Latest Comments by respstudent

respstudent 850 Views

Joined: Sep 3, '11; Posts: 11 (55% Liked) ; Likes: 12
Respiratory Care; from US

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  • 2
    eagle78 and Here.I.Stand like this.

    As a practicing RRT with experience dealing with ARDS patients, this is absolutely NOT appropriate. If the patient was being ventilated in APRV or BiVent, disconnecting the patient from the ventilator should be done only emergently and the tube needs to be clamped with a hemostat to ensure that de-recruitment doesn't happen. Then again, the same can be said for a patient in PC using the ARDSNet protocol.

    I have never, ever, ever, ever, ever, ever disconnected a patient or deflated a cuff for a CXR on any vented patient.

  • 0

    If the patient is DNR and CMO/CCO why is the patient getting transfused? I'm not sure the blame for the failure should be entirely yours either. Was the Hb part of routine laboratory work or did it come from an ABG? In the case of the former the lab really should have called you to alert you to the critical value and in the case of the latter the RT or the blood gas lab should have called.

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    I know this is an old thread, but maybe the response will be useful for the future.

    1. The starting pay depends on where you're located and what facility you're employed at. In my area the pay for a hospital based therapist with the RRT credential varies from 18.50/hour at a publicly-funded children's hospital to 28.50 an hour at a private not-for-profit. This translates to 40,000-50,000 as a first year salary, not including overtime. Some states have starting salaries in the 60's, but they're also states with much higher costs of living.

    2. Avoid California and Georgia. You'll have better employment prospects if you work in the area you went to school in.

    3. Large academic/teaching hospitals tend to see procedures like intubuation and line placement left to residents. It varies by facility.

    4. You can sometimes arrange to volunteer or shadow in a respiratory department. Nursing assistant experience isn't really very helpful for a career as an RT, although you will benefit from learning to listen to breath sounds and check vitals.

    5. I'm not familiar with many accelerated first-professional RT degree programs; I think Concord Career college offers a program that can be done in 17 months. IIRC the Concorde student I talked to during one of my early rotations was paying somewhere north of $40,000 per year (around 60k total). I paid under 10k at a community college and was done in 22 months.

    Don't let the generally poor opinion of respiratory therapists on AllNurses get you down, we gripe about each other all the time, but we're elbow to elbow when it matters.

    The profession is working on increasing therapist scope of practice, exclusive licensure, and advanced practice opportunities; it's a pretty good time to be a therapist.

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    If it makes you feel any better, respiratory therapists have to wait between 1-3 weeks in Florida for the license application to be processed. We do have the comfort of knowing, after an agonizing 5 minute examination experience survey, whether or not we passed our boards. RNs get licensed automatically in comparison to RTs in Florida.

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    Quote from SoldierNurse22
    Right...I get that you guys do ABGs and that sort of thing as well, but that's at least related to RT. PICC line insertion...not so much.
    My conversation was meant to be humorous, although we did actually have a former director of nursing take a bunch of our procedures and protocols and re-assign them to nursing based on a similar argument.

    I do agree that RTs doing PICC and central line placement in general is unusual, and I personally don't want to have to deal with them. I have enough on my plate without having to worry about becoming skilled at yet another procedure with its own host of complications.

    It's not like I have time to learn PICC placement or much about IV therapy with all the Q4 nebs these residents are ordering all the time.

  • 0

    Quote from SoldierNurse22
    I guess I don't understand why you'd pick respiratory to do a vascular procedure. It's not so much that they can't do it, but anyone can learn a skill.
    We already do ABGs and, in many places, arterial lines. We're not actually taught to look at our patients as a walking heart/lung with other stuff attached that we know nothing about.

    RTs have a pretty good understanding of the cardiovascular system in general, infection control, and haemodynamics, so if you had to pick another allied health professional to do PICCs aside from an RN an RT is a pretty good choice.

    Sometimes nurses seem to think "holistic approach" is a trump card that they are uniquely placed to play.

