nurses intubating newborns

GHGoonette, BSN, RN · Jan 30, 2011

Do any hospitals allow nursery/nicu staff nurses, (not nnp's) to intubate newborns for meconium deliveries?

I shouldn't imagine that would be within their scope of practice; however, in an emergency situation, and in the absence of a paediatrician, it may be allowable for a competent, experienced nurse to intubate, if the baby will not survive without being intubated.

I'll be very interested to see what responses you get from the NICU nurses. My observations of paediatric intubations is that they are frequently difficult, and the smaller the patient, the more difficult the intubation.

tablefor9, RN · Jan 30, 2011

Have seen it done by transport team RNs. Will not comment on scope of practice issues, will only say that I have seen it done and that they did a better job than most of our RTs and anesthesia folks.

TiffyRN, BSN, PhD · Jan 30, 2011

The NICU where I work allows RN's to intubate, but most intubations are done by RT's, NNP's or MD's. Very few RN's are checked off on it and I don't know if they are allowing new RN's get checked off on it. All the intubater RN's have been there for years. They generally intubate within the unit, but I imagine if they attended a delivery and there was not an RT, NNP or MD present they could intubate (for meconium or resp issues).

NICU_babyRN, BSN, RN · Jan 30, 2011

It is, as far as I know way out of our scope unless there is NO ONE, including a paramedic able to intubate and there is an emergent need. RNs do NOT intubate in my unit. However I do believe some transport team RNs in some hospitals have been certified to be able to do so.

GilaRRT · Jan 30, 2011

To be clear, we are not talking about every meconium delivery?

CRNA1982 · Jan 31, 2011

Have seen it done by transport team RNs. Will not comment on scope of practice issues, will only say that I have seen it done and that they did a better job than most of our RTs and anesthesia folks.

Really? With all due respect, I find it hard to believe that a transport team RN can tube a patient more proficiently than a CRNA/MDA. Intubating is a skill, just like starting an IV. The more you do, the better you become at it. If you are not intubating multiple people on a daily basis (And I find it really hard to believe that transport RN's are) then you simply cannot be as proficient as an anesthesia provider at managing an airway. This includes tubing newborns emergently as well as 430 pound pts. presenting for laparoscopic gastric sleeves; all of which are not uncommon during an average day for an anesthetist.

umcRN, BSN, RN · Jan 31, 2011

Really? With all due respect, I find it hard to believe that a transport team RN can tube a patient more proficiently than a CRNA/MDA. Intubating is a skill, just like starting an IV. The more you do, the better you become at it. If you are not intubating multiple people on a daily basis (And I find it really hard to believe that transport RN's are) then you simply cannot be as proficient as an anesthesia provider at managing an airway. This includes tubing newborns emergently as well as 430 pound pts. presenting for laparoscopic gastric sleeves; all of which are not uncommon during an average day for an anesthetist.

I work in a level IIIc NICU in a childrens hospital so all our babies are transported in, by our NICU Transport RN's. Those nurses can intubate, place lines (PICCS/UVC's/UAC's/Pals). They are very good at what they do, we never have anesthesia in the nicu, all our intubations are typically done by fellows, the occasional resident who has been given permission to try by their overseeing fellow, or transport RN's. I have also seen a once transport RN intubate when no one could get it in the kid.

platon20 · Jan 31, 2011

I work in a level IIIc NICU in a childrens hospital so all our babies are transported in, by our NICU Transport RN's. Those nurses can intubate, place lines (PICCS/UVC's/UAC's/Pals). They are very good at what they do, we never have anesthesia in the nicu, all our intubations are typically done by fellows, the occasional resident who has been given permission to try by their overseeing fellow, or transport RN's. I have also seen a once transport RN intubate when no one could get it in the kid.

I could see the occassional transport RN intubation, but transport RNs doing PICCs? Thats ridiculous. Do they do chest tubes too?

The transport RN's job is to stabilize infants for TRANSPORT, not to screw around w/ PICC lines. If they are holding up the transport to the NICU so they can put in PICC lines then they are providing poor quality care. A PICC line is NEVER an emergent issue that has to be dealt with during transport.

Our level III NICU has residents and fellows that do 99% of all intubations, PICCs, UVCs, UACs, chest tubes. Its rare that a transport RN does an intubation, but I've seen it happen once or twice when the baby somehow gets extubated during transport. But those situations are few and far between. Frankly someobdy that only does 1 intubation every few months is not qualified to do them. You need an experienced provider to do so.

tablefor9, RN · Jan 31, 2011

Look, I'm not taking potshots at anesthesia folks or RTs...work with them daily, respect them, yada-yada-yada...but how much practice, outside of a facility with a level III NICU, does the average CRNA or RT get in tubing newborns???

Transport RNs from a regional referral center may very well tube frequently, in pickups from outlying facilities.

Hate it that it seems to scrape the ego, and I certainly didn't start the practice, but I stand by what I posted as an accurate representation of what happens in my neck of the woods.

Ayeloflo · Jan 31, 2011

"Intubating is a skill, just like starting an IV"

This is true, CRNA1982. If you can't get it in, seize the next opportunity to intubate. In ACLS class it was very hard to hold the tools at the perfect angle in order to intubate. If at first you don't succeed, find out why and try again next time the opportunity comes. Practise, practise, practise

CCL RN, RN · Jan 31, 2011

I work per diem with a Transport RN and she intubates neonates frequently-and quite successfully to boot :)

Yep. A regular ol' RN.