who intubates?

[nocturnalnurse]

Who intubates at your deliveries? I work in a small hospital, 40-50 deliveries a month-no NICU, most of our delivery docs are not NRP certified so it comes down to the 2 nurses in the room for all rescucitations. Hospital policy right now does not say RNs can intubate (doesn't say we can't either, though). Almost none of our family practice docs who care for the newborns are not comfortable with anything "abnormal", key order is "set up for transfer" even though we do have our level 2 designation. Anesthesia is in house but not near our floor...5-7min for them to arrive once called IF they get the page the first time. All our nurses are NRP, ACLS, BCLS and STABLES certified, some are PALS certified. We COULD intubate. We COULD be trained and retrained on a frequent basis in the process (seeing as we wouldn't do it but rarely). Hospital legal team is dragging their feet about it, but since NRP standard of care requires someone able to intubate immediatly available at deliveries, would they be putting themselves at risk by NOT allowing RNs to intubate? I know most of us have done it once or twice because, really, what other option do we have if we need to give epi or can't get good vetilation with bagging? BTW our policy DOES say we can intubate for trach suctioning for mec and nonvigorous per NRP protocols.

would appreciate hearing what others do in their hopsitals. thanks.

[Fyreflie]

None of the units I've worked on have allowed nurses to intubate but it sounds like you guys need to and that the hospital is definitely setting themselves up for a disaster by not supporting that in policy.

What about LMAs?

[melmarie23, MSN, RN]

thats awful that your OBs are not trained in NRP. Talk about risky business.

Our OBs can intubate if need be, but we also have pediatric hospitalists in house 24/7 who will intubate for us.

[FlyingScot, RN]

Your anesthesia department needs to step up. Intubation is not a benign procedure and should not be done by people who only do it a few times a year. When I was transporting we needed 40 intubations in a month and if we didn't get them on transport we went to the OR. It would be more important for all of you to learn how to bag a baby correctly with a C-PAP bag and manometer and insert a short-term UVC for epi administration. Sure, there will be outliers with infants who do not ventilate well with a bag but those are really quite rare and your anesthesia department should be able to intubate them. How far away is the local NICU?

[nocturnalnurse]

the problem with our anesthesia is that they are not NRP certified, have refused in the past to come up and help recussitate, and the last code I have they refused to use the right sized ET tube as suggested by the nurse because the other ones "looked too big"...had to be extubated and reintubated when the transport team arrived. "local" NICU is not really a term I'd used...2hrs by the pediatric chopper, longer if the chopper can't go up. we also don't have a policy that says we can place temp. UVCs for epi, the policy just doesn't say who can do it and who can't. we are all trained in it and are more likely to use a UVC than the family practice docs in the area. I'm trying to get these policies changed but for now, on the code sheet there just isn't a place to write in who put in what...it just says it was put in. not really ideal, but just sayin...lol

[OBnurse95]

Our RT people intubate and are NRP certified! We also have NICU, but, when I started working at our hospital 18 years ago, we didn't have NICU and relied on our Resp. Therapist to attend all of our deliveries.

[Fyreflie]

the problem with our anesthesia is that they are not NRP certified have refused in the past to come up and help recussitate, and the last code I have they refused to use the right sized ET tube as suggested by the nurse because the other ones "looked too big"...had to be extubated and reintubated when the transport team arrived. "local" NICU is not really a term I'd used...2hrs by the pediatric chopper, longer if the chopper can't go up. we also don't have a policy that says we can place temp. UVCs for epi, the policy just doesn't say who can do it and who can't. we are all trained in it and are more likely to use a UVC than the family practice docs in the area. I'm trying to get these policies changed but for now, on the code sheet there just isn't a place to write in who put in what...it just says it was put in. not really ideal, but just sayin...lol[/quote']

This sounds like a legal nightmare to me. At my last job (rural, RT and peds available but out if hospital), the OBs were mandated to be NRP trained and the last travel job I did the family practice docs were. You must feel so unsupported!