RNs intubating

nowplayingEDRN · Sep 1, 2003

At our facility the only RNs that can intubate are the CRNAs...however, we are all taught intubation techniques in ACLS with the knowledge that if there is no MD or Anesthesia provider available.....guess who is gonna intubate. They also teach intubation in TNCC.....and interestingly enough, they frown on the RN intubating and yet my mega-trauma situation that I was given would not let me get beyond the airway....telling me that it was unstable......so I asked if I has intubation equipment available and they said yes.....so I said if there was no doc, sugeon or anesthesia provider available to help hen I would intubate to secure the air way so that the remainder of the assesment/care could be done......they said the hell you are and I said Honey, on my shift no one is dying because of an unstable air way and if I am the only person between that patient having a patent air way or his/her death you can bet your sweet ass that I am going to intubate and worry about the legal ramifications after I save them. She then let me proceed beyond the airway and when she passed me the instructor said...You have bigger kahunas that I do...I'll give you that....you are one ballsy nurse.

Soooo........that is how the cookie crumbles where I am. Hope this answers your question a bit.

gotosleep · Sep 1, 2003

Originally posted by UntamedSpirit
At our facility the only RNs that can intubate are the CRNAs...however, we are all taught intubation techniques in ACLS with the knowledge that if there is no MD or Anesthesia provider available.....guess who is gonna intubate. They also teach intubation in TNCC.....and interestingly enough, they frown on the RN intubating and yet my mega-trauma situation that I was given would not let me get beyond the airway....telling me that it was unstable......so I asked if I has intubation equipment available and they said yes.....so I said if there was no doc, sugeon or anesthesia provider available to help hen I would intubate to secure the air way so that the remainder of the assesment/care could be done......they said the hell you are and I said Honey, on my shift no one is dying because of an unstable air way and if I am the only person between that patient having a patent air way or his/her death you can bet your sweet ass that I am going to intubate and worry about the legal ramifications after I save them. She then let me proceed beyond the airway and when she passed me the instructor said...You have bigger kahunas that I do...I'll give you that....you are one ballsy nurse.
Soooo........that is how the cookie crumbles where I am. Hope this answers your question a bit.

You do not need to intubate someone to ensure an adequate airway. This is a major misconception among medical professionals. A bag-valve mask with or without an oral airway generally will suffice. Intubating is a skill that requires intensive instruction and continuing education and practice. There is a lot of liability associated with this procedure and the failure rate is fairly high among the inexperienced. So don't do it unless you are credentialed.

Just my thoughts....

RNMBA · Sep 1, 2003

I agree with gotosleep. Very basic concepts of intubation are "taught" in many life support classes. That instruction is not in any way adequate to ensure proper technique and safe practice. We have all seen MD's and CRNA's have difficulty intubating at times so imagine the trouble a neophyte would have in the same situation.

In my opinion, RN's intubating is the same as having a nursing assistant making vent changes. Anyone can learn how to push the buttons but it takes training and practice to push the right buttons at the right time.

Over the last 10 years I have been in several situation where faster intubation would have been nice but I'm not stepping over that line until I have CRNA behind my name. Besides, there should never be a situation where an RN is forced to make that decision. All hospitals should have qualified staff rapidly available for that type of crisis.

TraumaNurse · Sep 4, 2003

I agree too. However, the other group of RN's that intubate are Flight Nurses. As a former flight nurse, I have intubated many people in the ICU (with MDs present) when I got the chance (no resident around that needed the experience first). I was also able to do this because the docs knew me well as an ICU nurse and flight nurse. Since I have left that hospital, I have not intubated anyone. I am looking forward to learning the skills of advanced airway management as a CRNA (I start my program in the coming year).

Dave ARNP · Sep 27, 2003

Additionally, as an Acute Care Nurse Practitioner, I intubate people.

Not one of my favorite things to do... but I do it.

David Adams, ARNP

-ACNP, FNP

EastCoast · Sep 27, 2003

Nursey Person,

Like david i too am required to intubate. Generally several times in a week. It was/is an expectation by boss didn't take lightly and neither should yours. I received signifcant training including an anesthesia rotation and formal class work. It cost the hosptial a ton of money that my boss feels was worth every dime.

