Airways in PACU

At our facility, if a patient comes in with an airway. it is the expectation of the PACU nurse to remove it after the criteria for extubation has been met. If perhaps it was a difficult intubation (fiberoptic), or there was trauma to the head and neck or pediatric patient, the anesthesiologist may request to be at the bedside for extubation.

Are you referring to an endotracheal tube or an oral/nasal airway? In our PACU, only anesthesia providers remove endotracheal tubes, but the nursing staff can remove oral or nasal airways that have been temporarily placed to maintain a patent airway.

We remove ET's, oral and nasal airways in our PACU after criteria is met. We also have and use a NIF if any doubt. Some anesthesia docs prefer to remove their own but for the most part- we do. I have learned to appreciate, rather than dread ET's! Extubating obviously slows the PACU process a little, but I would rather have a secure airway!

Here in Australia in the PACU 99% of patients are brought into recovery with Laryngeal mask airways in situ. Rarely we will have a patient with an ETT and they are only removed by the PACU nurse if the cuff is already deflated. Do they use LMA's in the USA?

Here in Australia in the PACU 99% of patients are brought into recovery with Laryngeal mask airways in situ. Rarely we will have a patient with an ETT and they are only removed by the PACU nurse if the cuff is already deflated. Do they use LMA's in the USA?

Yes LMA's are used in the U.S.

At my hospital only anesthesia removes ET tubes in PACU but I have heard of other hospitals where this is done by PACU nurses and it seems fairly common.

The RNs in our PACU remove all tubes,including ETTs and LMAs -once set criteria is met,essentially to make sure their neuromuscular block has been optimally reversed, and that they are responsive enough to protect their airway.

The Anesthetists DON'T follow these criteria however and very occasionally they'll pull the ETT before there is much sign at all that the pt is responsive - leading to a whole lot of chin lifting + oral airway...like,what's the rush, buddy?!

I'm a little confused with the response from our Australian counterpart - why can you remove an ETT only if the cuff is already down? What is the reason? Thanks

As a rule, patients do not come into our PACU intubated, except in rare circumstances. LMA's yes, oral and nasal airways yes. We can remove those If a patient is intubated, anesthesia must extubate.

We will remove the airways when patient is able to breathe after reversal. If not, the airways stay. It may take a long time and anesthesia doesn't usually wait around.

It's a judgement call and we have policy parameters based on ASPAN standards.

I work in an inpatient pacu, yes we extubate.......everything, and without anesthesiology. RT is usually around if they need to be connected to the vent. The exception is when the anesthesiologist is worried about something, or pt had a difficult airway. In our pacu anesthesia is always available asap if we need them.