I'm am interested to know how ICU nurses travel with their intubated patients. For example when going to CT or specials how many people go with you, are the patients placed on a transport vent...what is RT's role etc.
I have worked in a zillion different places and every place has a slightly different twist on how they travel......the place I work at currently has an unusual (which translates into back breaking) transport method and I am curious to see if anyone does the same thing.
Two people: RRT and RN plus a Transporter if available and there are multiple drips and tubes.
Always on a transport ventilator for several reasons.
1. Reduces the chance of the person bagging being injured by being in an awkward position
2. Decreases the chance of inadvertent extubation.
3. Maintain arterial blood pH stability
4. Reduce exposure of radiation.
The RRT is responsible for the airway, including intubation or reintubation if necessary, the ventilator and all the paperwork that goes with losing an ETT.
Hearing about places not having a transport ventilator available is the equivalent of the days of past when we used Dial-a-Flows because we didn't have IV pumps that could be transported easily.
We always take nurse, RT, and fellow at a minimum. More if we have a bunch of poles, etc. We bag the way there and depending on the procedure and the length of the procedure we bag thru. For CT/fluoro we take the vent, for MRI the RT gets to sit by or in the tube with the kid to bag. Always a good time lol
Seems like I am the only nut out there bagging and pushing to CT!!!!!! It makes me want to scream......I would love to print out these responses and give them to the NM.
I've worked lots of places too and the most common I've seen is a vent ready and waiting in CT/MRI. I have never seen or heard of it done as you have described. Personally, I would deem it unsafe. Who is monitoring the patient while you bag AND push the bed? RT should stay with any patient who is being manually bagged. What if the tube accidentally disloged? What if the patient went into an arrythmia? Too many what ifs for my nursing license. Seriously, if something were to happen and there was a bad outcome, there could be some problems. Was this the same procedure a reasonable and prudent nurse would follow?
I've worked lots of places too and the most common I've seen is a vent ready and waiting in CT/MRI. I have never seen or heard of it done as you have described. Personally, I would deem it unsafe. Who is monitoring the patient while you bag AND push the bed? RT should stay with any patient who is being manually bagged. What if the tube accidentally disloged? What if the patient went into an arrythmia? Too many what ifs for my nursing license. Seriously, if something were to happen and there was a bad outcome, there could be some problems. Was this the same procedure a reasonable and prudent nurse would follow?
Okie....just to clarify....RT does wait at the elevator for us and we ride down together......but then they go on their merry way to CT and I meet up with them when I can get the patient there. Technically, I am sure I could scream loud enough before we got to the elevators to get RT's attention, but once we are off the elevators there is NO way RT could hear me if we had an emergency.....the tech would have to run and get them.
The whole thing is unsafe......but it is interesting..... in some hard core (and we all know those kinds of units) you seem uncool if you can't handle the situation. I think these nurses are nuts for letting this go on. I am not sure how to keep addressing the issue without coming off as a whiner. As I said, everyone up there thinks it is fine.
Look, I hear you. I get what you are saying that others might think you are uncool since all the other nurses can "handle the situation" as it is. Could you handle things if your patient crashed? Of course you could and would!!But you mention that you feel this is a safety issue, and it is. Maybe try and look at it from a safety combined with patient advocacy stance. What is the best interest of this patient (what if this patient was the CEO of the hospital, or other VIP - would it still be done this way?). Perhaps you could call and schedule an appointment with the Risk Management department at the hospital. Maybe they don't even know that this is a common practice at the hospital - only because nothing bad has happened yet. I would be very surprised if RM knew about this AND approved of the practice. Tell them exactly how it is done, the people available and those not readily available. They seriously may consider it a liability issue since their nurses are on their insurance policies and thus change will be born!
Before going all the way to the top you need a few key people on your side.
1. The Chief or Medical Director of Critical Care Medicine
2. The Medical Director of Respiratory (Cardiopulmonary/Pulmonary) Services who is also usually a critical care medicine physician.
These two physicians make protocols and determine what new equipment should be added to critical care. The RTs should also be your allies since this is a direct concern of theirs and then decide whose budget the appropriate additional equipment and personnel will come from. Radiology is also a good friend to support certain exposure data and information for what is standard practice in their journals. Chances are the policies may not have been updated to reflect current recognized practices.