It is not enough to intubate a dummy. It is the technique of learning 'airway management' that will save your butt in a difficult situation. Not every airway is accessible with a ETT and anyone who has stood at the head of the bed knows this. Learning to use a BMV corretly will save you 9 times out of 10.

I would strongly advise that if your institution demands this that at the very LEAST you attend a intense workshop called by titled 'the difficult airway'. (http://www.theairwaysite.com). It is run by a variety of professionals who are skilled in training. It is also alot of fun and you will have a new respect for the person intubating and the airway. Intubating is more than sticking a tube down someones throat. It involves evaluation and even deciding what drugs to give if needed. Also, how are you going to decide on the right vent settings?? ANd what do you do when you have a failed airway?????

This sounds very risky. I would find out if anesthesia is available. As well I would rather see a trained respiratory therapist doing this before an RN who passed ACLS. Before you touch a #3 mac blade know excatly the liablity involved.

In short: It doesn't matter if it is a 109 year old with near brain death with no limbs and minimal chance of survival...if you intubate their esophagus and they die...it's considered an 'avoidable death'. Let the hospital hire a PA/NP/RT or a resident to cover such things. Don't let the hospitals frugalness cost you your license.

Teach your manager how to do her job...have her/him speak to Risk Management and let them do the internet search.

LilgirlRN, ADN, RN · Sep 27, 2003

NICU nurses also often intubate their babies. It would be very hard for me as an ACLS provider to stand by and watch someone die because the airway couldn't be established. Ambu bags are great but say a patient has facial trauma and you can't get a good seal. I am lucky, as an ED nurse, I am never without a doc. If it were me and they were trying to tell me I had to intubate people, I would find another job. Your license is on the line here, ACLS may cover your butt for the intubation, but if chose the wrong vent settings etcetc. Good luck.

EastCoast · Sep 27, 2003

hi lilgirl, general question: does ACLS cert. make one qualified to intubate? i do not know the answer. despite my cert and previous instructorship i never felt that i was or should be the one to intubate, except as you mention in an extreme situation when standing by is not an option, and thankfully this never happened to me.

gotosleep · Sep 27, 2003

Originally posted by EastCoast
hi lilgirl, general question: does ACLS cert. make one qualified to intubate? i do not know the answer. despite my cert and previous instructorship i never felt that i was or should be the one to intubate, except as you mention in an extreme situation when standing by is not an option, and thankfully this never happened to me.

no..absolutely not. I am a ACLS instructor and anesthesia student. In fact, I teach the airway section of ACLS. The airway instruction of ACLS is designed as an "exposure" to airway management. You are in no way authorized to intubate simply because you took ACLS. I agree with EastCost 100%...nice post.

EastCoast · Sep 27, 2003

gotosleep,

that's what i figured. now that i've gone through airway training and gained exposure i am thankful i never was put in a tenuous situation before i was ready. i do remember as a bedside nurse in critical care during the episodes of repeated attempts thinking to myself (and sometimes mumbling to a colleague) 'geez, could you just get the patient intubated already...what the heck is the hold up'. it was humbling and scarey the first time i stood at the head of the bed and had expectant faces looking up at me. as a matter of fact no matter how many times i've intubated each time still brings some degree of worry that it will be a difficult airway. it's taught me to always have plan B.

however, rethinking this original post i also do not know why a supervisor would expect that it would be okay to add this burden of truly advanced procedure to a nurses responsiblity.

RNCENCCRNNREMTP · Sep 28, 2003

The only time an RN should be intubating is if:

1 - They are trained to do it (ACLS does not train you to intubate in any way, shape or form. It at best will make you a better assistant for the person doing the intubating. Same for PALS Speaking as an instructor for both)

2 - Your job allows/expects you to do it.

I am an RN but also a Paramedic and am allowed under my dual title to intubate in the hospital. If I ever lost my medic license (God forbid) I would no longer be able to intubate legally even though I would still have the competency and experience to do so.

Intubating is a fun and rewarding skill but a skill that takes practice and dedication to learning the little tips/tricks and nuances of not only when to intubate but also when not to (especially if needing to paralyze to do it).