Trachs/Vents - How much training?

caliotter3 · Jun 11, 2012

As with all training, it depends upon the agency. Some do a good job while others tell you to go to a class and pay for it out of your own pocket. You attend the class and find it wasn't worth the gas money it took for you to get there. I got my training from another nurse during my orientation to cases. I supplemented what they showed me by reading an owner's manual about one of the vent models, but practically everything I needed to know was shown to me. One nurse did a better job than the others. From then on, I just got used to working with the vents and doing trach care from actually doing it.

dirtyhippiegirl, BSN, RN · Jun 11, 2012

^like above, definitely depends on the agency. And the family. If you're doing nights, then family should be there to assist.

Nights *should* technically be fairly easy. As a new grad in the PPD environment, I was firm on only taking older (toddler to elementary school aged) & stable kiddos. Frankly, I learned good trach care from parents. "How do you want trach care to be done" is a great way to learn without letting out that you're inexperienced.

Like cali, most of my vent experience came from direct learning w/the previous nurse. Again, you may have to put your foot down and demand X learning hours from the offgoing primary RN on the case -- I know that I did.

umcRN, BSN, RN · Jun 11, 2012

I have no experience with home vent training but as a NICU/Peds CICU nurse I ask that you PLEASE make sure you get adequate training and feel comfortable with the patient and their needs before taking them on your own. I have full respect for the nurses that choose to work private duty nursing for complex patients, god knows I don't think I could do it, but I love those kids and it breaks my heart when they come in coding because the home nurse was uncomfortable with the care they needed, didn't escalate in time or didn't react appropriately to an emergency situation. This could be form inadequate experience, inadequate training or an issue with the agency not assigning nurses appropriately. I have seen too many kiddos come back in coding and suffer devastating brain injuries after coding from a plugged trach.

And like another person said, definitely train with not only the nurse experienced already with the patient but also whoever the primary caregiver is. If it's a child the parents almost always know what is best and right for their child and can show you how they like to do trach care, trach changes etc. So long as it is safe I don't try to change techniques even when they are inpatient in the ICU

realnursealso/LPN, LPN · Jun 11, 2012

My agency requires taking a vent class. Although I took the class I had many years of vent/trach experience from on the job experience. I've never missed a call.

mg2312 · Jun 11, 2012

When I did my orientation to my first case with a trach I just pulled the nurse who was with me aside and told her that I had no experience with a trach. She was very nice about it and explained everything to me and let me watch her do everything first. That was a huge help. Also, she knew not to ask me to do something on my own in front of the patient or family members. Of course I also reviewed how to do trach care before arriving to the home. That was enough for me to feel comfortable to go back and care for the patient. It mainly depends on you're level of confidence and how quickly you can think things through.

As far as vents: either take a class if they offer it or I would demand a minimum of 2 fulls shifts of on the job orientation.

ventmommy · Jun 11, 2012

I would much rather have a good nurse with no trach/vent experience then a lousy or barely decent nurse with years of barely decent trach/vent experience. The training I gave our nurses was 10 times what they got from their agencies.

Purple_Scrubs, BSN, RN · Jun 11, 2012

I have no experience with home vent training but as a NICU/Peds CICU nurse I ask that you PLEASE make sure you get adequate training and feel comfortable with the patient and their needs before taking them on your own. I have full respect for the nurses that choose to work private duty nursing for complex patients, god knows I don't think I could do it, but I love those kids and it breaks my heart when they come in coding because the home nurse was uncomfortable with the care they needed, didn't escalate in time or didn't react appropriately to an emergency situation. This could be form inadequate experience, inadequate training or an issue with the agency not assigning nurses appropriately. I have seen too many kiddos come back in coding and suffer devastating brain injuries after coding from a plugged trach.
And like another person said, definitely train with not only the nurse experienced already with the patient but also whoever the primary caregiver is. If it's a child the parents almost always know what is best and right for their child and can show you how they like to do trach care, trach changes etc. So long as it is safe I don't try to change techniques even when they are inpatient in the ICU

That is my worst nightmare and something I want to avoid at all costs! This would be a leap for me from stable kiddos, some with medical conditions but still stable enough to attend school, to a much less stable population, so it is a bit out of my comfort zone...but I think it's good to stretch myself...just not at the patient's expense!

I like the idea of ask the parent how they do care. They do indeed know the child best.

caliotter3 · Jun 11, 2012

Patients at home are deemed stable, however, that does not preclude a patient being discharged to the home prematurely or inappropriately. One needs to be ready for the unexpected. I always mentally "practice" emergency actions on my own and regularly with the parents. Should be one of the first teaching sessions that you provide.

umcRN, BSN, RN · Jun 11, 2012

Patients at home are deemed stable, however, that does not preclude a patient being discharged to the home prematurely or inappropriately. One needs to be ready for the unexpected. I always mentally "practice" emergency actions on my own and regularly with the parents. Should be one of the first teaching sessions that you provide.

Yes, the patients who are sent home are "stable" but complications can happen fast and be devastating. Also it really depends on what their other issues are. A cardiac baby/child with a trach can have 10 seconds of resp distress and go into a full blown cardiac arrest without warning (actually cardiac kids can go into cardiac arrest for no other reason than that they have cardiac issues trach or no trach), or a kiddo with neuromuscular issues may not be strong enough to cough and plug very easily. I am glad you mentally practice emergency situations on you own. I with others did so as well and I urge people caring for these patients to never underestimate their ability to go bad in the blink of an eye. Kids compensate for things much longer than adults do and before you know it they are dead in your arms. :crying2:

I sent a kiddo home once, trach/vent. Happiest little guy around, had the biggest smile that would light up a room, we held on to him probably way longer than necessary...he was the only ICU patient on the unit who spent time during the day up in his baby walker! He went home for a week, plugged, nurse/parents didn't change out the trach, he coded for three hours in the ER, received an ethically questionable number of Epi doses and now he is neurologically devastated, neuro storming constantly. His parents refuse to believe his prognosis so he went home but his spirit and life are no longer there.

OP I certainly don't want to discourage you from pursuing this career path, you sound like you definitely want to take all precautions to be ready for an emergency and so long as you are always prepared for the worst you will do fine! I am sure these events happen very infrequently, I am only aware of them because I see the kids after then are admitted. I wish you lots of luck!

BuckyBadgerRN, ASN, RN · Jun 12, 2012

My first (and current!) RN job is through an agency and I take care of a 1 year old on a vent. Got my peds-vent certification as required by the agency, listened to everything the parents had to say, read everything in the house related to her equipment and case and was trained by excellent RN's with previous vent experience.

There is an LPN who is on this case as well and she is always saying how stable our little one is---drives me crazy b/c if she were truly "stable", she wouldn't require machines to breath for her and deliver her nutritions! I think some are a little too relaxed with such situations and all of a suddden, BAM, everything umcRN is saying happens!

Purple_Scrubs, BSN, RN · Jun 12, 2012

OP I certainly don't want to discourage you from pursuing this career path, you sound like you definitely want to take all precautions to be ready for an emergency and so long as you are always prepared for the worst you will do fine! I am sure these events happen very infrequently, I am only aware of them because I see the kids after then are admitted. I wish you lots of luck!

Not discouraging at all...this is what I want/need to hear. I want to be sure to be vigilent and proper training to recognize when things are going south is a huge part of that. Working with this population after I have been out of acute care for so long is something I will not take lightly. I am already signed up to take an RN refresher course (although the focus there is mainly adult med/surg), and I will certainly brush up on my peds acute care issues.

Thanks to everyone for your input...this will help me know the right questions to ask when I interview!