    "Hey, so nursing wants to take over IABP management from RT."
    "Why?"
    "The nursing manager says their holistic approach to patient care makes them more qualified."
    "What's next? Are they going to try and take ECMO too?"
    "Don't say that out loud. Nurses are everywhere, and they'll get ideas."

  • 1
    Esme12 likes this.

    Quote from Esme12
    I don't think it unsafe either....I would think it helpful as an adjunct......but should never precede their responsibility of intubation, Rapid Response, vents...etc
    Oh, goodness, no! I didn't become a respiratory therapist because I wanted to insert PICC lines. I wouldn't want PICCs to be the only thing I did, but if a manager made it clear that being credential to work as part of the PICC team meant I got more shifts or wasn't furloughed as often, I would certainly give it some though.

  • 1
    Esme12 likes this.

    Quote from Esme12

    As a nurse in a critical care area for 35 years.......I have worked with RRTs that I could not be without them as a member of the team. My issue with resp therapy inserting PICC lines is that they have other focus to their practice and IV therapy should not have to be one of them....they have enough to do.
    I certainly agree that most RRTs have more than enough to do without having IV therapy added to their list of responsibilities; however, if it makes sense for a particular facility to train and credential an RRT to do PICC lines, I don't think it's inherently unsafe for an RRT to do that.

    My point in responding to Lindarn's post was chiefly that I disagreed with her caricature of the RRT skillset and educational process and that scope of practice varies from facility to facility for all of us.

  • 3
    iluvivt, damrcngrl95, and Esme12 like this.

    Linda,

    Scope of practice can vary considerably by state and facility. I placed arterial lines while still a student. It is also very common for RRT's to manage IABP and ECMO once trained for the modalities, and placing indwelling arterial line is certainly within our scope of practice. At most facilities I have interned at and worked at Nurses are not allowed to place arterial lines, perform arterial puncture, or interpret blood gasses.

    We've been hearing that RN's will take over respiratory care for decades. My father heard the rumor when he was an RT starting in the late 70's, and again when he was one of the first RRTs in the country. It has never happened, and it will never happen. Nursing and Respiratory Care are two distinct fields of practice with distinct education and scope. Nursing still hasn't managed to take over respiratory care.

    You have a very interesting perspective on RRT competency and education, and it seems to be exceptionally flawed. You took nursing courses, which prepared you to be a nurse. That's excellent. You did not take courses designed for respiratory therapists which had the depth required to understand cardiopulmonary A&P or pathophysiology or ventilation like an RT did.

    The A&P course required for nursing students at the college I attended was specially designed for them, because nursing pass rates on the standard courses were too poor; it was widely regarded as having less rigor than the standard two semester A&P sequence that everyone else (including dental hygiene students) had to take. The same with nursing pharm. We had to take a general pharmacology course and a course specifically for respiratory pharmacology. More depth more rigor. I tutored many nursing students through their pharmacology with my supposedly less rigorous education.

    I've met plenty of experienced RNs who want me to give more albuterol to their fluid-overloaded CHF patients with no evidence of bronchospasm. I've met plenty of experienced RNs who push far too much fluid and cause fluid overload. I've met plenty of RNs that overbag patients with pulmonary emboli because they don't know to look for spontaneous breathing and can't assess a patient quickly to figure out whether or not they're becoming fatigued. I've met plenty of RNs who cant use an inline suction catheter correctly, much less an open suction system. I've met plenty of RNs who don't know the first thing about properly managing a chest tube.

    For every story you have about the mythical "lazy RT" I have one about the mythical "clueless nurse" that I've had to spend time with physicians cleaning up after. There are people in both professions who are not actually very good at what they do at the worst or are simply lazy at best.

    I work with nurses every day who learn new things fro me and I from them. I work with experienced nurses who are happy when I come to assess their patient and troubleshoot their chest tube or ventilator or evaluate their ability to clear secretions. Why are these nurses happy to see me instead of bodily shoving my poorly-educated incompetent self out of their patient's room? Because I'm a highly skilled professional who has been educated, trained, credentialed, and licensed to manage the airways of their patient who very much needs my services.

