respitory therapists or CRNA's in ICU and Codes/ER

GilaRRT · Dec 7, 2009

within the scope of a CRNA they Intubate, Manage Airways, initiate resuscitation, manage and implement ventilation and respitory management etc
but do hospitals having respitory therapist prevent CRNA's from performing these tasks?
do hospitals prefer CRNA's or RT's to perform such tasks?

I think there may be some confusion regarding the roles and responsibilities of the CRNA and RT. The CRNA's responsibilities includes the modalities mentioned; however, airway management is but one small part of a CRNA's job. The CRNA's primary role is that of an anesthesia provider. This includes airway management, medication administration, monitoring, induction, maintenance, and many other modalities and concepts. Likewise, airway management and initial resuscitation is within the scope of an RT (Intubation may or may not, depending on the facility); however, these are only part of the overall responsibilities of the RT.

I would not say other providers prevent CRNA's from performing the said tasks if these other providers are able to perform the same tasks. It is more a function of the role within a specific operating environment. Typically, I do not see CRNA's in a code on the floor; however, anesthesia is often called for difficult airway management. Likewise, I do not typically see RT's in theatre. However, it is not uncommon to see an RT in a surgical area preparing a patient for a procedure or assisting with specific procedures. Example may include; administering a xylocaine nebulizer treatment as premedication for a procedure or assisting with a bronchoscopy.

Therefore, some crossover of skill sets is a fact of life; however, this does not mean providers interfere with each other's core duties.

Ivanna_Nurse, BSN, RN · Dec 7, 2009

our ICU intensivists do the tubing... rt's are oun our floor, but no CRNA's. ~Ivanna

PostOpPrincess, BSN, RN · Dec 7, 2009

We have intensivists.

sasha1224 · Dec 7, 2009

My facility doesn't have CRNAs. It is quite small. If the resp tx can't intubate, we have to wait for the ambulance to try. Just the other night, had a patient arrest, and we were not getting effective respiration with ambu bagging, so RRT intubated. And that did it. Patient was stable on transfer. I guess my point is, if it is in the scope of practice, who cares if it is resp or a CRNA? I certainly wouldn't hold back on intubation, waiting for a CRNA, if my RRT can do it. It would delay treatment. Now if the RRT can't get the ETT in, if I had a CRNA at my disposable, I would call for them. Otherwise I would continue bagging until a person arrives that can get that tube in.

meandragonbrett · Dec 7, 2009

Depends on your hospital. There all all different kinds of practice modes.

The person who has better training/more experienced provider should be the person to perform an intubation in an emergency.

In some hospitals CRNAs respond to all airway emergencies, codes, and traumas for the entire house.

Other hospitals have in house intensivists

Some facilities allow RT to intubate

Why do you ask?

loveanesthesia · Dec 7, 2009

within the scope of a CRNA they Intubate, Manage Airways, initiate resuscitation, manage and implement ventilation and respitory management etc
but do hospitals having respitory therapist prevent CRNA's from performing these tasks?
do hospitals prefer CRNA's or RT's to perform such tasks?

CRNAs can do those things, but most institutions won't pay a CRNA to be available on an emergency basis in case there is a code. 15 years ago my institution did, but that is one thing that was eliminated to improve efficiency. Now we don't respond to codes unless they can't get the tube, and then we try to get someone out (CRNA or anesthesiologist) to go over. It just costs too much to have someone available for emergencies.