First Ventilator Pt. Tonight...what to do?

DYatesRN · Aug 1, 2005

The private duty agency I work for called while ago and asked if I would please go to a case tonight for a man with end-stage COPD who had just come back from the hospital. The man is DNR and on a ventilator. I've never worked with a ventilator patient before but have been assured it is not that hard to do.
I'm still a little nervous, can anyone with more experience tell me what to expect?

I have worked with children on vents for several years. The new laptop vents are nice. I am more experienced on the LP10--but of course both accomplish the same thing:) The laptop is newer and more portable. I recall my first vent patient and how "on edge" I was. If possible look in a skills book or such to become familiar with the PIP, PEEP, and mode of the vent(some vents delivered set amounts of air volume and rate while others allow for the patient to breath on their own what they can while still delivering a set rate). A low pressure and low PIP usually indicated a leak in the circuit or possibly the patient is shallow breathing--a high pressure and high PIP usually indicated a need for the patient to be suctioned, or perhaps the patient coughed. Clearly document on the flow sheet the vent settings as appropriate and at the correct intervals. I do hope they at least give you some type of orientation with the prior nurse. Best advice read up on the basics in a skills book. Know how to lavage and suction. I would also like to add that my nursing registry made us have a full training with CEU's prior to caring for a client on a vent. I agree don't go to the case unless you have the training. Good luck!

Dorito, ASN, RN · Aug 1, 2005

I think I would be leary of doing a private duty vent patient if I had no experience with them. Especially if you don't really have any resource person available. I realize he's a DNR but things could still happen that are unforseen and you do have a license to protect.

Jo Dirt · Aug 1, 2005

Yes, I've always been told never to take on anything you are not comfortable with but the agency assured me the nurse giving me report tonight will be very knowledgable. Perhaps she will also welcome my phone calls if I get in a bind later in the evening?

I'm going to pull out my med.- surg. book and see what I can find.

BadBird, BSN, RN · Aug 1, 2005

If you don't have vent experience then I would definately NOT take that assignment. If you were in a hospital you could call for help, at home you are on your own. The agency doesn't care as long as they fill the shift but you could lose your license if you screw up. (Not to mention harming the patient).

Dorito, ASN, RN · Aug 1, 2005

If you don't have vent experience then I would definately NOT take that assignment. If you were in a hospital you could call for help, at home you are on your own. The agency doesn't care as long as they fill the shift but you could lose your license if you screw up. (Not to mention harming the patient).

I totally agree. If you've never passed or completed a vent competency of some sort- you could be held negligable for taking on an assignment you had no experience with. I agree with BadBird that the agency is just filling their slots and raking in the $$$$$.

live4today, RN · Aug 1, 2005

If you don't have vent experience then I would definately NOT take that assignment. If you were in a hospital you could call for help, at home you are on your own. The agency doesn't care as long as they fill the shift but you could lose your license if you screw up. (Not to mention harming the patient).

:yeahthat:

suzanne4, RN · Aug 1, 2005

If you have never taken care of a patient on a ventilator in a hospital setting, then you have absolutely no business taking care of a patient with one in a home setting for the first time. Unless, you are looking at ways to lose your license. Just because the patient is a DNR, ther are still many ways that you could get into serious trouble.

What happens if you have a problem with the ventilator, are you going to tell the family that you are going to need to cal someone? Sorry but it doesn't work that way in healthcare.

If you are already concerned enough about the position tonight, I would highly consider not taking it. And perhaps looking for another agency that isn't worried about just getting a body in there.

It may not be what you want to hear, but these are my views on the subject.

SharonH, RN · Aug 1, 2005

I must agree with the others. Just say NO.

sharann, BSN, RN · Aug 2, 2005

I also would vote no. I also question the person who asked you to do this. They have no right to send you into something that is so dangerous. Just because hes a DNR doesn't mean they can't or won't sue you since the cause of death could have been as simple as a leak or mucus obstuction or suctioning wrong etc..

babynurselsa, RN · Aug 2, 2005

This is a recipe for disaster. A reputable agency should NEVER send you on an assignment that you have no competency documented in.

In a home setting you had better be able to troubleshoot, and be able to assemble a circuit from scratch in a pinch if you needed to.

I have to agree with the others, not a good idea to taake this assignment.

Not only is your license on the line so is your patients life. Stuff happens and if you are anything like me it would.

At the very least arrange some ortentation shifts with someone experienced to teach you how to manage care of a vent patient and the vent.

gwenith, BSN, RN · Aug 2, 2005

If you need to ask for advice on the internet about how to do something then UNDER NO CIRCUMSTANCES should you take the assignment. Books only go so far. Trouble is there is sooooo much NOT covered in text books that it is a disaster waiting to happen. Bottom line - it is just not worth it.

Especially because if you take this assignment then you will, in very short order, find yourself as being considered "vent capable" by this agency and sooner or later you will find yourself looking after a patient that is NOT DNR and something has gone terribly, terribly wrong.