Traveling with intubated patients

detroitdano · Apr 7, 2011

First off they've gotta be somewhat stable and you have to know the reason for the test. A follow up MRI on a stable ICH isn't the best idea if you have a patient on 100 of Levo getting bolus' every hour, but someone on the same meds who needs a CT/PE to determine treatment may merit the trip. It's also a challenge to bag someone who is on APRV. This you should already know, just sayin'!

On a typical day for us, an intubated patient gets one RT, one RN, two transporters (1 takes vent, 1 maneuvers bed). They get bagged through the halls, we don't have travel vents, or at least I've never seen one. I've never had to travel with an extra nurse no matter the situation, but I've had to have people run me blood or fluids if I've gone to a tagged scan or what not. If we get desperate there's no protocol keeping us from doing one RT after they've run the vent down to wherever it needs to be, then coming back and going with one RT and two RN's/one RN and an aid. Transporters are limited on nights so that's actually a frequent occurrence for us. If you have to be at MRI at 12:30 and can't leave until 1:00 because of transport, well they ain't getting that MRI, so you best make it there at 12:30 no matter what you've gotta pull together.

BlessedMomRN · Apr 7, 2011

Yikes, my least favorite part of caring for an intubated patient! We are a little country hospital and bag them all the way there, during the procedure, and back. We don't have port-o-vents. Everytime I see an order for a CT for one of my intubated patient I wish the physician would participate in getting them through the process. I think they would rethink if the CT is really worth putting the patient through the struggle to get it done. Especially my 85+ olds.

By the way, it takes at least 4 people. RR to bag, One to manage the IV lines & poles and two to drive the bed. All 4 need to transfer on-off the CT bed. All while praying we aren't yanking out a line or tube somewhere along the way.

detroitdano · Apr 7, 2011

Nothin' like a rectal trumpet coming out on the CT table!

mcleanl · Apr 7, 2011

Thanks for sharing.....and here is my crazy situation. I am in a large trauma ICU. RT puts the pt to BMV and leaves and wheels the vent to CT......then myself and a tech transport the pt all the way (and I mean through twists and bends and hills) to CT all the while I am bagging the pt. It is freakin' impossible to bag and push those beds without killing yourself. Of course the nurses there are used to it and I get the feeling they think I am a wimp......but I think it is crazy and very unsafe. And of course given the nature of the patients.....I am running to CT almost every shift......it is killing me!

Darkfield · Apr 7, 2011

That's ridiculous. We have this old fashioned vents in CT and MRI that work on pts who are stable enough to transport. The RT sets them up and then bags while two people push the bed. How can you steer the bed and bag at the same time with an IV pole? Aren't you afraid you're going to extubate someone?

mcleanl · Apr 7, 2011

That's ridiculous. We have this old fashioned vents in CT and MRI that work on pts who are stable enough to transport. The RT sets them up and then bags while two people push the bed. How can you steer the bed and bag at the same time with an IV pole? Aren't you afraid you're going to extubate someone?

YES....yes, I am afraid. I have asked about a few options......like keeping vents down in CT....or having a transport vent. They look at me like I'm a nut. I find it very difficult to steer and bag......I attach the IV's to the bedside poles but even still....it is physically very difficult and dangerous.

ckh23, BSN, RN · Apr 7, 2011

We take a transporter, nurse, and RT. Sometimes if it's a big patient or someone on an insane amount of gtts we get another transporter. Like someone else said we have vents down in the procedure rooms.

The RT's role is to bag and make sure the ETT is secured and stays secured for the ride.

Sounds like it would be easier and safer to have the RT take the vent down and come back.

sunnycalifRN · Apr 8, 2011

Whenever we transport a patient on a vent, the RT brings an LTV vent for the transport. The team that goes along is always an RN, RT, a doc and an aide. As other posters have said, the patient must be stable enough for transport.

umcRN, BSN, RN · Apr 8, 2011

I work in a NICU so managing the bed is a little easier :lol2: But it still takes at least 3 people. 1transport nurse to bag, RT to take the vent and set up in ct/mri/fluro wherever, and the bedside nurse to manage meds/lines/poles and the transport isolette. If a baby is on a lot of meds and other accessories (I have transported an infant who was maxed on dopa/epi (and we dont use much else in neonates), and also had 2 sedation meds, a paralytic, milrinone, tpn/il, a-line, 3 chest tubes and foley) thats a lot for a 3kg newborn! It took an RT bagging, and RT manuvering the vent, bedside RN, transport RN and the fellow came for the ride in case we had to code in the elevator, this was for a cath lab procedure, it was one very nerve wracking trip :icon_roll

CCL RN, RN · Apr 8, 2011

2 people. Me and the RT. Pt goes on travel vent during procedure and transport.

littleneoRN · Apr 8, 2011

Ok, I work in NICU too, but the only real big difference here is how hard it is to maneuver the bed. In reality though, our beds are often almost as big and heavy as yours...they just don't come with a 100-500 pound person in them. :) Sometimes we bag...other times we use a transport vent. Bagging is a full time job since we're bagging at rates of 40-60 bpm, so this person really can't be doing much steering/pushing. This is usually an RT. Depending on the patient's needs, we usually bag through the procedure but may use the transport vent or a bedside vent. Two pushers...either 2 RNs or an RN and an extra RT. Plus an extra to push the IV pole, etc. if we can find someone. And for all intubated patients, a provider who can manage the airway/reintubate if necessary. This is generally a nurse practitioner. So in total, 1 to 3 RNs, 1 to 2 RTs, and one practitioner for the actual transport. One RN, one RT, and the practitioner must stay in attendance for the entire procedure.

Now think about transporting a patient on ECMO... :)