Vent unit in LTC??

hello everyone

nowdays i see alot of long term care facilities have a vent unit. isn't it too risky to have a vent unit in long term care, where they are not equipped with emergencies? they do have a respiratory therapists but what are the responsibilities of respiratory therapist?

has anyone here worked in a vent unit? what was it like? what are your duties as a nurse and do you feel comfortable doing it?

i've never worked in one, but have sent patients from ltc go to those places with vents. these have always been patients who had to sign dnr orders to go there. people with diseases like als, or a degenerative, genetic disease with no hope of recovery, and in need of vents were forced to go there when their conditions deteriorated to that point as most ltc's could not accomodate them. the impression was always that they were going there to die. one of our nurses visited and said it was very depressing. surely though, someone has had a good experience in those places as they are providing a needed function and service.

this has been my experience too;

the ltc facilities w/vents, have been holding places if you will, for pts that are dnr and are at an end-stage pathology.

in other words, when they arrive at the facility, the assumption is that they will die there in most cases, under a yr.

leslie

I worked for about 8 mos at a LTC facility on the vent unit. Most pt's on a vent unit require total care and assist w/ ADL's. Many are paralyzed d/t one med cond or another. In my exp it was not depressing. I loved it! I met some really wonderful people there and grew to admire them for just wanting to stay alive even if it meant living on a vent. Many do not die w/in a yr. We had some on the unit that had been there for many years. One thing about a vent unit - you will have a lot of TF! I had 21 for awhile. You always stay busy! One good thing about working a vent unit is you know your pt's will keep breathing! All will eventually die and their death can be messy. A young man who had been paralyzed in a motorcycle accident had an artery burst near his trach. Blood was pouring out his throat, nose, and mouth. Blood was everywhere. He was sent out and died at the hosp. You will see unique things working a vent unit. Would I ever work at one again? You bet!

Oh yeah! Forgot to mention that the vent unit was my 1st nsg job. Yes, I was scared but looked forward to the challenge. My duties? Admin meds via G-tube, wound tx, in my state I could and did admin meds (flush) picc's, occ IV ABO's, insert a lot of supp, and all the "usual" nsg duties such as charting, assessments, VS, note orders. Hope all this info helps!:caduceus:

i've been to two vented ltc facilities.

many of those pts are quite young w/no hopes of recovery.

i briefly visited one facility that even had sev'l vented babies, brain stem injury at birth.

but they remained full codes, so yes, these people do live sev'l yrs.

the contrast of the 2 facilities was evident.

one facility admitted vented pts w/life-limiting illnesses and all were dnr.

the other was like the one you described tammy; young folk whose only means of surviving was being hooked onto these vents. and most were full codes.

but their focus (unlike the other facility) was on life and all life-sustaining interventions.

obviously my (hospice) pts were from the facility w/the dnrs.

i found myself crying after visiting the vented ltc w/the full codes.

leslie

Long term vents are easy and stable. There's one airway you don't have to worry about, even in an emergency. They can be intimidating because people associate vents with a critically ill patient.

I think you need to have properly trained staff, and a safe ratio, but vents are really not too big of a deal.

I just started in a long term acute care facility; this is my first job so I know I have a lot to learn. The average LOS is 31 days but, they are multisystem failure pts so they are very sick. We have several pts on vents, we have an ICU, respiratory therapy, a Code team, etc. This hospital is primarily known for weaning pts off of vents...with a 60% success rate.

I worked for about 8 mos at a LTC facility on the vent unit. Most pt's on a vent unit require total care and assist w/ ADL's. Many are paralyzed d/t one med cond or another. In my exp it was not depressing. I loved it! I met some really wonderful people there and grew to admire them for just wanting to stay alive even if it meant living on a vent. Many do not die w/in a yr. We had some on the unit that had been there for many years. One thing about a vent unit - you will have a lot of TF! I had 21 for awhile. You always stay busy! One good thing about working a vent unit is you know your pt's will keep breathing! All will eventually die and their death can be messy. A young man who had been paralyzed in a motorcycle accident had an artery burst near his trach. Blood was pouring out his throat, nose, and mouth. Blood was everywhere. He was sent out and died at the hosp. You will see unique things working a vent unit. Would I ever work at one again? You bet!

I knew that there would be positive experiences, and I am glad for that. I wonder how do these patients occupy themselves all day? To want to stay alive to me, is to being doing something with my mind active. I could not be on a vent without some kind of activity, study or being able to read. What did they do?

The patients that we sent to those types of facilities, we considered to have poor quality of life by our standards. One watched TV all day. The other did also, but had a computer she used to communicate with her daughter in another country in real time. Who can say what quality of life is for them?

I am reminded of Stephen Hawking, the great physicist. What if we pulled the plug on him because he required too much care? The real reason our staff was glad to ship those patients out, was because they were very heavy care. Was your facility staffed for that kind of care? I know you say you had heavy care patients, but were you really staffed adequately for that kind of care?

There was only one nurse per shift for the vent unit. At night (my shift) we only had 2 CNA's for about 50-60 pt's. Not all were vented, only about 20 or so were vented. They had maybe 3 CNA's for the vented Rsd during the day. Were we understaffed? ALWAYS! I have found tho that the aforementioned ration of nurse/CNA/pt is not uncommon. I am working at my 3rd LTC now and the ratios (did I spell that right?) are about the same. Personally, I think there should be regulation in regard to nurse/CNA/pt ratio. Even working nights when most pt's were asleep I worked my butt off, very little downtime. I admit if the aides are good the care is adequate. What do they do during the day? Not a lot. If they could use their hands they wheeled themselves around the facility, talked to staff and other pt's if they were able, attended PT or activity sessions, which were offered QD. Watched a lot of TV! Several stayed in bed 24/7. These were the ones who wanted it to end. Not all want to live and I can't blame them. It is a horrible way to live re: of how much activity you have to keep you occupied during the day.

The staffing sounds typical of any LTC, but for the fact that you seemed to have way more very heavy care folks.

I have this daydream that those vented patients that are alert, and intelligent be encouraged to use that brain power, even further their education if they choose to. Or, they study something just because it interests them, and they have unlimited resources for that study. They become a valuable asset to society, a brain trust, a think tank. Too bad it'll never happen that way. And, I've never been on a vent. It's probably too tiring just existing that way.

I work on a LTC vent unit, and have had both wonderful experiences and horrible experiences. Yes, I have even seen at least one patient go home. Some of our pts are full codes, some are DNR's. We have feeders and eaters. Some are being weaned some can't be weaned.

I've learned not to panic when a pt comes disconnected, how to suction someones mouth using a yankauer, use a suction swab to do mouth care, and my biggest lesson of how to lift without injuring myself. As a CNA, I'm not allowed to do some things, like tracheal suctioning, trach care, g-tube care and the like; that duty goes to the RN or RT. I've also learned how to read lips.

From the sounds of what others are saying, I'm in heaven as far as staffing goes. I have an RN and an RT and often a second CNA as part of my team to care for 11 patients.

i was recently hired by an hospital to work on the vent unit, i was also offered a position to work on the surgical unit in another facility. i graduated last year and this will be my first hospital job. Does anyone know which position will be most beneficial to me experience wise, since i'm palnninig to go for master's program. Also under what class can i classify a vent unit, is it critical care or what... i am so confused will be glad if anyone can answer these questions. thanks