how is Vent weaning supposed to be done?

[wantsthebest]

Quick question, if your patient is on a vent and they are being weaned off, shouldn't you be there? Shouldn't suction be ready? Should your patient be number one on your mind? Will someone please correct me if i am wrong....I am a nurse, my daughter was on a vent, she was being weaned off, resp. therapy walked away, the nurse was no where to be found and my daughter began vomiting. Therapy picked this moment to walk in and stood there for a full minute before reacting. I had to ask for them to get suction and assistance. Please, give me some feedback on this..I have never been so shocked in my life.

[NRSKarenRN, BSN, RN]

full explanation:

ventilation management online nursing ceus contact hours page 10

please report your concerns to unit manager...leaving for a minute or 2 after you've watched a patient for a few minutes may occur to get equipment, chart, take another off nebulizer treatment not uncommon. suction unit, however should always be setup in room with suction kit at head of bed ready for immediate use.

[GreyGull]

If the patient is already on a ventilator or has any artificial airway, there should be a suction set up at bedside. It is doubtful that a patient on a ventilator has made it to the weaning phase without ever requiring suctioning. Even the oral care should require a suction setup for patients with artificial airways.

Weaning is a process and not just a spur of the moment thing. There is a list of variables that must be acceptable before it is initiated. You also did not make it clear whether your child was removed from the ventilator to a trach collar or placed on PSV or VSV.

One RT may have 6 patients to initiate a weaning protocol on before rounds with the physician to determine extubation readiness. So yes, the patient will be placed in a weaning mode, watched for a few minutes and then move on to the next patient. If the patient is in the ICU, there should be a low nurse to patient ratio such as 1 : 2, with monitoring. RNs are also capable of suctioning when the RT is not around but may have another patient. If the patient was still on the ventilator, there are many alarms that are usually set with tight parameters especially during a weaning phase. The RT may also have felt secure moving on to the next patient since you were at bedside and also a nurse. Granted you may not be familiar with ventilators or suctioning as an LVN.

Vomiting can sometimes be predicted but no always. However, it does sound like RT was there when the vomiting started. What may seem like several minutes to you as a parent, it may only have been a few seconds. I personally would have a difficult time focusing on a clock for a minute instead of my child if he was in trouble. RNs and RTs deal with parents frequently who are screaming for someone to help even when there are many professionals at bedside already helping. As a parent you sometimes lose sight and just focus on one incident.

RNs and RTs are human and both carry some big responsibilities. As much as they would like to do 1:1 care on all patients, it is not always possible. I am not trying to judge you but there is always more than one side to every story. If someone was venting about you not doing your job, I'm sure you would like your side known. If there was an error made, the peds RN and RT are probably beating themselves up since it is doubtful anyone wants harm to come to a child in their care.