Portable Chest XRay protocol

[icuRNmaggie, BSN, RN]

Imaging nurses,

I need your expertise and advice to deal with a recent incident in the MICU. A CT tech was doing the routine am PCXR on an intubated pt in ARDS who was on maximum ventilatory support, 100% Fi02 and high PEEP.

This CT person had a respiratory therapist put on lead and told her to deflate the ETT cuff and take him off the ventilator so that he could get a "clear picture." I voiced my concerns and the tech went it to such a rage that I was afraid for my personal safety.

To the best of my knowledge deflating the ETT cuff allows pooled secretions to go straight into the lungs and stopping the vent on a pt on high PEEP can cause a lung to collapse.

Please advise me if there is any kind of rationale for doing what they did.

Thank you,

Maggie

[icuRNmaggie, BSN, RN]

To my Critical Care colleagues,

Please read my post under Radiology in the Nursing Specialties forum. The situation I described was appalling and I would appreciate your advice.

Thank you,

Maggie

[Esme12, ASN, BSN, RN]

thread merged for best response. Radiology nurses wouldn't have knowledge about CXR protocol per se...they deal with procedures like angios.

Why on earth would they deflate the ETT cuff? Is that guy crazy? Did the RT let him? Taking someone off high PEEP can cause a pneumo and unnecessary oxygen deprivation

Regardless...report his aggressive behavior.

[icuRNmaggie, BSN, RN]

The RT deflated the ETT cuff and disconnected the vent while the CT tech shot the film and the dayshift nurse, whom I thought was a friend, watched from the hall laughing inappropriately ( or nervously) as I was being abused.

Apparently it is customary to do this in this hospital and no one else has a problem with it but me.

[MunoRN, RN]

I don't get the rationale for thinking that's going to produce a better image.

[icuRNmaggie, BSN, RN]

My coworkers either hid under the desk or in their patients' room. One actually chastised me by saying " I don't know what your problem is the man was just trying to do his job." I am not that creative and I could not make this up.

[MunoRN, RN]

I've worked at one place where the nursing culture was pretty cowardly, but never anyplace where the nurses would stay away or avoid getting involved in a situation where a nurse is getting yelled at, it's usually more like what happens to someone who trips and falls in a crowd of zombies, they just sort of disappear as the angry mob engulfs them. What kind of facility is this?

[icuRNmaggie, BSN, RN]

350 bed regional medical center, a non profit

[87RN]

I've never had to disconnect a vent or deflate the cuff for a CXR. Definite pneumo/ aspiration risk. The radiologist should be able to read a CXR on a vented pt, geez! also good to check for proper placement. I would definitely bring this up with your manager as well as radiology dept. Do the ICU docs know about this? I don't understand the rationale either. And shame on your coworkers!

[calivianya, BSN, RN]

Wow, I would not have let him take the X-ray and I would have filed a complaint about his behavior. That is crazy.

[icuRNmaggie, BSN, RN]

Wow, I would not have let him take the X-ray and I would have filed a complaint about his behavior. That is crazy.

As the nurse in charge of the pt, I tried. The entire staff is terrified of this person because of his size and threatening behavior. I just wrote this post to find out if there could possibly be a valid reason for doing what they did.

[shootfromthehip, BSN, RN]

Do they do this for CT as well?! I am flabbergasted.