Do you as an RN insert nasopharyngeal or oral pharyngeal airway adjuncts?

[42pines]

Simple question: When for one of various reasons, a non-responsive person with no gag reflex needs airway resuscitation and a head-tilt is inappropriate or inadequate do you as an RN have the right within your scope of practice to use these airway adjuncts?

This is a scope of practice question, and I've been all through my state scope of practice data and run into the question (in their algorithm): " Is this practice within an accepted standard of care which would be provided by a reasonable and prudent nurse with similar education and experience?"

If so, what sort of training did you receive, do you have certification, and how often must you renew said certification?

Thanks

---

The rest of the story for those interested. I'm on Occ Health Nurse in Industry. I have taken the EMT-A National Registry Course, and have passed the practical exam the results of which are now registered with my state. I have yet to take the computerized answer/question exam and prefer to do so in November when I have plenty of free time to bone up on the questions/answers. Upon completion then I would use such adjuncts not as an RN but rather as an EMT-B. However I hold the view that I am an RN who is trained in these procedures to an adequate degree and have proof of proficiency.

A co-nurse where I work essentially says: "no, you can't" unless you are fully EMT-A. I respectfully disagree and would prefer to use an adjunct and save a person's life rather than sit back and say: Oh well, the bag-valve mask doesn't work and the adjunct airways would make it work, but I'm not allowed to use them so good-bye patient--see you in your next life.

The state of MA has an algorithm for determining scope of practice and I'm wondering how many RNs (Not LPN's or APN's) get trained and occasionally use these adjuncts when necessary. If some do, then "is this practice within an accepted standard of care...(see above)" becomes a yes. If so, even in the absence of the EMT-A certification the algorithm leads me to believe that it would be within allowed Scope of Practice with my level of training.

[SummitRN, BSN, RN]

Both the OPA and NPA are generally considered first responder level interventions. So, RNs absolutely in the hospital and probably you are fine doing them under your state's Good Samaratin law if they are in the supermarket's first-aid kit when someone arrests and you help out (check your local state).

[Kidrn911]

in my past position i had the right, it was apart of the cs procedure in the er we used if necessary. i had to only us it once on a combative homeless drunk, irony, it was when i worked at a pediatric er

[nurse2033, MSN, RN]

These devices are basic ACLS interventions. If you fail to open a patient's airway you would be negligent.

[Esme12, ASN, BSN, RN]

in my past position i had the right, it was apart of the cs procedure in the er we used if necessary. i had to only us it once on a combative homeless drunk, irony, it was when i worked at a pediatric er

the nasal air way can be used with an gag reflex but the oral airway cannot. i am curious what was the scenario for i have always found combative drunks able to maintain their own airway.

[Altra, BSN, RN]

The nasal air way can be used with an gag reflex but the oral airway cannot. I am curious what was the scenario for I have always found combative drunks able to maintain their own airway.

Combative does imply "airway stable", does it not? :)

[42pines]

Thank you all for all your helpful posts.

[ByTheLake]

It's not just about the ability to stick a trumpet in someone's nose, or an oral airway in place, it's about the ability to be able to rescue a patient if something goes wrong, and even to recognize when it's really the best course of action. Even if you were a new RN already and not still a GN, you still wouldn't just be cut loose to do that on your own because you'd still be orienting, and then you'd be spending most of your time teamed up with a more experienced RN to continue to guide you and the rest of your time in non-urgent areas honing skills and gaining experience. If you are working as an EMT then you must act as one, even if you are a GN. If you haven't taken NCLEX-RN then you aren't yet an RN and can't practice as one. We have lots of techs at work who are EMTs also, and can do all sorts of things in the box. But at work as a tech, they can't so much as start an IV! Same with our RNs who also are EMTs and ride the boxes on off-days because they love it. While working as EMTs they must practice within EMT scope of practice, not within RN scope, even though they have RN next to their name, because they are not working AS nurses in that capacity.

[TheSquire, DNP, APRN, NP]

Even if you were a new RN already and not still a GN,

I'm confused as to how one could be a Registered Nurse without having been a Graduate Nurse. In all the states I'm familiar with, one must have graduated before sitting the NCLEX.

[sapphire18]

I'm confused as to how one could be a Registered Nurse without having been a Graduate Nurse. In all the states I'm familiar with, one must have graduated before sitting the NCLEX.

You're no longer a graduate nurse once you pass the NCLEX and receive your license.

[ZippyGBR, BSN, RN]

I'm confused as to how one could be a Registered Nurse without having been a Graduate Nurse. In all the states I'm familiar with, one must have graduated before sitting the NCLEX.

in those places where you cannot work as a 'Nurse' until your registration is at least in process if not in place ...

In terms of the original question OP and NP airways are basic airway adjuncts and if you weren't capable of using either or both I'd question what you had been taught in Basic Life Support classes whether that's through your school of nursing or any other employer. the fact the OP has done an EMT course adds evidence of competence because s/he will have inserted them on airway annie there as well and on any clinical placement if the opportunity arose...

various of the supra-glottal airways ( LMAs and derivates like I-gels ) are sold by their makers are not requiring theatre time and anaesthetist supervised practice to claim or maintain competency ( unlike conventional endotracheal intubation), so unless there was an explicit ban or explicit requirement by the BON to use them then assuming the medical director and/or the lead nurse were happy with the OPs competence ...

[Esme12, ASN, BSN, RN]

Most facilities consdider the supre-glotic devices "advanced" airways that require addition training here in the US. Many facilities only have them in the OR for use by those with advanced airway training.

[TheSquire, DNP, APRN, NP]

You're no longer a graduate nurse once you pass the NCLEX and receive your license.

Exactly, which is why I'm confused by what ByTheLake had said.