Trachs/Vents - How much training?

  1. 0
    I am leaving my position as a School Nurse to be home with my kids, but I am strongly considering applying for a weekend night position advertised with a private duty company. They advertise trach and vent experience preferred, but will train. I have no experience with either, but I have some g-button experience.

    How much vent/trach training should I expect before taking a case on my own? More specifically, what is the typical amount of training offerred, and what is necessary in your opinion for me to safely take a vent or trach case on my own? I just want to have an idea so I can ask about training during the interview. Thanks!
  2. 23 Comments so far...

  3. 4
    As with all training, it depends upon the agency. Some do a good job while others tell you to go to a class and pay for it out of your own pocket. You attend the class and find it wasn't worth the gas money it took for you to get there. I got my training from another nurse during my orientation to cases. I supplemented what they showed me by reading an owner's manual about one of the vent models, but practically everything I needed to know was shown to me. One nurse did a better job than the others. From then on, I just got used to working with the vents and doing trach care from actually doing it.
  4. 1
    ^like above, definitely depends on the agency. And the family. If you're doing nights, then family should be there to assist.

    Nights *should* technically be fairly easy. As a new grad in the PPD environment, I was firm on only taking older (toddler to elementary school aged) & stable kiddos. Frankly, I learned good trach care from parents. "How do you want trach care to be done" is a great way to learn without letting out that you're inexperienced.

    Like cali, most of my vent experience came from direct learning w/the previous nurse. Again, you may have to put your foot down and demand X learning hours from the offgoing primary RN on the case -- I know that I did.
    Purple_Scrubs likes this.
  5. 1
    I have no experience with home vent training but as a NICU/Peds CICU nurse I ask that you PLEASE make sure you get adequate training and feel comfortable with the patient and their needs before taking them on your own. I have full respect for the nurses that choose to work private duty nursing for complex patients, god knows I don't think I could do it, but I love those kids and it breaks my heart when they come in coding because the home nurse was uncomfortable with the care they needed, didn't escalate in time or didn't react appropriately to an emergency situation. This could be form inadequate experience, inadequate training or an issue with the agency not assigning nurses appropriately. I have seen too many kiddos come back in coding and suffer devastating brain injuries after coding from a plugged trach.

    And like another person said, definitely train with not only the nurse experienced already with the patient but also whoever the primary caregiver is. If it's a child the parents almost always know what is best and right for their child and can show you how they like to do trach care, trach changes etc. So long as it is safe I don't try to change techniques even when they are inpatient in the ICU
    Purple_Scrubs likes this.
  6. 0
    My agency requires taking a vent class. Although I took the class I had many years of vent/trach experience from on the job experience. I've never missed a call.
  7. 1
    When I did my orientation to my first case with a trach I just pulled the nurse who was with me aside and told her that I had no experience with a trach. She was very nice about it and explained everything to me and let me watch her do everything first. That was a huge help. Also, she knew not to ask me to do something on my own in front of the patient or family members. Of course I also reviewed how to do trach care before arriving to the home. That was enough for me to feel comfortable to go back and care for the patient. It mainly depends on you're level of confidence and how quickly you can think things through.
    As far as vents: either take a class if they offer it or I would demand a minimum of 2 fulls shifts of on the job orientation.
    Purple_Scrubs likes this.
  8. 6
    I would much rather have a good nurse with no trach/vent experience then a lousy or barely decent nurse with years of barely decent trach/vent experience. The training I gave our nurses was 10 times what they got from their agencies.
    TeacupPom, brillohead, HGTVrn33, and 3 others like this.
  9. 0
    Quote from umcRN
    I have no experience with home vent training but as a NICU/Peds CICU nurse I ask that you PLEASE make sure you get adequate training and feel comfortable with the patient and their needs before taking them on your own. I have full respect for the nurses that choose to work private duty nursing for complex patients, god knows I don't think I could do it, but I love those kids and it breaks my heart when they come in coding because the home nurse was uncomfortable with the care they needed, didn't escalate in time or didn't react appropriately to an emergency situation. This could be form inadequate experience, inadequate training or an issue with the agency not assigning nurses appropriately. I have seen too many kiddos come back in coding and suffer devastating brain injuries after coding from a plugged trach.

    And like another person said, definitely train with not only the nurse experienced already with the patient but also whoever the primary caregiver is. If it's a child the parents almost always know what is best and right for their child and can show you how they like to do trach care, trach changes etc. So long as it is safe I don't try to change techniques even when they are inpatient in the ICU
    That is my worst nightmare and something I want to avoid at all costs! This would be a leap for me from stable kiddos, some with medical conditions but still stable enough to attend school, to a much less stable population, so it is a bit out of my comfort zone...but I think it's good to stretch myself...just not at the patient's expense!

    I like the idea of ask the parent how they do care. They do indeed know the child best.
  10. 3
    Patients at home are deemed stable, however, that does not preclude a patient being discharged to the home prematurely or inappropriately. One needs to be ready for the unexpected. I always mentally "practice" emergency actions on my own and regularly with the parents. Should be one of the first teaching sessions that you provide.
    elprup, ventmommy, and Purple_Scrubs like this.
  11. 1
    Quote from caliotter3
    Patients at home are deemed stable, however, that does not preclude a patient being discharged to the home prematurely or inappropriately. One needs to be ready for the unexpected. I always mentally "practice" emergency actions on my own and regularly with the parents. Should be one of the first teaching sessions that you provide.
    Yes, the patients who are sent home are "stable" but complications can happen fast and be devastating. Also it really depends on what their other issues are. A cardiac baby/child with a trach can have 10 seconds of resp distress and go into a full blown cardiac arrest without warning (actually cardiac kids can go into cardiac arrest for no other reason than that they have cardiac issues trach or no trach), or a kiddo with neuromuscular issues may not be strong enough to cough and plug very easily. I am glad you mentally practice emergency situations on you own. I with others did so as well and I urge people caring for these patients to never underestimate their ability to go bad in the blink of an eye. Kids compensate for things much longer than adults do and before you know it they are dead in your arms.

    I sent a kiddo home once, trach/vent. Happiest little guy around, had the biggest smile that would light up a room, we held on to him probably way longer than necessary...he was the only ICU patient on the unit who spent time during the day up in his baby walker! He went home for a week, plugged, nurse/parents didn't change out the trach, he coded for three hours in the ER, received an ethically questionable number of Epi doses and now he is neurologically devastated, neuro storming constantly. His parents refuse to believe his prognosis so he went home but his spirit and life are no longer there.

    OP I certainly don't want to discourage you from pursuing this career path, you sound like you definitely want to take all precautions to be ready for an emergency and so long as you are always prepared for the worst you will do fine! I am sure these events happen very infrequently, I am only aware of them because I see the kids after then are admitted. I wish you lots of luck!
    Last edit by umcRN on Jun 11, '12
    Purple_Scrubs likes this.


Top