Intubation

  1. I hear many of you talking about RT/doctors etc... required to be at your deliveries for infant intubation/cord viewing purposes. This is a nursing job at our facility. Many of our nurses are hesitant to do this and we are going through an issue right now during which an infant was coded and neither nurses nor anesthesia attemped to intubate. Surgeon ended up leaving an open uterus (breaking scrub) to do the intubation. Our chief OB is up in arms!

    Many say that we shouldn't have to intubate if anesthesia is on the floor. Anesthesia's argument is that the infant is not their patient. Our NRP instructor says that as L&D nurses we are more qualified than anesthesia to intubate newborns. Because we have more oppurtunity to do it. Generally our peds agree with this. In the OR anesthesia uses devices that occlude the esophogus when operating on an infant/child.

    For those of you that do intubate... how successful are you at doing it and how comfortable are you with it? Do you practice only on dummies or do you practice with anesthetized kittens?

    Thanks,
    Paula
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  2. 13 Comments

  3. by   gotosleep
    Quote from fourbirds4me
    Our NRP instructor says that as L&D nurses we are more qualified than anesthesia to intubate newborns. Because we have more oppurtunity to do it. Generally our peds agree with this. In the OR anesthesia uses devices that occlude the esophogus when operating on an infant/child.


    Thanks,
    Paula
    hahahaha

    That is pure nonsense. You're NRP needs to spend some time in the OR.
  4. by   athomas91
    Our NRP instructor says that as L&D nurses we are more qualified than anesthesia to intubate newborns. Because we have more oppurtunity to do it. Generally our peds agree with this. In the OR anesthesia uses devices that occlude the esophogus when operating on an infant/child.
    you might want to check your facts before printing such silly things. First of all - Anesthesia is the guru of airways - there is none better (an equal perhaps may be an ENT) - and we do not use devices to "occlude" the esophagus in the OR. Nurses without anesthesia training shouldn't intubate period.
  5. by   BittyBabyGrower
    Quote from athomas91
    you might want to check your facts before printing such silly things. First of all - Anesthesia is the guru of airways - there is none better (an equal perhaps may be an ENT) - and we do not use devices to "occlude" the esophagus in the OR. Nurses without anesthesia training shouldn't intubate period.
    Hmmm....better check into your states scope of nursing. Unless we have EMT training or are an NNP, we aren't allowed to intubate! Guess whose heinny would be on the chop block if that kid's esophagus got perfed or something else went wrong and the kid ended up gorked or worse....better get your legal department in on this little problem!

    And when we intubate little ones, I have never heard of of anything to occlude the esophagus???????
  6. by   fergus51
    That is SO not a nursing job. Unless they are an NNP. I have never even heard of CRNAs doing this.
  7. by   nekhismom
    sounds scary to me.
  8. by   suzanne4
    Quote from fourbirds4me
    I hear many of you talking about RT/doctors etc... required to be at your deliveries for infant intubation/cord viewing purposes. This is a nursing job at our facility. Many of our nurses are hesitant to do this and we are going through an issue right now during which an infant was coded and neither nurses nor anesthesia attemped to intubate. Surgeon ended up leaving an open uterus (breaking scrub) to do the intubation. Our chief OB is up in arms!

    Many say that we shouldn't have to intubate if anesthesia is on the floor. Anesthesia's argument is that the infant is not their patient. Our NRP instructor says that as L&D nurses we are more qualified than anesthesia to intubate newborns. Because we have more oppurtunity to do it. Generally our peds agree with this. In the OR anesthesia uses devices that occlude the esophogus when operating on an infant/child.

    For those of you that do intubate... how successful are you at doing it and how comfortable are you with it? Do you practice only on dummies or do you practice with anesthetized kittens?

    Thanks,
    Paula
    They teach intubation in ACLS, that does NOT mean that it gives you the license to do it. Just because your NRP instructor told you that, it does not mean that it is the rule to follow. I seriously suggest that you check your department's policies and procedures, as well as from your BON. I have worked as a flight nurse in the past and was trained to intubate, and I have my ACLS, PALS, and NRP certifications. Would I do it in a hospital setting? NO! Because I am not legally covered to do so. You are wide open for a law suit then...........
  9. by   dawngloves
    Why isn't peds at the delivery? Or another anesthesiologist? Are you in a small hospital? I don't understand's Anesthesia's arguement. Do they not go to codes because "That's not my pt." ?
    My NRP is due for renewal so I can't remember if we practiced intubation, but it wasn't on kittens I'll tell ya that! And the past two times I did ACLS (back in the day) they didn't have the RNs do intubation (which was fine by me as that class is long and I needed a break!)
  10. by   SmilingBluEyes
    They DO teach and practice INTUBATION in NRP. We had to intubate anesthesized kittens way back when, I remember, and I remember being horrified too. (this activity WAS supervised by the humane society, by the way). We do it on DOLLS now.

    But on a real baby, nope, I would NOT want to do this. In ANY high risk delivery, a PEDS must be present where I work.....this would include many things such as really bad fetal strip, extreme prematurity, mod to thick mec staining, etc. I can see a situation where there is NO ONE right away to intubate. Still won't do it. I will bag/mask baby, do compressions, having suctioned all I can first, but not intubate. We have anesthesia and doctors to do that and that is in THEIR scope, not mine. JMO.
  11. by   gypsyatheart
    This is soooo not in an RN's scope of practice! I can't believe RN's are actually intubating where you work! What is with these lame excuses from anesthesia....and what is up w/your docs? Peds should be at any high risk deliveries and respond to any pages when problems occur. It's true, you can bag/mask all day, do all your other interventions, but RN's don't intubate. Yes we are trained to do so and practice, as a matter of fact, I am an instructor, and I can't imagine an NRP instructor stating those things! Boy, they have the nurses snowed where ever it is you work! LOL I would definitely get on the ball to present the appropriate info. Start w/BON and go from there! Good luck!
  12. by   karenmcd
    I can't understand how an anesthesiologist can say that it isn't their patient...???!!! The person that said that you are the best to intubate is crazy!!! I work in a hospital that delivers from 30 weeks on...of course we get younger at times and I go to resuscitations every night I work because I am on the resuscitation team and I strictly do babies and I have not felt like I have come across that many opportunities to intubate to say that it is a common procedure for me to perform.
  13. by   kimmicoobug
    Nurses have intubated at the facility I work at. I believe our policy is MD's first, RT second, and then nurses third. However, it is very rare for RT to do it, and even rarer for nurses. I have only heard of one OB nurse to intubate a neonate in distress, and don't know the reasons behind it. Now, would I want to intubate...NO...but I think it would be neat to really learn how.
  14. by   BRANDY LPN
    Quote from SmilingBluEyes
    They DO teach and practice INTUBATION in NRP. We had to intubate anesthesized kittens way back when, I remember, and I remember being horrified too. (this activity WAS supervised by the humane society, by the way). We do it on DOLLS now.

    But on a real baby, nope, I would NOT want to do this. In ANY high risk delivery, a PEDS must be present where I work.....this would include many things such as really bad fetal strip, extreme prematurity, mod to thick mec staining, etc. I can see a situation where there is NO ONE right away to intubate. Still won't do it. I will bag/mask baby, do compressions, having suctioned all I can first, but not intubate. We have anesthesia and doctors to do that and that is in THEIR scope, not mine. JMO.
    What Deb said, except haven't been around long enough to practice on kittens, have only used dolls, Thank Goodness!, and only have FPs but have an MD or CRNA and RT back up, although RT usually is just there more for setting up a vent or to assist, have never seen them intubate.

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