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Any ICU's ambulating vented patients?

Posted

Specializes in ER trauma, ICU - trauma, neuro surgical. Has 10 years experience.

I'm starting to here about vented pts being ambulated with the RN, PT, and RT. Do any of you practive this at you hospital? There's videos on Youtube, which is pretty wild. The pt has a walker with the vent on a rolling table.

lovingtheunloved, ASN, RN

Specializes in LTC, home health, critical care. Has 12 years experience.

ICU isn't my area, but that sounds like it's about a 3 person job!

Sun0408, ASN, RN

Specializes in Trauma Surgical ICU. Has 4 years experience.

We don't do it in our dept, obviously trauma's aren't gonna walk all that soon, however, they do walk vented pts in the CCU. They have a portable vent on wheels or they just bag the pt. I have yet to see it but others that have floated there said its wild to see at first :)

missnurse01, MSN, RN

Has 18 years experience.

I have worked in many icu's across the country but only saw it in one and it was pretty rare.

commonsense

Specializes in ICU. Has 2 years experience.

I'm starting to here about vented pts being ambulated with the RN, PT, and RT. Do any of you practive this at you hospital? There's videos on Youtube, which is pretty wild. The pt has a walker with the vent on a rolling table.

I think they only do that in specialized ICU departments located in Crazytown, USA.

At Kaiser in Portland we ambulate our vented pts once or twice daily with RT, PT (or another nurse) and the RN. The pts like it and they get extubated sooner. You use less sedatives because the pts are genuinely tired, less delirium, etc. I love it. Most of the nurses I work with love it too. Of course there are pts who don't qualify to walk, but a lot do. It's great, check it out!

justatraveler

Has 5 years experience.

Some of our patients stand up out of bed, walk in place, and take a few steps over to an easy chair, where they might sit for a few hours or so. :)

sapphire18

Specializes in ICU.

I wish my hospital did this!

juan de la cruz, MSN, RN, NP

Specializes in APRN, Adult Critical Care. Has 27 years experience.

We ambulate patients on vents in our ICU. This has been one of our quality initiatives and has been successful so far with the combined effort of nursing and PT. There are numerous articles that address this:

Early Mobilization in the ICU: Improving Patient Outcomes | The American College of Chest Physicians

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286494/pdf/cptj0023-0005.pdf

http://depts.washington.edu/pulmcc/conferences/lungday/Hough%20Mobilization.pdf

http://ptrehab.ucsf.edu/sites/ptrehab.ucsf.edu/files/documents/Early%20Mobilization%20in%20the%20ICU.pdf

The last link is from our institution.

hodgieRN

Specializes in ER trauma, ICU - trauma, neuro surgical. Has 10 years experience.

That's so awesome! Let me ask you this...What do you say to people that argue pts who can ambulate don't need to be intubated in the first place?

juan de la cruz, MSN, RN, NP

Specializes in APRN, Adult Critical Care. Has 27 years experience.

That's so awesome! Let me ask you this...What do you say to people that argue pts who can ambulate don't need to be intubated in the first place?

My answer would be that this is a generalization that does not apply to all vented patients. In the same manner, not all patients that are vented are safe to ambulate if they do not fall within the criteria we use in our institution.

Patients that are ready for extubation based on established parameters need to be extubated regardless. Patients with true lung injury (such as due to ARDS) have a longer course of lung recovery which can take time to be liberated from the vent. Some require gradual pressure support wean, some require bi-level ventilatory mode wean. In the meantime, they can start PT and receive assistance with mobilization.

opossum

Specializes in ICU/CCU, Med Surg.

I remember first learning about this at an AACN conference last year and was blown away by it - it truly does lead to faster extubations.

However, I think it requires a dedicated team approach of MDs, RNs, RT and PT to make this all happen; in my hospital, that's simply not an option. We're a small, rural hospital and do not have enough staff around to just even get the pt UP. It's sad, because it's something from which a lot of intubated pts could benefit.

I think they only do that in specialized ICU departments located in Crazytown, USA.

Worked in a top 10 hospital and there was a unit at that hospital that did this with portable vents. The patients had better outcomes and were extubated quicker. Guess that's one of the reasons they are in the top 10.

PMFB-RN, BSN, RN

Specializes in burn ICU, SICU, ER, Traum Rapid Response. Has 16 years experience.

Yes, since the late 90's it has been common for many, but not all types of vented patients in our ICUs. I was unaware until this discussion that there were still places that didn't have such practices.

We use portable vents and no more than two patients (on a 26 bed unit) can be ambulated at a time (related to staff avalabiliety). Totaly normal to arrive on the unit for report and see one or two intubated patients being ambulated. Usually patient is ambulated with two people, an ICU RN (RNs run our own vents) and either a PT or a PT assistant. At night a second RN or even a CNA will fill in for the PTA. BID Amublating vented patients is part of the standing protocol if certain conditions are met. The physician must check the ambulation orders if he does NOT want them ambulated, otherwise it's up to the RN using the protocol. I't enough work that usually each RN will only amubulate once on his shift and the day nurse will preform the other ambulation. Always at the RNs desicretion. However if when giving report and you have not ambulated your elligable patients the RN comming on will want to know why not. Since many of our patients are trauma patients and have numerous fractures they are often not elligable. Same for patients fully expected to be extubated in less than 24 hours.

At the time it was started (before I worked there) in (I think 1997 or 1998) the unit considered it's self tardy on implamenting the protocol.

Edited by PMFB-RN

nrsang97, BSN, RN

Specializes in Neuro ICU and Med Surg. Has 19 years experience.

There is talk of us doing this soon.

SwansonRN

Has 2 years experience.

We're working on it, but a lot of nurses have reservations about the process. I've gotten a few of my vented patients OOB to chairs and whenever I do my patients and their families are SO happy and I feel like the best nurse ever :yeah: Not to mention how beneficial it is to their recovery. It is a lot of work though, sometimes a 2-3 person job...lots of unplugging and untangling and rearranging the room. I've heard of some ICUs having patients walk down the hallways, standing up playing wii games while vented. It sounds wild.

SummitRN, BSN, RN

Specializes in ICU + Infection Prevention. Has 8 years experience.

I WISH we did. It can be awesome for the patient. It just needs adequate staffing and the right patient.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

We ambulate our intubated patients extremely rarely, our problem has been finding the right patients. We sent two RN's and an RT to another facility to observe their protocol and practices, their observation was that the patients they were ambulating would have been extubated had they been in our ICU.

So for places that do this more often, what is you inclusion/exclusion criteria? What's your criteria for extubation?