Scope of practice for transport nurses

[littlepeach]

I work in a rural ga hospital. we had a kiddo today transported for a subtle pneumo. term infant, 24 hours old on oxytent since delivery @40%. Did 100% o2 after pneumo detection for 3 hours, repeat x-ray showed resolving pneumo. transport team got there and nurse did decompression by butterfly needle aspiration. baby CRUMPED!!! 5 chest tubes later, baby is transported practically still unstable. Question: do you have a standard protocol for transport practices, and if so how do ya'll address any issues that may be grey areas in this standard? I'm not saying this was in fact anybody's fault, but if the baby was relatively stable, why intervene before reaching primary care facility if not an emergency?

[BittyBabyGrower, MSN, RN]

I think that it is hard to say what would be right or wrong here. Were they going by ground or by air? We will place a chest tube or decompress if we are going by air for a distance.

As for the scope of practice, I believe each state is different. Flight nurses here can do invasive procedures if the need be, but as a neonatal nurse I go on transport with a fellow, an Rt and a flight nurse at all times. Generally we follow our hospital policy and procedures.

[littlepeach]

they went by ground, it is an easy 2.5 hr. drive. transport nurse and rt took baby. but, if the baby was satting 98%, vigorous, and alert. i'm not saying he would have crashed eventually, what would be the reason your folks would have performed an intervention away from the advanced hospital. it is a tough one. i just feel bad for the nurse, the baby, and the family, oh, and the mom is one of our icu nurses

[SteveNNP, MSN, NP]

If going by ground, I would have held off needling the chest until absolutely necessary. Since the pneumo was resolving, and obviously non-critical, the baby probably would have done fine on the transport. However, the back of a swaying ambulance is no place for an emergent needle apiration.

[BittyBabyGrower, MSN, RN]

Yikes, 2.5 hours in an ambulance, yeah, we may have needled it just to be on the safe side....I hate having to pull off to do invasive things in the back of a rig! But where I work, that would have been an air transport! Hope the little one is doing okay!

[FlyingScot, RN]

they went by ground, it is an easy 2.5 hr. drive.

A lot can happen in that 2.5 hours...and most of it ain't pretty. I'd rather needle in the relative stability of the referring hospital than in the back of a squad in the middle of nowhere. If the pneumo was under tension then they really had no choice even if it had resolved somewhat. I'm thinking there might have been a little more going on since he required 5 chest tubes afterwards which was unlikely caused by a simple butterfly decompression. I feel for that transport nurse. I've been doing this for a long, long time and needle chests still have a high pucker factor for me (and everyone else I've ever spoken to about them). BTW our team is RN,Medic, RT...no physician.

[nytflytrn]

i work as a neonatal/pediatric transport nurse and with a 2.5 hour trip by ground i must admit i probably would have also attempted to needle decompress the chest. i agree with the others who stated it is much preferable to do these types of procedures in the stability of the referring hospital's nursery than to attempt them in the back of a helicopter or ambulance.

in response to the second part of the question ... yes, we have protocols and procedures we follow. they are more like standing orders as the physicians have trained and tested us and trust us to be their eyes and ears on the road. if we run into an unusual situation or something that we are uncomfortable with we do have a medical command officer (neonatologist for NICU trips and PICU resident for peds trips) with whom we have direct telephone contact.

[nytflytrn]

i work as a neonatal/pediatric transport nurse and with a 2.5 hour trip by ground i must admit i probably would have also attempted to needle decompress the chest. i agree with the others who stated it is much preferable to do these types of procedures in the stability of the referring hospital's nursery than to attempt them in the back of a helicopter or ambulance.

in response to the second part of the question ... yes, we have protocols and procedures we follow. they are more like standing orders as the physicians have trained and tested us and trust us to be their eyes and ears on the road. if we run into an unusual situation or something that we are uncomfortable with we do have a medical command officer (neonatologist for NICU trips and PICU resident for peds trips) with whom we have direct telephone contact.

our team is RN/RT and EMT driver