What is on your LTC crash cart?

Bird2 · May 18, 2005

We have a suction pump and tubing, an ambu bag, a CPR board, an 02 cylinder, a couple of oral airways and IV set ups with no bags of fluid in sight. Thats it, no defibrillator, no ACLS drugs, or much of anything else. I was wondering if anyone had anything else on their carts? After the full code I worked this weekend I realize that in the future the county ambulance service may not always be able to get there quickly due to staffing and other runs during which time the few minutes in which defibrillation and CPR have a decent survival rate are long gone. I am going to recommend upgrading the current cart to the administrator as soon as I have a good idea where we are lacking. As far as vital sign measuring devices we have a small pulse oximeter on each unit blood pressure cuff and stethoscope. I have been dreaming of a vital signs monitor for ever if only on the crash cart.

Amazing isn't it. I have worked in LTC for 11 years and your crash cart sounds exactly like ours. Thankfully our squads are at the facility in 2-3 minutes. I will try to remember to ask why we do only field CPR instead of having defibrillators etc?

crjnursewarrior · May 18, 2005

When I graduated from nursing school , almost 6 yrs. ago, I went to work in a long-term care facility. The crash cart there had...are you ready for this?...a box of gloves and an Ambu bag. THAT'S IT! Not only that, it did also have a bunch of books piled on the top of it...I guess maybe they thought you might be able to "read" the person back to a normal sinus rhythym! Anyhow, when I asked about it, I was told "We run slow codes around here." Needless to say, I quit there 3 months later...thanking heaven that I never was involved in a code while there. UNREAL!

bobnurse · May 18, 2005

I think you need to look at your policies and what response your facility provide. Most LTC facilities perform a BLS only approach. So CPR Only. I have worked with several LTC facilities with large Skilled units in acquiring an AED for their cart. I recommend the ZOLL AED.

But many times, nurses with an acute care background go to work in an LTC center and want a crash cart comparible to the one they had in their acute setting.

As compared to most LTC facilities, your crash cart seems pretty well stocked compared to most who dont even have an ambu bag..........I would recommend getting an AED for your cart.....That would probably be all that you need to perform BLS support until EMS arrives.

Long Term Care Columnist / Guide · May 18, 2005

What's a crash cart?? :chuckle

Not one LTC facility I've ever worked in had anything like the OP has described.......the best place I worked had an old Gomco suction machine, a couple of Yankauers, and some portable O2 on its crash cart. The other places didn't even have one, unless you consider IV fluids under lock & key in the nurses' station, plus portable O2 tanks in the storage room, plus tubing and cannulas in the janitor's closet to be a "crash cart" :angryfire

Now, full-code status for today's average ICF patient is something I don't necessarily agree with, but that's not my decision to make, and if I've got to code someone the facility had better have the approved equipment on board. That's one of the many reasons why I don't, and will not EVER, work LTC again if I can help it......legally it's just too risky. :stone

LPN01112005 · May 19, 2005

Our crash cart is fairly sufficient: suction equipment (of course there are nights when we have to go in search of a cannister when we are checking off on the crash cart!!!) and the tubing and accessories to go with it, a portable 02 tank with non-rebreather; CPR board, ambu bag, mouth shields, oral airway, unopened box of gloves, tape, sterile bandages, scissors, hazaradous materials bags, a small bottle of normal saline and packages of lubricant and betadine. We don't keep any drugs or IV set ups on the crash cart. These must be kept in the med-room at all times.

Antikigirl, ASN, RN · May 19, 2005

None in my place, but then again...I am the only ACLS certified person in the entire facility! They aren't going to buy that stuff for just me if I am on duty...LOL!

No, I tried really hard to get an AED in our facility but they say we don't have the funds...so not even an AED. They told me..."hey at least we have O2"...umm yeah..the huge tanks down in a very hard to get location! No time in a code to go get the dolly and strap one on I will tell ya!

So we call 9-11 and perform CPR till they arrive (if they are not a DNR)...

CoffeeRTC, BSN, RN · May 19, 2005

I wanted to post on this before and think I started a thread on this a while ago?

Not many LTC nurses are ACLS certified, nor should they need to be. Yes it would be nice, but look around...

