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ventmommy's Latest Activity

  1. ventmommy

    Families Saying "No" To Male Nurses?

    I fired a male nurse and it had NOTHING to do with gender and everything to do with him sucking as a nurse.
  2. ventmommy

    Forced 24 hr shift

    If the patient isn't safe, then call Adult Protective Services.
  3. ventmommy

    Forced 24 hr shift

    I'm confused by this entire post because there are absolutely zero hospitals that will discharge a patient without a fully trained caregiver (parent, foster parent, guardian, grandparent, whoever) in the home. Many children's hospitals require a second person to be trained. Training includes trach care, medication administration, nebulizer treatments, suctioning, ventilator circuit changes, cough assist and/or CPT/vest, tube feeding, etc. Training also includes independent overnight stays with no nursing assistance. When a family signs up with a nursing agency, the FIRST thing the agency does is have the family sign a document that states that nursing is provided as best as possible as scheduling allows but that the FAMILY is ultimately responsible for the care of their child.
  4. ventmommy

    Black scrubs—help!

    I have dogs and cats. I don't have an assigned color because my hospital lets us wear what we want but I have a lot of black tops and bottoms. I wash my uniforms (and everything I own) with a heavy dose of Downy liquid fabric softener because eventually it helps repel everything.
  5. ventmommy


    I'm really unimpressed when an MD prescribes an antibiotic without a tracheal aspirate and subsequent sensitivity. The MD needs a lesson in antibiotic stewardship.
  6. ventmommy


    The only reasonable policy your agency should have regarding trach tube processing is to follow the manufacturer's instructions for use.
  7. ventmommy


    As a mom, I'd fire the nurse. Touching the tube is a no-no. Her method isn't even a clean procedure. The reasons that we use an obturator: 1. A selling feature of Bivona is that they are super flexible. A downside is that they are super flexible. When you put it in without an obturator, you risk the tube bending back on itself. 2. The obturator provides the proper shape/angle for insertion. 3. Trach tubes are blunt. Mucosal lining of the airway is fragile. The smooth, rounded tip of the obturator prevents damage to the delicate mucosal lining. No one wants to be suctioning out blood from a rough insertion. Sadly, I see trach collars upside down all of the time in the hospital. If the flow is right and it's positioned over the tube, it should not affect SpO2 negatively.
  8. ventmommy

    Privately hired for trach+vent.

    I think a lot depends on the parents and how comfortable they are having an inexperienced nurse. Vent assessments are more than just checking the settings. If you see that the tidal volume is now 10mL instead of 240 mL (or whatever the expected value is), you need to know what to assess and how to fix it. If the high pressure alarm is sounding, you need to know what that can mean, what to assess, and how to fix it. We took new nurses and nurses with no trach/vent experience but I was home about 99% of the time. But if you search my name, you should see some stories of near misses that would have killed my child if I had not been home because the nurse wasn't able to handle the situation appropriately.
  9. ventmommy


    Trach changes anywhere outside of the OR are clean procedures. Bivona has VERY SPECIFIC instructions for how to process their trach tubes in the home setting. I would not recommend using generic trach processing instructions because Bivona trachs are silicone. The information is in every box. @ThisIsMandy If you don't have any new boxes, I can scan the insert from one of the boxes I have at home. Bivona is pretty clear on the number of times that a trach tube can be re-used (5 times) so it's important to keep track of that. How involved/uninvolved are the parents?
  10. ventmommy

    Privately hired for trach+vent.

    There is a lot that can harmful. Can you handle an accidental decannulation with a hard-to-replace trach that turns into a code? Are you comfortable with trach care and trach changes independently? Can you replace a Mic-key or know how to keep a stoma open if a GJ? Do you know trach CPR? Do you what all the settings and outputs mean on the vent? I'm definitely not trying to be negative here but want you to be aware of the implications of what can happen.
  11. ventmommy

    Privately hired for trach+vent.

    I would be EXTREMELY nervous to have a trach/vent patient with no experience and not having an agency to back you up. Who are you going to call if you have an urgent question and the parent isn't available? Why don't you want to work for an agency that takes these kinds of cases? Sidenote: Ventmommy is NOT a nurse but trained all of our PDNs and still takes foster trach/vent babies and is a respiratory therapist.
  12. ventmommy

    Sentara College of Health Sciences

    I'm not a nurse but I work in the ICU. I have worked with nurses precepting many Sentara students and almost all of the students have been delightful, inquisitive, and thoughtful. They all seemed prepared. Most were very interested in learning anything about ventilators, ET tubes, trachs, ECMO, etc.
  13. ventmommy

    Ventilated Patients

    A patient can be sedated and paralyzed on any mode, or be in such a poor state that they are neither adding rate nor triggering a breath. On a conventional vent, if you are using APRV/Bi-Level, you DO want them to breathe over the vent. On the oscillator, you never want them to breathe over the vent. Same for VDR and I think the Bronchotron. For babies on jets, the rate is usually 360 or 420, and they can also have conventional breaths (sometimes called sigh breaths), as well as breathe over the vent but they shouldn't be fighting it. If they are asynchronous, that is my cue to speak to my RN and MD. On a conventional ventilator in AC/PC, AC/VC, PRVC, SIMV, and any other mode except for PSV/Spont/PS/CPAP (which don't have rates, only apnea settings), the patient can trigger or not and add rate or not. If the rate is set on 12 and they are breathing 12, they aren't adding rate but they could be triggering. Every ventilator uses different names for modes of ventilation. If you tell me the vent that you have and any specific questions, I'd be happy to help. At my hospitals, if the patient is on the jet, oscillator, or VDR, the respiratory rate is left blank on vital signs and under oxygen device, you would select the appropriate piece of equipment. Only the RTs, under vent assessment would put the Hz and in the case of the jet, if any sigh breaths are added.
  14. ventmommy


    I'm a friendly neighborhood RT! On the jet/oscillator, the MAP and FiO2 are for oxygenation and hertz, Ti, and amplitude (delta P) are for ventilation. For blood gas analysis, I love when an RN wants to know more. I could talk about blood gases all day. The most important thing is to look beyond the pH and recognize that there are two or even three primary problems. If you have specific blood gas questions, I'd be happy to answer them.
  15. ventmommy

    Post-Extubation Policy

    Do you have a respiratory therapy department? There are definitely evidence-based best practices for assessing for extubation readiness, extubation, and post-extubation care. Extubation readiness: able to follow commands, off most sedation, minimal use of vasopressors, PEEP less than 8 cm H2O, FiO2 less than 0.5, a pressure support trial with minimum settings while achieving adequate tidal volumes. PS trial means different things in different facilities. A true PS trial would be a PEEP of 3-5 cm H2O, and a PS of 0-3 cm H2O. The patient needs to have a significant leak when the cuff is deflated, not be producing excessive secretions, and able to manage those secretions. Post extubation depends on the patient's needs. Many patients are fine on room air or 1-4 LPM NC. Some people will extubate to HHFNC, CPAP, or BiPAP. Some patients need a dose or two of racemic epi to manage swelling. And of course, some patients will fail extubation and need to be reintubated which is absolutely not a failure on the part of the RT/RN/MD.
  16. ventmommy

    Sentara Healthcare Nursing

    I turned down a position there but I did many, many hours of clinical there. Sentara is a HUGE system in Hampton Roads. Whatever adult specialty you are interested in, they have it. For neo/peds, they only do labor & delivery and level 2 nursery. For adults, they have everything from primary care to ECMO/cardiac surgery ICU to Trauma ICU to LTC and long-term trach/vent units. Lots of room to grow. Pay is similar to every other facility in this area.