Vented Patient Should A Minimal Experienced Nurse Be Caring For A Vented Patient?

[SOMA]

Hi everyone, I've been a travel nurse for less than year, and an RN for 4 with minimal experience with vented patients. My patient the other night coded while on the vent and the patient is alive , but should a nurse with minimal experience with vents be caring for a patient with on a vent.

[Mommy_of_3_in_AL..RN]

As a new student, i was horrified by a vent. The thought of someone with a tube in their airway scaraed me to the point that i was worried i wouldnt get through school.

My first ICU clinical, we walked through the floor and i saw a LOT of vents, and a couple patients on CRRT. Of course, i had no idea what CRRT was, and i thought all those bags were medications! I was HORRIFIED. I got my patient assignment, and low and behold, it was a man being DC home after an MI. He was fine..up showering and getting his things together to go home. Still, i was horrified, and i walked out to the desk, and passed out cold. In the floor. Spent the day in the ER. The patient was distraught that it was his fault. The instructor was very forgiving and even laughed when it was all said and done. After that, my next patient was a vented CRRT patient, and i didnt pass out!! I actually learned alot, and was fine after that.

I did my preceptor in SICU, and pretty much everyone i cared for was vented. I learned a lot there, and am so much more comfortable with vents. I dont know everything, but my preceptor and the RT and other staff members went out of their way to help me and teach me and let me do things for myself, only stepping in if there was a chance i would do something wrong. I learned to troubleshoot the vents, and became a lot less worried about every alarm and beep. I also learned a few tricks i had never heard of, and am not looking forward to a job in the ICU. I feel that i will take well to it, and after orientation, will hopefully feel comfortable enough to work with vents by myself.

By the way, the unit where i was, some patients were 1:1, some 2:1. It was based solely on the acuity of care for that patient, not just because they were vented or on a drip. I had one that was 1:1, although she had already been decalred brain dead, because the family had not agreed to pull suport yet, and there was a lot of titrating there. Had another, newly vented that was stable and was not 1:1, despite being dx with status epilepticus. Never know what you are going to get!!!

[pH7.40, LPN]

I could teach you everything you need to know about BASIC care for a patient on a vent in about 10min. Most of it you should have gotten in school with a refresher in critical care orientation. Vented patients can many times be more stable than

non-vented. It's much easier to mantain an airway and ventillate a patient with an ETT than to try to saturate a patient with problem lungs using only non-invasive equipment (NC,mask, CPAP treatments, IS,..). Try not to let the gagets worry you. No matter how many toys we attach to a patient, there is still a person under there that will benifit from basic patient care interventions.

I couldn't agree with you more. At least with a vent you know you can control airway and ventilation, ie know your patient is breathing. I would much rather care for a patient on a vent than BIPAP where they could go into respiratory failure and have to emergently intubate. My second Med/Surg rotation I always volunteered to care for the chronic patients on ventilators and after getting over the initial fear realized that they are some of the more stable patients. Don't be scared, just ask for help and remember the RT is your friend.

[ICUmanager]

Is your travel contract in the ICU? I believe that if you were uncomfortable with caring for vented patients that it should have been made clear during the assignment of such a patient. Also, we have always had travelers that had their skills/experience made clear during the recruiting phase. If this was a rare assignment that you will have I would recommend a little refresher on vents just in case you run into this again. If R.T. is available where you are, I would recommend that you spend 20-30 minutes going over the ventilators. You can access a lot of information on-line regarding ventilator modes and safety, however your peers would probably be best at providing information regarding ventilator safety and what to do in emergencies since they are familiar with the vents, policies, procedures, physician preferences, etc.... Hope this helps.