Any ICU's ambulating vented patients? - page 2
by hodgieRN, MSN, RN, NP | 7,181 Views | 23 Comments
I'm starting to here about vented pts being ambulated with the RN, PT, and RT. Do any of you practive this at you hospital? There's videos on Youtube, which is pretty wild. The pt has a walker with the vent on a rolling table.... Read More
- 3Nov 15, '12 by juan de la cruz, MSN, RN, NP GuideQuote from hodgieRNMy answer would be that this is a generalization that does not apply to all vented patients. In the same manner, not all patients that are vented are safe to ambulate if they do not fall within the criteria we use in our institution.That's so awesome! Let me ask you this...What do you say to people that argue pts who can ambulate don't need to be intubated in the first place?
Patients that are ready for extubation based on established parameters need to be extubated regardless. Patients with true lung injury (such as due to ARDS) have a longer course of lung recovery which can take time to be liberated from the vent. Some require gradual pressure support wean, some require bi-level ventilatory mode wean. In the meantime, they can start PT and receive assistance with mobilization.
- 0Nov 16, '12 by opossumI remember first learning about this at an AACN conference last year and was blown away by it - it truly does lead to faster extubations.
However, I think it requires a dedicated team approach of MDs, RNs, RT and PT to make this all happen; in my hospital, that's simply not an option. We're a small, rural hospital and do not have enough staff around to just even get the pt UP. It's sad, because it's something from which a lot of intubated pts could benefit.
- 2Nov 16, '12 by DoeRNQuote from commonsenseWorked in a top 10 hospital and there was a unit at that hospital that did this with portable vents. The patients had better outcomes and were extubated quicker. Guess that's one of the reasons they are in the top 10.
I think they only do that in specialized ICU departments located in Crazytown, USA.
- 0Nov 16, '12 by PMFB-RNYes, since the late 90's it has been common for many, but not all types of vented patients in our ICUs. I was unaware until this discussion that there were still places that didn't have such practices.
We use portable vents and no more than two patients (on a 26 bed unit) can be ambulated at a time (related to staff avalabiliety). Totaly normal to arrive on the unit for report and see one or two intubated patients being ambulated. Usually patient is ambulated with two people, an ICU RN (RNs run our own vents) and either a PT or a PT assistant. At night a second RN or even a CNA will fill in for the PTA. BID Amublating vented patients is part of the standing protocol if certain conditions are met. The physician must check the ambulation orders if he does NOT want them ambulated, otherwise it's up to the RN using the protocol. I't enough work that usually each RN will only amubulate once on his shift and the day nurse will preform the other ambulation. Always at the RNs desicretion. However if when giving report and you have not ambulated your elligable patients the RN comming on will want to know why not. Since many of our patients are trauma patients and have numerous fractures they are often not elligable. Same for patients fully expected to be extubated in less than 24 hours.
At the time it was started (before I worked there) in (I think 1997 or 1998) the unit considered it's self tardy on implamenting the protocol.Last edit by PMFB-RN on Nov 16, '12
- 0Nov 16, '12 by SwansonRNWe're working on it, but a lot of nurses have reservations about the process. I've gotten a few of my vented patients OOB to chairs and whenever I do my patients and their families are SO happy and I feel like the best nurse ever Not to mention how beneficial it is to their recovery. It is a lot of work though, sometimes a 2-3 person job...lots of unplugging and untangling and rearranging the room. I've heard of some ICUs having patients walk down the hallways, standing up playing wii games while vented. It sounds wild.
- 0Nov 16, '12 by MunoRNWe ambulate our intubated patients extremely rarely, our problem has been finding the right patients. We sent two RN's and an RT to another facility to observe their protocol and practices, their observation was that the patients they were ambulating would have been extubated had they been in our ICU.
So for places that do this more often, what is you inclusion/exclusion criteria? What's your criteria for extubation?
- 0Nov 16, '12 by KelRN215, BSN, RNQuote from commonsenseI am not an ICU nurse but I don't think it's that crazy... I'm thinking about the hospital that I used to work at. No floor other than the ICUs took vented patients. So, if you have a chronically vented child and they get admitted for something that would land another patient on a regular floor, they're obligated to an ICU bed because of their vent. Many of them walk at their baseline, you would think they should ambulate these patients before they are discharged, no?I think they only do that in specialized ICU departments located in Crazytown, USA.
- 0Nov 18, '12 by Kitesurfing bumWe will be starting an entirely new vent protocol this week actually. The major goals are decreasing delirium and early mobilization. Many RN's, MD's, RT's, PT's and OT's have spent months and months developing our new protocol. Training has been done for all of these disciplines over the last few weeks.
Much of our information has come from Vanderbilt's research (no affiliation). They are doing cool stuff...
Here's a link to a recent article in Critical Care Nurse:
Fun to be starting something new that can decrease delirium, vent days, hospital days, etc...