From the Guidelines
If a patient starts to vomit during oral care, immediately stop the procedure and turn the patient's head to the side to prevent aspiration. This is crucial in preventing complications such as aspiration pneumonia, which can significantly impact morbidity, mortality, and quality of life. According to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1, if vomiting occurs, one should turn the victim to the side and remove the vomitus using a finger, a cloth, or suction. In the context of oral care, this principle still applies, and removing any tools or materials from the patient's mouth and providing a basin or emesis bag to collect the vomit is essential.
Key Considerations
- Suction may be used if available to clear the airway, as this can help prevent aspiration and ensure the patient's airway is clear.
- Once the vomiting episode has subsided, helping the patient rinse their mouth with water and providing tissues to clean up can aid in recovery and comfort.
- Assessing the patient for any signs of distress, choking, or aspiration is critical, as these can be life-threatening complications.
Preventing Future Episodes
- Modifying the oral care approach by using smaller amounts of toothpaste, a smaller toothbrush, avoiding the back of the tongue, positioning the patient more upright if possible, or scheduling oral care before meals rather than after may help reduce the likelihood of vomiting.
- If vomiting persists or becomes a recurring issue during oral care, consulting with the healthcare provider about potential interventions, such as anti-emetic medication, is necessary to improve the patient's quality of life and prevent further complications.
From the Research
Patient Vomiting During Oral Care
- If a patient starts to vomit while doing oral care, it is essential to prioritize their safety and prevent aspiration.
- There is no direct evidence from the provided studies on how to manage vomiting during oral care. However, studies 2 and 3 discuss oral care practices for orally intubated critically ill adults, which may be relevant in this situation.
- According to study 2, oral care is a nursing intervention that may help prevent ventilator-associated pneumonia, and it is usually performed every 2 or 4 hours with foam swabs.
- Study 3 found that cotton and foam swabs were the main oral care cleaning instruments used with intubated patients, with dilute mouthwash as the primary cleaning solution.
- In terms of antiemetic medication, studies 4, 5, and 6 compare the efficacy of ondansetron and metoclopramide in preventing nausea and vomiting in different patient populations.
- These studies suggest that ondansetron may be more effective than metoclopramide in preventing postoperative vomiting 5, 6, but the evidence is not directly applicable to managing vomiting during oral care.
Antiemetic Medication
- Ondansetron and metoclopramide are two antiemetic medications that have been compared in several studies 4, 5, 6.
- Study 4 found that reductions in nausea severity were similar for 4 mg intravenous ondansetron, 20 mg intravenous metoclopramide, and placebo in adult emergency department patients with undifferentiated nausea and vomiting.
- Study 5 found that ondansetron was superior to droperidol or metoclopramide in preventing emetic sequelae after general anesthesia for dilatation and curettage.
- Study 6 found that ondansetron was twice as effective as metoclopramide in preventing postoperative vomiting in patients undergoing maxillofacial surgery.