Non-visualized Airways?

[Zalan]

Hi,

I`m an Emt-b student, & had a question. Can Nurses RN or LPN insert non-visualized airways? I know Docs, Resporatory Therapist, & Emts can do this.

Thanks for any answers.

[ObtundedRN, BSN, RN]

In NC, the nurse practice act allows RNs to intubate as long as the facility has a policy for it and maintains continued competancy. Since there isn't enough tubes to go around for every nurse in the hospital to maintain competancy and it would be hard to track, most places don't allow their nurses to do it. Also, they can get reimbursed for a MD to do it. However, we do have a few RNs in the system that is allowed to intubate, but they are in special areas, like the flight crew, neonates, etc. And besides, in a hospital there are plenty of doctors, mid-level providers, and the select few RTs that are allowed to intubate, that can easily be found to do it for you.

As an RN, I'm more concerned about other things going on during intubation (giving drugs, documentation, making sure things are done properly, and monitoring the patient). After doing it so many times in the field, I no longer find any glamour in it.

[Asystole RN]

In Arizona they can as long as the RN has been trained and educated in it. Typically MDs and to a lesser extent, the RTs.

[GHGoonette, BSN, RN]

King tubes, Comitubes-ok, LMAs I know very well, but I don't recognize the other names. We have a type of LMA called a FasTrack which is designed to allow a reinforced ET tube to be passed through it, so it acts as an introducer. Does this describe what the OP is talking about?

Our RNs are allowed to intubate, provided they have been properly trained, have maintained practice and feel competent to do so. I usually pop into one of the theaters and ask the anaesthetist if he minds me intubating his patient. Hey, the worst he can do is say no... We don't have much in the way of specialized equipment, but we do have the usual range of introducers, and the McCoy Laryngoscope. We haven't persuaded management to let us have one of the fibreoptic ones.

One of the local private hospitals introduced a rule that all staff, from the cleaners up, had to complete a CPR course, and to be trained in the insertion of an LMA. The rationale behind it is, that such a skill could mean the difference between life and death if trained help is not immediately available in an emergency.

As for the usual Guedal airways, I don't think there's a single person in our Recovery Room who doesn't know how to insert one of those.

[GreyGull]

The OP is an EMT-Basic student so the supra/extraglottic devices would probably be his/her options since only a few states allow the EMT-B to do ETI. For the EMT-Basic to perform any of these airways, the patient generally must be "dead" as in CPR needs to be initiated.

I know a couple of flight services (Flight RNs) that use the Fastrack and it is generally in most of the hospital difficult airway carts which can be used by whoever intubates and is trained for many different types of intubation.

The CombiTube probably would not be found on any hospital cart since it contains latex. The King in not a definitive tube but could be used temporarily if there would no other alternative. However, with the complications of that tube which can occur, hopefully the arrival of trained help won't take long. Someone might also be tied up bagging the patient for a long time until ETI can be performed.

But, the LMA and King are decent alternative devices.

I always suggest RNs/RRTs/MDs/EMTs/Paramedics know and understand the use of the BVM which can be used while the correct equipment and personnel are being sought.