Nurses and extubation

  1. I would like to know if nurses or allowed to extubate patients without having the anesthesiologist around? Or if nurses have intubated patients without having and anesthesiologist around? Is a CRNA eligible to extubate and intubate without having a anesthesiologist around?

    Thanks,

    Melinda
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  2. 31 Comments

  3. by   athomas91
    a CRNA can intubate/extubate no matter who is present.... but nurses can't - and shouldn't - too much liability.
  4. by   zambezi
    We extubate our post open hearts without MD/MDA/CRNAs around, but it is not within our scope of practice to intubate. For extubation we have a weaning flowsheet/list of criteria that the patient has to meet in order to extubate, usually it works without difficultly...
  5. by   mattsmom81
    We extubate all the time in ICU, but like Zambezi notes, we have protocols. We have also checked CPAP ABG's and closely asessed pt's NIF, etc and responses. Plus, we always have an anesthesia provider on the premises for emergency reintubation if necessary.
  6. by   zambezi
    Recently we changed our extubation policies...originally (in my unit we usually are recovering post op hearts) we had a list of nursing criteria and RT criteria...the RT criteria was NIF, TV, Respiratory rate, adequate ABGs, FIO2 40 or less...anyway as we were revising the protocol to make it faster and more streamlined..our pulmonoligist stated that things such as NIF/TV etc does not correlate to how a patient does after extubation, so there is no point in doing them. He even mentioned that ABGs are not a great predictor and was ready to axe those too (but we can't bring ourselves to not do it, old habits...). Just curious to her others opinions on this.

    We took a bunch of our criteria out...now pt must do a five sec. head lift, have a couple of other "nursing parameters" intact, five minute cpap trial, have a MV between 6-12 OR a good TV
    and do and ABG OR have a good ETCO2 (when we finally get them...)
    Right now we only have ABGs available. OF course there are written parameters for all of this...

    Just wondering how short/long others extubation trials are...of course they will be different for those that are post ops that those that have been chronically vented (which is a seperate protocol).
  7. by   psychomachia
    Quote from athomas91
    a CRNA can intubate/extubate no matter who is present.... but nurses can't - and shouldn't - too much liability.
    Not to argue, but I'm sure there are a few flight nurses out there who perform intubations (pre-hospital).
  8. by   canoehead
    I've worked in a NICU where the nurses intubated after being certified by the hospital.
  9. by   suzanne4
    Quote from psychomachia
    Not to argue, but I'm sure there are a few flight nurses out there who perform intubations (pre-hospital).
    A flight nurse has specific training in intubation. They actually rotate through an operating room to get signed of on a certain number of intubations. Flight nursing and hospital nursing are completely two different things.
  10. by   psychomachia
    Quote from suzanne4
    Flight nursing and hospital nursing are completely two different things.

    Really? Thanks for clearing that up...
  11. by   jaimealmostRN
    dumb question: whats the point of learning intubations in ACLS if nurses (unless cert. by nicu/op. as other posters mentioned) can't ever do it?
  12. by   psychomachia
    Quote from jaimealmostRN
    dumb question: whats the point of learning intubations in ACLS if nurses (unless cert. by nicu/op. as other posters mentioned) can't ever do it?

    ACLS is also taught to paramedics, RTs and MDs who do intubate and are required (usually) to demonstrate the skill on Mr. Mannequin. Nurses may or may not have to perform the skill. Also, ACLS doesn't really teach one to intubate, but is more of a "refresher" skill for those who may not do it often.
  13. by   mattsmom81
    ACLS is not a certification for intubation. ACLS protocols state only the most experienced person should intubate. I don't want that liability and there is some confusion out there with some who think because its covered in ACLS, we should be able to do it. Not so.
  14. by   PA-C in Texas
    Quote from mattsmom81
    ACLS is not a certification for intubation. ACLS protocols state only the most experienced person should intubate. I don't want that liability and there is some confusion out there with some who think because its covered in ACLS, we should be able to do it. Not so.
    Yeah, you really can't learn advanced airway management in a 16 hour class.

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