nurses intubating newborns

jkpowell23 · Jan 31, 2011

At our hospital, RN's do intubate newborns. They prefer the RT to do it, or the MD or NNP, but they do do it. Our transport team usually consists of a RN and RT. They were discussing it with the neonatologist in our NRP class the other day. (I work mother/baby/gyn, NOT NICU).

Music in My Heart · Jan 31, 2011

The NICU at Sutter Memorial Hospital in Sacramento has specially trained nurses who routinely do the intubations and umbilical lines; vanilla RNs, not APNs.

klone, MSN, 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.

Just wanted to say that it's been my experience as well, that the transport RNs have a helluva lot of experience with intubating newborns, putting in UVCs, etc, and are often better at it than the peds, RTs and anesthesia as well. A lot of it depends on where you are - where I came from, this was a small town in central AZ, hundreds of miles from a level III, and these transport RNs HAD to be good at what they did.

Further, most anesthesiologists, while they do put in airways on a regular basis, rarely do it on neonates. CRNAs - when's the last time you used a 2.5?

CCL RN, RN · Jan 31, 2011

I don't think I've ever seen a CRNA intubate a neonate, come to think of it. But then again, CRNAs are few and far between. I work in a teaching facility, so we rarely use them at all.

BabyLady, 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.

At our facility, RN's are never checked off for intubations...ever.

The only ones that are, work on transport teams and even then, you are with an RT, who will do it first.

Now, in that rare circumstance that there is a bona fide emergency, an NNP or MD is not available (b/c the one assigned may be on a delivery as well) and let's say that the RT that is assigned to your unit is also on a delivery, and a nurse from the transport team is not staffing that day, the most SENIOR nurse that is present attempts the intubation.

Now, you will NEVER find a nurse on our unit that will call a CRNA to intubate an infant..ever.

We intubate all of our kiddos prior to sending them to surgery...CRNA never does it.

The reason: CRNAs, for the most part (not all), do not seem to have a true appreciation for this particular patient population and will attempt multiple intubations if they fail (rather than allowing someone else to try) with the "I am a CRNA, and I can get this myself" mentality.

The reason for the decision, at least at our hospital...is that this has happened more than once and with more than one CRNA...intubations with 14, 15 attempts..with the RN begging the CRNA to call someone else...and he/she refusing....permanently damaged vocal cords, horrific gashes to the interiors of the mouth, huge slices to the gums or deep depressions.

You see that a few times and nope..you don't call the CRNA anymore.

umcRN, BSN, RN · Jan 31, 2011

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.

They are certified to place lines on our unit (they don't do it prior to transport), if they are not on transport they are on the unit, placing lines, changing line dressings, we have a 60bed unit and usually more than one or two kids needs lines at once, the more trained hands the better. We also have staff RN's trained to place PICCS. And yes, they (transport RN) can needle aspirate chests and assist with chest tube placement...I actually saw this done a few weeks ago, fellow needling one side, transport RN needling the other...And our transport RN's go on multiple transports a day, not only for the NICU but also the pedi cardiac ICU, any infant that is coming to the hospital gets picked up, usually, by the NICU transport team, so it is not a once a month kind of thing

I should also mention that our transport RN's are nurses with at least 5 years NICU experience, they have an intensive 6 month training program and are at that point no longer "staff" nurses but are transport nurses, unless they pick up extra at bedside they do not have an assignment when they work, they are there to go on transport, place lines, change line dressings, help with taking babies to/from surgery/mri/fluroscopy etc. And they do ALOT of line placement when they are not out in transport, most of the docs recognize that they are usually very good at it and will have them give it a try first if they are not out.

**canoehead, BSN, RN** · Jan 31, 2011

Babylady- I've seen that myself. At a small rural hospital with a NICU team on the way, and 4 CRNA's attempting more than 50 times over 3 hours. The laryngoscope was coming out with blood on it after 90 minutes....they wouldn't stop. The anesthesiologist was right there, so no one to call that had the authority or the inclination to stop it. OF COURSE once the NICU team got there the airway was too swollen and bloody to see anything. The RN called the NICU, and a neonatologist came up by private car. They didn't even stop to wait for him. It was a redneck firedrill, and I wanted to dropkick every one of them.

Katie5 · Jan 31, 2011

Originally Posted by tablefor9

RN

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.

CRNA

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.

RN

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.

Etcetera etcetera... Herein lies the reason:(