Non-visualized Airways?

Nurses General Nursing

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Hi,

I`m an Emt-b student, & had a question. Can Nurses RN or LPN insert non-visualized airways? I know Docs, Resporatory Therapist, & Emts can do this.

Thanks for any answers.

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Specializes in Tele, ICU, ED, Nurse Instructor,.

At the hospital I work, no we can't.

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You mean like LMAs, King Airways and Combitubes which are supraglottic or extraglottic devices?

That depends on their state and where they work. If doctors, Respiratory Therapists, PAs and NPs are always around, the RN will have other responsibilities.

If the RN works on a flight team , CCT or specialty, then yes, they will need to know alternatives to endotracheal intubation since not all patients can be safely intubated in the field. Some rural EDs will also allow the RNs to establish an extraglottic device until a qualified physician or Respiratory Therapist arrives. Even in L&D the RN may have an infant LMA as a backup to endotracheal intubation for a congenital anomaly In most states RNs are allowed to intubate but due to logistics, it is difficult to train over 1000 RNs in a hospital and expect them to get enough intubations each year to be proficient.

Also, not all states allow EMT-Basics to use Combitubes, LMAs or Kings.

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I was wondering about the whole ball of wax including LMAs, King Airways and Combitubes. Emt-b`s scope of practice on the national level may soon be changing. In the fact that non-visualized airways may be removed from Scope of Practice for Emt-b by the NREMT.

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This link will explain the new levels.

http://www.ems.gov/education/nationalstandardandncs.html

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Specializes in Emergency, Case Management, Informatics.

It would be nice if an RN could intubate with a King or Combitube, but it's not allowed here. Blind insertion airways are typically not even used in the hospital setting, at least in my area. I personally think that they should be, after witnessing an ER physician and an RT struggling for half an hour to get an ETT on a full arrest. Why were they still trying to get an airway on a dead patient after half an hour with no airway, you ask? Hell if I know.

Some medics in my area prefer to use blind insertion airways instead of ETT's because it gets the airway in fast, and seems to work just as well as an ETT. Yeah, it looks cool putting that scope down the patient's throat and fiddling with the tube, but the patient could be breathing for an extra 30-60 seconds while you try to get that airway. :D

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Nope. Only nasal and oral airways, but nothing where a patient is NOT spontaneously breathing.

That is our scope of practice in the hospital setting in the South, USA.

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Thanks for the link. Its still up to the states to choose which they go by. My instructor was saying Indiana was still undecide on if they were going with nationals.

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It would be nice if an RN could intubate with a King or Combitube, but it's not allowed here. Blind insertion airways are typically not even used in the hospital setting, at least in my area. I personally think that they should be, after witnessing an ER physician and an RT struggling for half an hour to get an ETT on a full arrest. Why were they still trying to get an airway on a dead patient after half an hour with no airway, you ask?

The RT or doctor could also place one of these devices. However, the object of the game is to do ETI in a hospital. It is possible that a patient can not be intubated by regular larynoscopy and a fiberoptic device might be needed. A cardiac arrest can go on for 1 or 2 hours in some cases. If a BVM can be used adequately, ETI might be deferred initially. However some patients need an ETT but if the hospital is too cheap to provide the necessary tools, the providers may have to do the best they can with the equipment they have.

I had thought that RNs in TN could intubate or at least those on transport like at Vanderbilt.

Some medics in my area prefer to use blind insertion airways instead of ETT's because it gets the airway in fast, and seems to work just as well as an ETT. Yeah, it looks cool putting that scope down the patient's throat and fiddling with the tube, but the patient could be breathing for an extra 30-60 seconds while you try to get that airway. :D

If the person is breathing and has an intact gag, the supraglottic devices are probably not the correct device to use.

There are many EMS agencies that no longer have ETI as a primary airway for their Paramedics.

In the hospital the ETT must be used if the person is to be placed on an ICU ventilator. If the supraglottic device is left in place too long, complications including anioedema will occur making intubation very difficult and the patient may need to be taken to the OR for a trach or a percutaneous one with be done at bedside...quickly and hopefully the patient is stable enough.

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Specializes in CEN, CPEN, RN-BC.

PA NPA states that nurses can intubate, but I'd like to see a facility that actually lets a RN do that

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Big difference between what a nurse practice act allows and the facilities policy and procedure and crednetialing committe allowes.

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There is a difference between the supra/extra glottic devices the OP was asking about and ETI. Except for the OR where the LMA may be used on a regular basis, you probably won't see these devices initiated in a hospital if someone can do ETI and has the back up equipment to facilitate ETI on a difficult airway. The exception might be in a very rural hospital or in an L&D. Yes, there are RNs that do intubate in some L&Ds. There are also RNs who are allowed to maintain their ETI skills for flight or specialty transport while working in a hospital.

However, don't expect a hospital to try to train and maintain the intubation skill level along with the other alternative devices for 1000 or even 100 RNs in a hospital. Someone who does ETI should have no less then 20 tubes per year to remain proficient. I would not want someone who might only do 1 intubation per year, if that, messing with my cords or those of someone I care about which includes my patients. Also, if the RN is focused on intubating, who will be starting the IV, pushing meds, caring for the family and setting up for other procedures? Nurses already have a lot of responsibility and they shouldn't have to do the intubation to feel like they are important when in fact they are already a very important part of the intubation process. We just had another thread where some placed their whole professional worth on being able to intubate.

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