    I am eminently grateful that I work with nurses who are capable of recognizing that they are part of the team. I am grateful that they recognize there are limits to their education, scope, and experience. I'm grateful that they're willing to let me show them how to bag a patient appropriately and that they'll kindly "let" me manage the airway I'm licensed to manage when things go south. These nurses care about their patients and not professional siloing and breastbeating.

  • 2
    Hbpenney and chare like this.

    I'm always amazed at the disdain some nurses show for respiratory therapists. Thankfully, it's the kind of disdain I've only ever encountered on the Internet, and it's usually about therapists who want to expand their scope of practice. How dare a lowly respiratory therapist express a desire to expand the scope of practice for his or her profession? Only nurses get to do that!

    And, I'm sorry, but anyone who says that RT education is like remedial education compared to ADN education either went to a poorly managed for-profit RT program or didn't pay attention very well in school. The sheer amount of detail we go into regarding cardiopulmonary A&P, renal physiology, gas and fluid dynamics, respiratory pharmacology, and ventilation makes most nursing students cringe.

    We're trained to specialize in cardiopulmonary diseases, disorders, and modalities of treatment. Yes, inserting central lines requires additional training, but to say that a respiratory therapist isn't qualified to the task after that training is risible at best. I can place an indwelling arterial catheter but somehow learning how to place central lines is beyond my ken?

    I understand you don't like loosing tasks and procedures that, as a profession, impacts your value to your hospital; I don't either, and I fought just as hard when nursing tried to take balloon pump management, asthma and COPD education, and the ability to initiate lung expansion therapies (like IS) from respiratory care at my hospital.

    However, I managed to do that without denigrating nursing as a profession or disparaging nursing education just because nurses wanted to expand their scope of practice at this particular facility.

    It's a shame that some nurses see the need to take the low ground and run around banging pots about how nurses are going to be replaced and yell about the sky falling just because another allied health profession is making reasonable expansion to its scope of practice at hospitals in some states.

  • 3

    Quote from paulwalkman
    Thank you for that last mention. Since PaO2 is assumed during routine testing, how would it specifically be tested? Does an arterial blood sample need to be taken to get the ABGs? Early in my career I had a jerk doctor ask me 10 minutes after he wrote an order to put a pt on 3L O2 because her PulseOx was 88ish. I told him the PulseOx and he repeated 3 times successively louder each time "what is the PaO2!!?" I asked "if labs had to be drawn and he yelled back, "No, You go tell me what it is...NOW!" I had to get the charge nurse to talk to him. I just never thought to ask again.
    Paul,

    ABG = Arterial Blood Gas. You most definitely need arterial blood to get an ABG. You can maybe make some inferences from a venous blood sample if you jab it by mistake. However, it's not a great idea to do that with a critical patient.

    You cannot measure SaO2 with a pulse oximeter. Pulse Oximeters measure SpO2 or the saturation of oxygen measured by pulse oximeter. Sp02 generally hovers within 1-2% of SaO2, but in cases where a patient has high carboxy-hemoglobin the SpO2 will include CO-Hb as well as O2-Hb. Always, always get an ABG (with Co-Oximetry if your facility requires a special order for that) if you suspect CO poisoning.

    PaO2 is the measurement of the O2 that is 'free' in the plasma and not bound to Hb. PA02 is the pressure of alveolar O2 and is one of the measures used to assess a patient's oxygenation status.

    If your patient had an SpO2 of 88% 3LPM via nasal canula would probably bring the patient's SpO2 up into the 90's.

    I don't know if it's common for nurses to draw ABGs... I've never heard of a nurse drawing an ABG because they can't interpret them.

    Next time a doctor yells for a PaO2 (depending on your hospital policy) make sure the doctor orders a stat ABG and call respiratory... unless your state allows nurses to draw, run, and interpret ABGs. In my state I would be scared if that were the case as I've met many nurses who confuse SpO2 with SaO2.



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