I want to get some ideas going about making intubations smooth and easy for the patient, doctor (sometimes very nervous resident....; ) ), RT, and nurse.
Today, my patient had to be re-intubated and the doc asked for versed and propofol... started the gtt for propofol and set it up so i could use it to bolus. Versed 5mg/ml- gave 2.
then, i get all set in the room (gown and all) and the doc asks to run saline at 999/hr to keep pressure up, but i had no saline. So should I just anticipate the need for saline bolus next time around.
How else do you facilitate intubating your patients to make it quick and easy?
Specializes in Trauma ICU, Surgical ICU, Medical ICU.
I LOVE prop for intubation, whats great about it is that when you are ready to extubate, people can wake up within MINUTES! Also when you have pts that are drug abusers (coke and meth esp. ETOH too) they usually have some serious hypertension and you can control that easily with prop (sometime too well and you have to add some levo lol). I am really suprised that some states dont allow you to push prop. Learn something new everyday I guess, I'm glad we can! Its also our policy to have dopa at bedside and i usually bring some phenylephrine for good measure lol.I ALWAYS have NS wide open during intubation too, its in our policy also!
when you say, NS wide open.... do you mean that you have the roller clamp open fully and the tubing not on a pump, or do you have the tubing in a pump set at a really fast rate? thanks.
Specializes in Trauma ICU, Surgical ICU, Medical ICU.
when you say, NS wide open.... do you mean that you have the roller clamp open fully and the tubing not on a pump, or do you have the tubing in a pump set at a really fast rate? thanks.
Sorry, on a pump on 999/hr. Should have clarified that one
Our CRNA's who show up for electives like a liter bag NS hung and mainlined, wide open. They will put diprivan in that themselves most of the time. They usually bring their own drugs and are ready to go, respiratory assists and sets up the vent.
So I usually have straightened the room as soon as I got to work (hopefully) and will set up by moving the bed out from the wall, take headboard off and put away, flatten patient if possible. Put two bedside tables in room. One for resp. and one for me. Mine has syringes, flushes, towels, the flowsheet/clipboard, and anything else I happen to want. The one for resp. has suction catheter kits, bottle sterile NS for irrigation/lubrication, new yankauers, gauze, gloves, etc. Also I doublecheck the suction setup and make sure there is room for respiratory, the vent, and for the CRNA to be able to get to the head of the bed and back. This is usually done pretty quickly. I like organized chaos, not surprise *********** chaos.
Most of the time in an OR situation they would use, say 100 mcg of NEO in addition to the propofol and the versed. If you take a 10 mg vial and mix in in 100 cc's it will give you 100 mcg's per ml. You should anticipate hypotenion with versed/propofol combination. I have had several CRNA's and MDA's tell me that this is why they dont like to use it for induction (due to hypotension). I have intubated patients for several years and its always nice to have someone at your side that knows what order you will need your equipment in. Now you know that next time you might need a saline bolus, neo or whatever else. In the case of my facility, you can usually take out what you need and return it if you dont use it.
I want to get some ideas going about making intubations smooth and easy for the patient, doctor (sometimes very nervous resident....; ) ), RT, and nurse.
Today, my patient had to be re-intubated and the doc asked for versed and propofol... started the gtt for propofol and set it up so i could use it to bolus. Versed 5mg/ml- gave 2.
then, i get all set in the room (gown and all) and the doc asks to run saline at 999/hr to keep pressure up, but i had no saline. So should I just anticipate the need for saline bolus next time around.
How else do you facilitate intubating your patients to make it quick and easy?
I had a question. I am in school for nursing and I was curious as my Dr. that I work with now informs me that nurses do not intubate! I have read that they have. In the real world out there....do ER nurses or ICU nurses intubat a patient? :) Thanks
Specializes in multispecialty ICU, SICU including CV.
You should check your States BON about pushing propofol. It is outside the scope of practice in some states and you can't rely on Doc's to know what is legal for you.
I think in most states you can bolus propofol ONLY IF THE PATIENT HAS A PROTECTED AIRWAY. Meaning, post-intubation only. If there isn't an anesthetist there to do it, you can't.
Specializes in multispecialty ICU, SICU including CV.
I had a question. I am in school for nursing and I was curious as my Dr. that I work with now informs me that nurses do not intubate! I have read that they have. In the real world out there....do ER nurses or ICU nurses intubat a patient? :) Thanks
No. Out of the scope of practice in most cases.
CRNAs do intubate regularly -- that is considered an advanced practice role.
EMT-Ps also intubate. In some facilities, respiratory therapists will intubate. Other than that it needs to be a provider (MD, DO, perhaps rarely a specially trained NP.)
CRNAs do intubate regularly -- that is considered an advanced practice role.
EMT-Ps also intubate. In some facilities, respiratory therapists will intubate. Other than that it needs to be a provider (MD, DO, perhaps rarely a specially trained NP.)
Anesthesia intubates our patients. Usually the doc gives them a call and they are there within a few minutes. They also respond to all codes and intubate if needed. They bring a bag with all the meds and other supplies (ETT, stylet). They push the meds and do an RSI.
When the decision is made to intubate, I notify RT to get a vent and come to bedside. I assure that there is working suction, pull the bed out from the wall, set my BP for q 2 min cycling and open fluids up in a dedicated IV site. Anesthesia likes to have fluids running wide open. I get an order for sedation and set that up so it is ready post-intubation. I also quickly review allergies and recent lab values because anesthesia always asks for this information.
Some of tythis stuff might have already been covered, but here's my 2 bits:
1. Get the bed ready, away from the wall, raisednup to about belly button level.
2. Suction ready
3. Pt on 100% O2
4. BP cuff on arm that does not have IV access in it.
5. Get ready to bolus pt with sedation, paralytics, pressors, fluid (Every Dr is different with what thaey want, depending on the type of pt they will be intubating)
6. have masks, face protection ready for staff assisting with intubation
poppy07
208 Posts
thank you, i checked. it is, indeed, within our scope of practice in this state to push propofol if ordered by a licensed provider at bedside.