PACU airways

Perpetual Student · Jan 20, 2012

In the 3 PACUs I've had experience in it was common for at least some patients to come back with airways in. I don't really see the point in even having a PACU if you're not going to take patients who need airway support. I actually prefer when my patients come out asleep with an airway. It gives me more time to connect to the monitors, get my paperwork in order, and assess the patient before running for drugs. Removing an oral/nasal airway or LMA is just about the easiest thing we do all day.

An ETT is bit more involved, but it's still a breeze. That said, an anesthesiologist or CRNA should be around still (in the general periop area) in case the patient requires reintubation. PACU RNs should be competent in placing basic airway adjuncts like oral and nasal airways and have the supplies @ the bedside.

meandragonbrett · Jan 20, 2012

Yes, ETT and LMAs roll in the door all the time. RNs remove when criteria is met.

GHGoonette, BSN, RN · Jan 20, 2012

Yes, ETs, LMAs, Guedal. Of the 3, the ET is the safest. I prefer extubating the patient myself, especially if the surgeon's running a long list; situations like that can cause the anaesthesia provider to pull the tube too quickly, and we end up with an apnoeic patient in PACU with no tube in place to ventilate. Pain in the butt. Most of our anaesthetists know better than to extubate though.

nf nurse · Jan 20, 2012

Thank you so much for the input, I agree with you all. I needed this info to back up what I already knew. Thanks again!!

brownbook · Jan 21, 2012

Okay, I may be comparing apples to oranges. I currently work out patient surgery (I have worked main OR PACU and ICU.)

99% of our patients come out from OR easy to arouse. I know out patient surgeries are "lighter" than a main OR but my gut feeling is a good anesthesiologist can control the sedation/anesthesia effect to coincide with the surgeries start and finish.

If a patient comes out with an airway the anesthesiologists stays with the patient. We used to have a great, nice, "older" anesthesiologists who's patients almost always came out with an airway. The "young" newer generation of anesthesiologists rarely have that happen.

nursedejuan · Mar 16, 2012

Okay, I may be comparing apples to oranges. I currently work out patient surgery (I have worked main OR PACU and ICU.)
99% of our patients come out from OR easy to arouse. I know out patient surgeries are "lighter" than a main OR but my gut feeling is a good anesthesiologist can control the sedation/anesthesia effect to coincide with the surgeries start and finish.
If a patient comes out with an airway the anesthesiologists stays with the patient. We used to have a great, nice, "older" anesthesiologists who's patients almost always came out with an airway. The "young" newer generation of anesthesiologists rarely have that happen.

ours is the same way. Alot of the younger CRNAs will keep there patients in OR until they are extubated then they might still have a oral airyway in place...

I think alot of that is laziness!!!