a higher risk of developing pressure sores and results in them having decreased level of alertness and sleeping more often. Be mindful of the length of their tubing and assist them in transitioning into sitting edge of bed or helping them transfer into a chair. I will admit that this does take some practice and experience, so for safety do ask a nurse or physical therapist to assist you in helping the patient to transfer and manage the tubing. Be very aware of the time they started sitting in the chair and how long they can tolerate sitting for in order to ensure there is someone who can transfer them back to bed. While mobilizing is the hardest of these treatment ideas, it is extremely beneficial to the patient in multiple ways.
  • Upper extremity strengthening exercises: As mentioned, patients in the ICU are often very weak, and their muscles atrophy quickly due to immobilization while hospitalized. Active-assisted exercises are a great way to prevent further atrophy and to improve their strength in order to be able to feed and groom themselves. 
  • Leisure tasks: It is quite common that patients experience some cognitive difficulties due to a prolonged stay in the hospital, lack of mental stimulation, and a lower level of alertness from being unwell. OTs can therefore provide opportunities for cognitive and physical stimulation through engagement in a leisure task that they enjoy. What I love is when they can continue to engage in leisure tasks outside of therapy time in order to have that ongoing stimulation as well as a boost to their mood. Examples of this can be reading a magazine, drawing or painting, completing a word search or crossword, knitting or crocheting, and using a laptop or phone.
  • Stress management: The ICU is a very overwhelming environment. Consider the loud beeping noises, the sound of a machine helping you to breathe, tubes and wires connected to your body, health care practitioners walking in and out, bright lights, and most importantly, the fear of your health. It is no wonder, then, that our patients often feel anxious or stressed. OTs are known to be holistic practitioners, and sometimes we are the only ones considering our patients’ mental health amongst the medical chaos. If your patient is alert enough, take the time to check in with them to see how they’re coping. You can teach them relaxation strategies to help with their anxiety, such as deep breathing (if their intubation is nasogastric), mindfulness, visualization, and progressive muscle relaxation
  • Education: Do not underestimate how scary and foreign everything might be to the patient and their family and friends. Take time to educate the patient or their loved ones on the following information: what is intubation, the different tubes and monitors attached to them, the importance of pressure relief and mobilization, the benefits of stretches and exercises, equipment and assistive devices, discharge planning, and the next step in their rehabilitation journey. You can also educate family members on what items to bring to the ICU room for leisure activities or just for the patient’s comfort.

If you want to learn more about working in the ICU, be sure to check out our companion articles, Occupational Therapy in the ICU: an Interview with an ICU OT and the Critical Role of Occupational Therapy in the ICU.

Occupational Therapy in the ICU: An Interview with an ICU OT

In Conclusion

Working with intubated patients in the ICU can be very intimidating at first, mainly due to the initial lack of exposure. Once you familiarize yourself with your facility’s protocols, vital signs, lab values, and the different lines and tubes we promise you’ll feel much more confident in working with these patients in the critical care settings.

We hope these tips and treatment ideas will also give you some added courage and inspiration for what to do with your intubated patient in the ICU.

If you’re a seasoned ICU OT, what treatment ideas or tips would you add for OTs and students new to the ICU? Please share them in the comments!

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One comment

  • Vivian Manyanga January 31, 2024   Reply →

    This is helpful for all occupational therapist with experience and those without experience. Working In ICU in Tanzania for OTs is difficult as occupational therapy is not well known.The perception we have on the use of daily living activities limits our creativity and thoughts on what we can do with ICU patients. This article is useful on where to start and what activities can be useful in ICU settings, I also learn on importance of holistic and client centered ness approach and interdisciplinary approach in ICU.

    I wish to get more articles in Occupational therapy working in Acute mental health settings. Thank you

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