To do a transport to radiology, we always have the RN and a wardie, and a doctor if the patient is tubed, or not if they are extubated. Tubed patients are transported on an Oxylog transport vent, with the wardie pushing the bed, RN guiding the bed and watching the monitor and ventilator and juggling the IV tree, and the doctor generally strolling on ahead. Additional equipment always include the emergency transport bag (containing intubation equipment, drugs, cannulation equipment etc), the defibrillator, monitor (which has the module from the bedside monitor in it, and then is reconnected to the bedside monitor again at the end of the transport), several O2 bottles, bag valve mask and tubing, and a selection of drugs (morphine or fentanyl, midazolam, vecuromium, maybe some propofol).
To do a transport to radiology, we always have the RN and a wardie, and a doctor if the patient is tubed, or not if they are extubated. Tubed patients are transported on an Oxylog transport vent, with the wardie pushing the bed, RN guiding the bed and watching the monitor and ventilator and juggling the IV tree, and the doctor generally strolling on ahead. Additional equipment always include the emergency transport bag (containing intubation equipment, drugs, cannulation equipment etc), the defibrillator, monitor (which has the module from the bedside monitor in it, and then is reconnected to the bedside monitor again at the end of the transport), several O2 bottles, bag valve mask and tubing, and a selection of drugs (morphine or fentanyl, midazolam, vecuromium, maybe some propofol).
We make them help with guiding the bed. They're not too good to help!!
some of them (especially the SR's) you can cajole, ask, tell...but they still manage to be blissfully unaware of the concept of helping out Most are pretty good though, and will pitch in when asked.
I'm am interested to know how ICU nurses travel with their intubated patients. For example when going to CT or specials how many people go with you, are the patients placed on a transport vent...what is RT's role etc.
I have worked in a zillion different places and every place has a slightly different twist on how they travel......the place I work at currently has an unusual (which translates into back breaking) transport method and I am curious to see if anyone does the same thing.
Thanks!
Yes, I have done transports as you described later in this thread. Currently, we do not use transport vents, on the night shift (can't answer for days), RT usually bags and the RN monitors and pushes the beds and drugs. We can usually find another RT (from somewhere else in the hospital) or a tech who will push the vent down ahead of us. It can get dicey, especially considering as with us, RT is downstaffed on nights and if they get called to the OR to start Nitric for one of our cases, it can be nuts.
That being said, people here are advising you to contact the administrators/risk manages at the facility you are working at to make them aware of the situation. Ideally, this would be the correct way to handle things. But may I share that as a traveler, carrying out such actions could lead to your contract being cancelled and you left without a job. What you may deem as unsafe (and I'm not saying you're wrong) will more than likely not be changed by your actions. You will be at that facility for a short time, they aren't going to change policy based upon your input. I don't think you'd be wrong to ask for extra help when you transport, don't criticize the others but you could say something like "as I"m new to the facility, I have concerns that I can safely transport by myself" and ask for assistance. The worst thing they can say is no. Then the ball is in your court to see if you feel you can safely finish the assignment. Please, please make sure you've apprised your company of the situation and the concern you have for your license. Your company liasion should be aware in case you decide you need to break your contract (also, realize your company may become your worst enemy if you decide you have to leave.). I am speaking from years of personal experience, good luck to you.
some of them (especially the SR's) you can cajole, ask, tell...but they still manage to be blissfully unaware of the concept of helping out 
Most are pretty good though, and will pitch in when asked.
GreyGull
517 Posts
Two people: RRT and RN plus a Transporter if available and there are multiple drips and tubes.
Always on a transport ventilator for several reasons.
1. Reduces the chance of the person bagging being injured by being in an awkward position
2. Decreases the chance of inadvertent extubation.
3. Maintain arterial blood pH stability
4. Reduce exposure of radiation.
The RRT is responsible for the airway, including intubation or reintubation if necessary, the ventilator and all the paperwork that goes with losing an ETT.
Hearing about places not having a transport ventilator available is the equivalent of the days of past when we used Dial-a-Flows because we didn't have IV pumps that could be transported easily.