I need your expertise and advice to deal with a recent incident in the MICU. A CT tech was doing the routine am PCXR on an intubated pt in ARDS who was on maximum ventilatory support, 100% Fi02 and high PEEP.
This CT person had a respiratory therapist put on lead and told her to deflate the ETT cuff and take him off the ventilator so that he could get a "clear picture." I voiced my concerns and the tech went it to such a rage that I was afraid for my personal safety.
To the best of my knowledge deflating the ETT cuff allows pooled secretions to go straight into the lungs and stopping the vent on a pt on high PEEP can cause a lung to collapse.
Please advise me if there is any kind of rationale for doing what they did.
Makes me wonder if heads of RT, ID and the critical care/pulm docs know this is happening. If its really a 'protocol' even if it's not really written out, that needs to change.
It is not a protocol. Originally I posted this is the Radiology nurses forum to ask for a standard of practice. Thankfully it is just two rogue employees who are endangering patients.
That behavior is completely unacceptable, first of all.
But to answer your question, I've never seen anyone do this...not two typical IUCs nor in one LTACH which had a lot of vented pts. I'm not understanding the rationale either. You're right about secretions. Remove their PEEP and they can de-recruit quickly. And better hope they're taking spontaneous breaths with large enough volumes to keep them ventilated...which I'm guessing they're not if they need mechanical ventilation.
ETA--I just re-read your post; I read it quickly and then was away from the computer for a bit. I see now that this is an ARDS pt. That confirms the stupidity of taking a pt off the vent for a CXR. (need another one of those bang-head smileys)
Besides, wouldn't it make the most sense to get a picture of the pt as he is? Not change anything for the x-ray?
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
When do you say Take a deep breath in and let it out now hold it..... for a chest x-ray. It is inflation that gives the best picture. This whole thing makes no sense.
It is my duty to stop a person who is doing something harmful. I once had to stop a new graduate RT when he attached a neb tx to another ARDS/IRIS pt who was on APRV. He had never had a pt on that vent mode. He thanked me for the help and we always worked well together after that.
But the people in this incident were not new. This has been going on for a while and I am determined that what happened last week in this MICU never happens again. Than you for confirming this.
As a practicing RRT with experience dealing with ARDS patients, this is absolutely NOT appropriate. If the patient was being ventilated in APRV or BiVent, disconnecting the patient from the ventilator should be done only emergently and the tube needs to be clamped with a hemostat to ensure that de-recruitment doesn't happen. Then again, the same can be said for a patient in PC using the ARDSNet protocol.
I have never, ever, ever, ever, ever, ever disconnected a patient or deflated a cuff for a CXR on any vented patient.
Who the heck cares how big and threatening this guy is....I'd be in his face faster than he would care for me to be. And your co-workers need to step up too! Write an incident report, go to your unit manager. This person needs to be fired. My husband is in radiology and he said this is never protocol and if this tech is saying the radiologist said to do this he is lying! Step up and protect your patients
Who the heck cares how big and threatening this guy is....I'd be in his face faster than he would care for me to be. And your co-workers need to step up too! Write an incident report, go to your unit manager. This person needs to be fired. My husband is in radiology and he said this is never protocol and if this tech is saying the radiologist said to do this he is lying! Step up and protect your patients
I deserve that. I do not frighten easily but I can sense danger. Nothing short of a physical altercation by multiple police officers could have stopped this psychotic individual. I check CNN before going to work to make sure that there has not been a mass shooting by this person. It may happen yet. In retrospect I wish that I had hit the code button on the wall.
As a practicing RRT with experience dealing with ARDS patients, this is absolutely NOT appropriate. If the patient was being ventilated in APRV or BiVent, disconnecting the patient from the ventilator should be done only emergently and the tube needs to be clamped with a hemostat to ensure that de-recruitment doesn't happen. Then again, the same can be said for a patient in PC using the ARDSNet protocol.
I have never, ever, ever, ever, ever, ever disconnected a patient or deflated a cuff for a CXR on any vented patient.
The pt I wrote about initially was in ARDS and on AC 30/450/100/10.
icuRNmaggie, BSN, RN
1,970 Posts
I have not been in a CT with this tech though I have to wonder what other experiments he is doing on helpless patients.