I ran into a situation last night that I wasn't quite sure how to handle. I work in a CCU/MICU and was in charge last night, which is actually the norm. Anyway, a fellow nurse, who is rather new, had a patient with respiratory failure who was vented, but not sedated nor restrained. He was extremely anxious and only getting Xanax q6hrs. Anyway, at one point, she went to tha back part of the unit to help someone else with their patient. While she was gone, her patient put on his call light and began to violently shake his bedside rails. So, I went in the room to find out what he needed. He had copious amounts of thick secretions coming out of his mouth, his SPO2 was low (about 90%) and his HR was 140bpm. He was also holding onto his ETT and OGT. I quickly suctioned out his mouth and then happened to notice he had what looked like TF coming out of his ETT. Now, seeing as he had just been pulling on his tubes, I really didn't doubt that this was the case. So, I suctioned him very quickly until his tube was clear, and realized I suctioned out about 200ml of TF-like substace. Since I was in charge and she was no where to be found, I paged the doc and immediatly got a chest x-ray and stat treatment ordered for him. Once she finally reappeared, I filled her in on the situation, and for the most part let her handle the situation from there seeing as it was her patient. She seemed lost, and I really mean lost...she just stood there. So I asked her if she had had high TF residuals or problems earlier and she said no. I told her to check her OGT and if it didn't seem right, just to pull it (better safe than sorry) and put a new one in, and the doc would be up soon. The doc called a few min later, and I told him the patient was much better and seemed okay (and we got him sedated). Anyway, he came up about a half an hour later to check the chest X-ray. As he was checking it, he called me over and asked me to look at it with him, and asked where the OGT was....it was mid-esophagus...and it was clearly in the wrong spot. So he told me to tell the nurse to go pull it...which I did (and had already done 45 min earlier). Soon after, he went back in the room, and the tube was still in! Finally, he told her to pull it as well and she finally did. I guess my question is how would I handle this type of situation? I've been up in the unit for about 3 years, so I in no way consider myself an expert, but to me, she seemed not to get how serious the situation could have gotten had no-one caught it...or how serious an aspiration pneumonia can get when you have a chronic venter. Any advice?
