who should do the ambubagging during xray and ctscan procedures?

GreyGull · Mar 22, 2011

They had 2 vents and both are at least 20 years old. I think the next ice age will come before they spring for a portable vent.

One of our best MRI ventilators (Monaghan) was built around 1980.

We still have BIRDs from the 70s. These are excellent vents when electricity is lost.

Age does not always matter if it can still do the job for that level of unit and the needs of the patient. I think the same can also be said for those managing the ventilators.

linearthinker, DNP, RN · Mar 22, 2011

lol, ITA.

15isto2 · Mar 22, 2011

I would think if you cand get a transport vent then I would call the budget holder down to do all bagging and be exposed to all the radiation untill they get you one.

The only time I have been involved with bagging a patient trough CT was a weeks old child who we needed to CT while waiting on the retreival team (they requested the scan) and our vent could not go to a tidal volume low enough

rachelgeorgina · Mar 23, 2011

Do your vented patients not have an airway certified doctor with them for all transport? Perhaps they should be bagging in the absence of the portable vent, which really, seems silly not to have

GreyGull · Mar 23, 2011

Do your vented patients not have an airway certified doctor with them for all transport? Perhaps they should be bagging in the absence of the portable vent, which really, seems silly not to have

No, if a doctor went on all the inhouse transports, they would not have time to see any other patients in some hospitals. Also if a doctor does intubate, rarely do they do their own bagging and probably haven't since residency. The Respriatory Therapist and/or a nurse will do that.

The Respiratory Therapist accompanies all patients with an artificial airway on transports which may also include interfacility as well as inhouse. This may also include stoma patients who do not have an airway in place and nonventilator trachs. The exception is if they are very stable although they will still accompany on interfacility unless there is a Critical Care RN on the ambulance.

The Flight RNs and Respiratory Therapists will do the majority of intubations in the hospital with the exception of the OR. Some hospitals also have their flight or specialty teams do the inhouse transports during their down time instead of giving them a patient assignment in the unit or ED.

If the patient has significant acute changes during any inhouse transport or procedure, the Code or Rapid Response Team will respond to stabilize the patient and the airway.

Of course there are many facilities that do require a physician to be present for transport and doing intubations. But, you will still find the RN or the Respiratory Therapist doing the bagging and lifting.

ZippyGBR, BSN, RN · Mar 23, 2011

First, it should be a transport ventilator. Ambu bags don't deliver consistent or comfortable ventilations and may cause a patient to deteriorate.
Secondly, if you wear lead, I wouldn't be particularly concerned about chest xrays. The amount of radiation received from the scatter off of a normal chest xray in minuscule anyway, if you wear lead that risk is pretty well negated. A CT is an entirely different kettle of fish, and depending on the study, can involve large amounts of radiation. However, my concern would be the potential for displacing the ETT considering the patient is on a moving table.
Lastly, who do YOU think should be doing the bagging? I'd reccomend getting with your diagnostic imaging department and getting a class on radiation safety for the nurses who might frequently be exposed.

when I worked in theatres if we xrayed in theatre and it didn't need the operating team to be by the patient we'd be across the other side of the OR even if scrubbed and wearing lead and anyone not wearing lead was in the anaesthetic room ...

in terms of minimising exposures the patient should be on a transport vent and the their monitoring should be able to be seen from behind the lead in plain film and shouldbe visible in the control room for CT ... if the NHS can achieve that in evil socialised healthcare ...

GreyGull · Mar 23, 2011

Too often I see people get caught up in a emergency and forget a few basic safety rules or think that this exposure doesn't count for much. One chest X-ray might not seem like much but it all adds up when you work in a direct care profession involving patients and radiation. When you consider how many times those working as nurses are exposured over the course a career, it adds up. At one time we were given radiation badges to track our exposure and while not overly significant, the badges were only issued for a couple of months.

Some rush in or get very casual about being around just a chest X-ray and forget to properly fit the apron. Some will just dangle it loosely and most will not remember to place the Thyroid cover. Some may not even know what that is or blow off its importance. Others will jump in with little protection and make ridiculous statements like "I didn't want kids anyway". You'll also find someone who wants to stand out as not being afraid of anything.

You don't find Radiology Technologists standing right next to the patient. They know the risks and will do what they can to protect themselves for a long career.

We also will position our CR monitor and ventilator to be viewed while we are standing in the control area with the Radiology Technologists. Where they are standing is where I want to be.