Nurse-led weaning of ventilation

[p3ad3br1t13hukward02]

I'm a staff nurse on a busy Paediatric Intensive Care Unit (UK) and am currently looking into the practicalities of introducing Nurse-led Weaning of Ventilation.

I would appreciate any advice / guidance from individuals who have been involved in such an initiative regarding the difficulties they encountered and how the weaning of ventilation was undertaken

i.e. was there any restriction on which nurses performed this extended role,

was the weaning performed according to guidelines / protocols or was it down to the nurses initiative to wean appropriately for that patient,

and what training / teaching did the staff members undergo prior to undertake this role.

I would welcome any and all assistance in these matters

[ECMOismygame]

I'm a staff nurse on a busy Paediatric Intensive Care Unit (UK) and am currently looking into the practicalities of introducing Nurse-led Weaning of Ventilation.

I would appreciate any advice / guidance from individuals who have been involved in such an initiative regarding the difficulties they encountered and how the weaning of ventilation was undertaken

i.e. was there any restriction on which nurses performed this extended role,

was the weaning performed according to guidelines / protocols or was it down to the nurses initiative to wean appropriately for that patient,

and what training / teaching did the staff members undergo prior to undertake this role.

I would welcome any and all assistance in these matters

no answers to this post....

well in the US and Canada, respiratory therapists take care of the vents in the ICUs. many places in the US only allow MDs and NP/PAs to wean patients off of the vents and to order vent changes. there are some more progressive hospitals in the US where the RTs can make changes, although with the use of protocols.

just a student though

[AliRae]

It depends on which attending is on for us and also how sick the kid is. Certain docs, if they trust you, will give you more free rein to wean. Usually we'll discuss it at rounds, and work kind of a rough game plan, provided it's not a kid in severe ARDS or anything. But, for example, the kiddos who get WAY too much ativan when they're in status and have to get intubated until they wake up? They'll let us roll with that. Usually they'll just say to get them down to a rate of 8 or 6 and then let them know when the kid is ready to go on CPAP. Something like that. With kiddos on really high settings (drownings and things) we don't make any changes other than FiO2 on our own. FiO2 is pretty much always up to us to monkey with, but they'll give us a sat they want to stay above.

[slcpicu]

We are allowed to wean vent for certain set parameters. Say wean toward a rate of 10 for a ph greater than 7.25 without metabolic acidosis. But most of the weaning is done by the RRT with our input. So, with orders like those we can wean toward extubation fairly quickly. Also, as stated earlier those orders are attending and fellow perference. But can be done and is much easier than calling every time you get a gas when you already know that you can drop the rate. Hope that helps!!

[bbluvnursing, RN]

The RT's generally do most of the weaning per physician order, but some of the veteran RN's seem to have more freedom/confidence in weaning the patient from the vent on my unit.