Intubation

[rnwithtof]

Why aren't nurses trained to intubate? I know other health care professionals are there to do it, but I am just curious why nurses were never trained.

[Rio, ASN, RN]

Why aren't nurses trained to intubate? I know other health care professionals are there to do it, but I am just curious why nurses were never trained.

To answer your question, and not to debate whether or not nurses should, can or do intubate:

First, I think it is a matter of establishing and maintaining competency. As it has been pointed out by Red Cell; repetition improves outcomes: i.e., first look successful intubation.

How many live intubations does it take to become proficient? How many intubations per week/month/quarter to maintain proficiency?

Secondly, who is the RN allowed to intubate? Intubating the unresponsive patient in cardiac arrest is not the same as intubating the patient that is in fulminating pulmonary edema. Risk managers and physicians are NOT going to allow hospital based RNs to order and administer induction or RSI drugs for example.

Third, What RN's in a given hospital are allowed to under go training? There is a JCHAO standard that the same level of care must exist for every patient on every shift. Therefore if you have RN's intubating in the ICU on days there must be the same level of care on the night shift. This may not be problematic in the teaching hospital where there are residents available but then it is a moot point. The problem is in the community hospital where it is common for the ER doc to respond to the ICU.

So the argument goes that IF the ICU nurses could intubate then the airway could be secured before the attending or ER physician arrives.

In my opinion, I agree that ETI is the definitive airway control BUT that is NOT necessarily the best airway management for the patient IF the person performing laryngoscopy is inexperienced. I agree with RedCell, that the best practice is for nurses to learn and practice effective BVM technique. Even experienced providers should continue to practice and maintain skills in the BLS airway.

[TiredMD]

Intubating is easy. My 8yo could intubate 80% of America. Blade in, lift up, drop tube, inflate. No big deal.

The hard part is learning who (and who not) to intubate and when.

[PageRespiratory!]

Intubating is easy. My 8yo could intubate 80% of America. Blade in, lift up, drop tube, inflate. No big deal.

>

Again, a ridiculous statement....

The hard part is learning who (and who not) to intubate and when.

>

....followed by a good point.

[newohiorn, BSN, RN, EMT-P]

GilaRN: True, EMTs do work off of established protocols...it just amazes me how much more indepence they have--necessarily so, of course.

Rio: We were required to have 4 or 6 live intubations in OR (I can't remember) but that was only as a medic. Our EMT basic required none but we were still trained and allowed to intubate. I don't even think all medic programs require live intubation in the training or can find an OR/anesthesia group that will allow them to do so. Some of the anesthesiologists were nice about it--others were complete jerks.

[GilaRRT]

I am not even going to touch the subject of Basic EMT's intubating...

I guess independence is a very subjective concept. I know ICU/CCU nurses that care for cardiac cripples on a regular basis. These patients are on balloon pumps, multiple drips, and have multiple invasive lines. These nurses are titrating meds and settings all day long. Very independent if you ask me. In addition, a good ER will have standing orders or protocols in place so nurses can take proactive steps and perform interventions on specific sets of patients. (Chest pain for example.) Again, it takes inependent thinking on the nurses part to properly deliver these guidelines.

[TiredMD]

Again, a ridiculous statement....

Not really. It's usually really easy: lift and shove.

The problem is that when it's hard, you can't stop and go take ten minutes to find someone else to try.

[suanna]

My ACLS instructor quoted the statistic that a person should intubate at least 100 people per year to be considered proficient. I hope I don't ever have enough patients go down the tubes to make me proficient. It isn't that nurses aren't allowed to intubate, it is just the best policy to have only expert/trained persons preforming this proceedure. When I have a patient in that much respitatory disrtess I have plenty to do without the added responsibility of intubating.- although there have been a few times when I wanted to snatch the tube from the resident on his 3rd or 4th attempt and show him/her how it's done.

[GilaRRT]

Not really. It's usually really easy: lift and shove.

The problem is that when it's hard, you can't stop and go take ten minutes to find someone else to try.

Then it is not so easy. You see, once you push your NMBA of choice, you have crossed the airway Rubicon so to speak. You essentially have three outcomes: First, a tube in the trachea. Second, gork for life. Finally, "the clean kill." The last two are primary indicators that I may need to consider going bankrupt in a hurry.

[TiredMD]

Then it is not so easy. You see, once you push your NMBA of choice, you have crossed the airway Rubicon so to speak. You essentially have three outcomes: First, a tube in the trachea. Second, gork for life. Finally, "the clean kill." The last two are primary indicators that I may need to consider going bankrupt in a hurry.

I keep a scalpel in my pocket at all times for any emergency trach that comes up. Sometimes I use my pen just for dramatic effect.

Kidding. No more intubations for me. The day I have to tube anyone is the day I get to clean up a corpse.

[PageRespiratory!]

Then it is not so easy. You see, once you push your NMBA of choice, you have crossed the airway Rubicon so to speak. You essentially have three outcomes: First, a tube in the trachea. Second, gork for life. Finally, "the clean kill." The last two are primary indicators that I may need to consider going bankrupt in a hurry.

>

Heh, heh.....paralytics are for wimps.

[GilaRRT]

I keep a scalpel in my pocket at all times for any emergency trach that comes up. Sometimes I use my pen just for dramatic effect.

Kidding. No more intubations for me. The day I have to tube anyone is the day I get to clean up a corpse.

That's pretty funny. It's all about the drama.

Yeah, I am a wimp.

[Dinith88]

Intubating a dude...