Years ago (almost 10!) I put together a "crash" cart for my building. I am the only person who checks it or stocks it. I only work every other weekend, so you do the math. I also dust it off when checking it :uhoh21:

What I included is..suction machine with supplies (often times this is borrowed), O2 tank with nrb mask, nasal canual, ambu bag, back board for cpr, masks, oral and nasal airways, basic dressing supplies, saline, gloves, gowns, blood spill kit, note book for recording info.

Meds (what little we have) are kept in the E Box. IV supplies are next to meds in the med room. (of course its locked...err sometimes proped open :uhoh21: ) We only have one pulse ox machine for the building, but its always availble.

This seems to be enough for our facility. An AED will never happen..aren't they like 3-5,ooo? Ha...your lucky if we have basic supplies. Out of 50 pts maybe only 8 are full codes. We also have a great response time with EMS..3 to 5 minutes and the medics are in and getting to business.

One more thing to consider...What is the response time of EMS in your area? I'm not sure what the acceptable time is, I'm sure some other posters might be able to chime in on this? We have a local service that does the bulk of our transports, but sometimes they are busy so I will call 911. Pretty much we as nurses are responsible for BLS until the medics arrive...our supplies are enough for that. When you get into drugs, etc then you need protocols and policies....LTC doesn't allow for may standing orders either. By the time I would get ahold of a doc, EMS is in and doing thier thing.

CapeCodMermaid, RN · May 19, 2005

I'm confused. Your crash cart sounds like ours, but are you saying you call a local ambulance company instead of rescue if you're coding someone??? We have a local transport company that has wheelchair vans and "ambulances" for those who need stretcher transport, but for all emergencies, including, of course, a code, we always call 911. Our local transport company wouldn't ever take an emergency.

CoffeeRTC, BSN, RN · May 19, 2005

No a code would be 911, allthough our local co is located almost right next door to the city medics. Our local co is also ACLS with paramedics. Of course we will start the code.

Speaking of codes, we havent had one for years! Done the heilmick a few times this year, but no CPR.

My point in the post is that most LTC that are truely long term care are not equipt to do "codes" just basic life support until the EMS arrive.

bobnurse · May 19, 2005

I wanted to post on this before and think I started a thread on this a while ago?
Not many LTC nurses are ACLS certified, nor should they need to be. Yes it would be nice, but look around...
Years ago (almost 10!) I put together a "crash" cart for my building. I am the only person who checks it or stocks it. I only work every other weekend, so you do the math. I also dust it off when checking it :uhoh21:
What I included is..suction machine with supplies (often times this is borrowed), O2 tank with nrb mask, nasal canual, ambu bag, back board for cpr, masks, oral and nasal airways, basic dressing supplies, saline, gloves, gowns, blood spill kit, note book for recording info.
Meds (what little we have) are kept in the E Box. IV supplies are next to meds in the med room. (of course its locked...err sometimes proped open :uhoh21: ) We only have one pulse ox machine for the building, but its always availble.
This seems to be enough for our facility. An AED will never happen..aren't they like 3-5,ooo? Ha...your lucky if we have basic supplies. Out of 50 pts maybe only 8 are full codes. We also have a great response time with EMS..3 to 5 minutes and the medics are in and getting to business.
One more thing to consider...What is the response time of EMS in your area? I'm not sure what the acceptable time is, I'm sure some other posters might be able to chime in on this? We have a local service that does the bulk of our transports, but sometimes they are busy so I will call 911. Pretty much we as nurses are responsible for BLS until the medics arrive...our supplies are enough for that. When you get into drugs, etc then you need protocols and policies....LTC doesn't allow for may standing orders either. By the time I would get ahold of a doc, EMS is in and doing thier thing.

You can get a used AED for 500-800 dollars.......you can get a new one for around 1100 now....They have come down considerably in price.

CoffeeRTC, BSN, RN · May 19, 2005

:uhoh21:

You can get a used AED for 500-800 dollars.......you can get a new one for around 1100 now....They have come down considerably in price.

Wow. But like I said...they love to scimp on the budget. Last week no colostomy bags...the week before no 4x4s...one week we ran out of Toilet Paper and diapers :uhoh21: