Any ICU's ambulating vented patients?

[hodgieRN]

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.

[DoeRN]

I think they only do that in specialized ICU departments located in Crazytown, USA.

Worked 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.

[PMFB-RN, RN]

Yes, 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.

[nrsang97, BSN, RN]

There is talk of us doing this soon.

[SwansonRN]

We'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.

[SummitRN, BSN, RN]

I WISH we did. It can be awesome for the patient. It just needs adequate staffing and the right patient.

[MunoRN, RN]

We 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?

[KelRN215, BSN, RN]

I think they only do that in specialized ICU departments located in Crazytown, USA.

I 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?

[Kitesurfing bum]

We 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...

http://www.mc.vanderbilt.edu/icudelirium/

Here's a link to a recent article in Critical Care Nurse:

http://www.mc.vanderbilt.edu/icudelirium/docs/ABCDE_Bundle.pdf

Fun to be starting something new that can decrease delirium, vent days, hospital days, etc...

[Kitesurfing bum]

I think they only do that in specialized ICU departments located in Crazytown, USA.

They also did open heart surgeries, PCI's, and even rode in something with an engine to move it instead of horses there in Crazytown, USA. I guess Crazytown became... the world.

[tagRN1]

The few patients that I have seen that have the strength to ambulate, usually are attempting to self extubate themselves. Saw a patient who would have probably been able to ambulate that was being ventilated convince a family member to give them a crucifix that was on the wall of the room, and while restrained extubate them self with the cross. "Holy Extubation." Anyways with all that said, in my experience I have seen very few patients who have the ability would be willing to walk as well as willing to resist extubating themselves. I do work in a neuro trauma unit so that does account for the main reasons I don't see many patients that would have this ability.

[Wile E Coyote, ASN, RN]

My own small hospital experience in ICU/CTICU (sub-250 bed facilities) also leaves me posing the question just how often one encounters a pt well enough to ambulate yet unable to extubate (assuming orally intubated pt's here and not trachs).

[blucrna]

I've seen videos of this and its wild. We don't do it in my ICU (mixed ICU and CCU) but I've heard nothing but good things outcome wise as long as the pt can tolerate ambulation

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