Extubation Q

piper77 · Jul 22, 2003

When I worked in a PACU 15 years ago, that was the way we always extubated patients - pulled the cuff line apart. Not sure if there has been any research done on this. I know I felt the same thing as you when I first saw it, but Everybody did it that way, and I did as well; was very comfortable with it, and never saw any problems whatsoever.

Tenesma · Jul 22, 2003

THIS CAN BE A POTENTIAL FOR BIG MISTAKE!!!!

Most of the time, pulling on the pilot tubing to the cuff you can let the cuff deflate passively - however there have been reports of ETT being pulled out like this, and surprise: THE CUFF IS STILL INFLATED! the thought process behind this is that by pulling on the tubing, you can actually create a vacuum inside the tubing and thus the cuff will stay up.... plus even if it does deflate passively you still will have a wider diameter passing the cords and thus possible irritating the cords more ??

nonetheless, it isn't a sexy practice ... and remember sexy anesthesia is good anesthesia :)

CRNA, DNSc · Jul 22, 2003

And what happens if at that momemt you need to reinflate the balloon to protect the airway (You are in trouble). Not a good practice I wouldn't do it. And "just because everyone does it" is never a good rationale for an action!!!!!

SCHMEGGA · Jul 22, 2003

I agree with the replies, this doesn't seem like a very safe practice when deflation with a syringe takes a whole 3-5 secs more.

fedupnurse · Jul 22, 2003

I have seen lack of deflation by pulling off the cuff tube for both ET tubes and foley caths. The port is there for a reason. I would also check out what the hospital policy is regarding deflating the cuff. If it clearly states to use a syringe and someone pulls the cuff instead, they better pray nothing happens to the patient.

yoga crna · Jul 22, 2003

I also think it is sloppy practice. Deflating the cuff is easy and gives me confidence that I will not extubate with the cuff inflated. If you use the theory that if you are going to extubate the patient, you should be able to quickly intubate, having a usable tube very handy can be important.

I would like to question something fedupnurse said, is it really necessary to have a hospital policy on deflating a endotracheal tube cuff? I think that is overdoing policies and believe that most things should be left to common sense and not legislated. Don't get me started on sacred cows in nursing--I could write a book, but mostly they come from the powerlessness of the nursing profession.

That is one of the reasons I love anesthesia; I can use my professional judgment in caring for pattients.

YogaCRNA

javajunkie · Jul 23, 2003

I think that policies serve a good purpose in concert with common sense. There are many ways to skin a cat in nursing, fortunately policies based on best practice research exist. Not only are policies helpful for newbies, but for all nurses who wish to provide the best evidence-based care for their patients. At the very least, policies are good reading material for those who claim to be doing things "the right way."

yoga crna · Jul 23, 2003

java,

Write back when you are a CRNA and we will discuss this again.

Evidence based practice is a fancy way of saying what we have been doing for years. I read about anesthesia daily, search medline for relevant information, understand the concept of peer-reviewed journals, while realizing that a lot of people publishing have not seen the inside of an operating room in years.

I just don't need a policy that says that I must pressure check my anesthesia circuit before every case. It is good practice, makes for safe care, reduces mistakes etc.

I know I am going against current thinking, but as long as I practice, I want to always be able to use my clinical judgement. By the way, I just got a beautiful letter and lovely gift from a patient who said that the best anesthetic experience she ever had was with me. Her husband is a very well known and influential surgeon and there was some concern about having a CRNA. The extra care and concern I gave her can never be found in a policy, it has to come from the heart.

YogaCRNA

Qwiigley, BSN, MSN, DNP, RN, CRNA · Jul 23, 2003

Well said, Yoga!

javajunkie · Jul 23, 2003

Originally posted by yoga crna
Write back when you are a CRNA and we will discuss this again.

So I guess I missed the part about this board and its discussions being exclusive to nurse anesthetists only. I will refer to the policy.

Evidence based practice is a fancy way of saying what we have been doing for years. I read about anesthesia daily, search medline for relevant information, understand the concept of peer-reviewed journals, while realizing that a lot of people publishing have not seen the inside of an operating room in years.

I agree that evidence-based practice is a fancy way of saying what we have been doing for years, but my point is that there are a few people out there who have not been doing this for years, like myself, who would like to know that what we do for our patients is in fact scientifically proven to be the BEST thing to do.

One example: saline instillation into ET tubes prior to suctioning. As recently as 3 years ago I was taught NOT to do this by my professors, but was instructed to do it by many experienced nurses. Who knew it would increase pneumonia rates? Who cares, even? We are achieving more effective suctioning, right? WRONG! And how did we get this through our heads? From an evidence-based study published in Heart & Lung.

I know I am going against current thinking, but as long as I practice, I want to always be able to use my clinical judgement.

If you refer back to my previous post, you may note that I am not debating the the value of clinical judgement. You too can use clinical judgement harmoniously with policy.

WntrMute2 · Jul 23, 2003

Evidence based practice is a fancy way of saying what we have been doing for years.

Actually, I belive that is exactly the opposite. Evidence based practice is doing what has been shown to work by research, not just because that is the way things have always been done. Research is the basis for evidence based practice not beliefs, hunches, etc. That doesn't mean clinical judgements are not valuable.