question on Vent patient

[EllbellRN]

I recently oriented on a case for an adult who is on a vent. I was told that he periodically gets anxious and asks the nurse to manually bag him for long periods of time. The nurse orienting me said all the nurses on the case will bag him for short periods of time until he calms down. I asked the nurse to demonstrate this for me, and she showed me how she bags the patient. The patient was happy to let the nurse show me, and she bagged him while he sat at a table working on a puzzle.

I've only manually bagged trach patients prior to suctioning, and they were lying down. This is my first vent case and as I was trying to take over bagging for a few minutes to get the feel, and it was a bit awkward bagging someone sitting in a chair. I was also not hearing an "expiration" from the bag when I was bagging, but the orienting nurse said I should hear this sound if I am bagging correctly. No matter how I held the bag or squeezed the bag, I didn't hear any type of expiration back through the bag.

My question is, is it common for Vented patients to come off the vent and be manually bagged as a way to calm anxiety? They do give him PRN meds for his anxiety, but I was not expecting to be bagging a vented patient PRN. I certainly expected to bag in an emergent situation.

Am I totally green in this area, or should I run this by an RT? Thanks for any help you can offer.

[LTV950rn]

I haven't heard of being bagged manually specifically to reduce anxiety, but what I have found in private duty is that patients/families find little tricks like these that work for them/help out, even if it seems not to be "the norm." I have bagged a patient sitting in their wheelchair while another nurse changed out the patient's circuit (he is a patient that cannot be off the vent at all) and didn't have any problems. Is your patient cognitively aware? If so, I'd just ask him if the bagging "feels right." If he truly can't exhale, he should be able to tell you and/or his sats and heart rate would reflect it was not effective. I'd practice bagging him before a situation comes up just to get more comfortable. When in doubt, it is always ok to connect with RT- they truly are amazing and I think sometimes their knowledge and expertise isn't utilized enough!

[nursel56]

No, that hasn't come up in my cases as a means to control anxiety and I would be curious to know why he feels safer being manually bagged than he does getting his breaths from the vent, since you'd think he'd find the the number of breaths you give less consistent and/or problems with positioning.

Normally people will use the bag during transfers and circuit changes that aren't done quickly. One patient wanted a full shower so they would bag him while he sat in a shower chair.

The most important thing about these patients, though is they become very attached to their rituals and routines. Usually it's best to let them have that control over their immediate environment. One of my patients liked to have a fan blowing on her face when she became anxious. Another lady liked to have chest percussions done when she started to panic.

I would probably ask the orienting nurse to listen to his lungs while you bag him and then observe her methods again. It won't be long for you to get a feel for it like any new task. Good luck and I agree pick your RTs brains whenever possible! Seriously. They are an invaluable resource and know these vents backwards and forward.

[EllbellRN]

Thank you both so much. I did reach out to the RT who did a Vent inservice for me and he said some patients can find manual bagging a relief to anxiety. He said he would only do it for 2-3 minutes and then put the patient back on the Vent.

I do think in this case it is a ritual/control issue as you both mentioned and I am definitley going to practice with the family and orienting nurse so I can improve my skills and be effective with this intervention. I also like the idea of monitoring his pulse ox/heart rate and since he is cognitively aware, he should be able to let me know how effective I am.

This is my first Vent case, so I'm a little nervous, but at the same time viewing this as a challenging assignment with the opportunity to learn new skills! I appreciate the support and suggestions and will try them on my next shift!

Thank you:)

[caliotter3]

When you chart this, remember to add "at patient's request" to distinguish from a situation that you would assess a need for bagging.

[EllbellRN]

Great point! Thanks so much. I need to get used to charting in homecare, as opposed to charting by exception in the hospital. I'll take all the pointers I can get!