Walking vented patients

SummitRN, BSN, RN · Feb 18, 2012

There has been talk. There is apparently a lot of good research supporting it that I haven't read. Some of the other hospitals do. It sounds very personell intensive. To be safe, you'd need RT, RN, CNA, and maybe PT.

sapphire18 · Feb 18, 2012

We don't even sit them up in a chair. I saw a thread about this a while ago and started researching it; at first I thought it was absolutely nuts but once I read more about it I see the benefits are many. I think that at least getting them OOB should be a routine thing, and if you are able to get them off sedation then walking seems to prevent many complications, especially deconditioning.

massrn116 · Feb 18, 2012

We used to get vented patients up to chairs, these days patients are overly sedated with fentanyl and versed. One cough and some of the nurses will up the drugs. The intensivists promote a RASS of -2. Patient's will be a -3 or -4 and still the drugs will be tanked. The result...an overly sedated, deconditioned patient that will take weeks to get moving again if not months.

EMSnut45, BSN, RN, EMT-P · Feb 19, 2012

Yes, I have done this on multiple occassions.

The trick is to get a patient that does not cough/gag on the ETT when off of sedation, strong enough, and stable enough. If they meet this criteria, then they have earned a walk around our unit!

We usually have at minimum the patient's RN, RT, and PT/OT. Throw in a few cheerleaders, and off we go!

We also get every patient who is stable OOB to the chair daily-- either by their own power, or we pull them over to a stretcher chair.

And being "short staffed" is not a reason not to get them up and moving. You really have to have a team approach. Our physicians have been known to pitch in when needed.

I was not initially a fan of this mobility program, but since we have started, I am a firm believer that it helps the patient. The patient and their family feel like they are progressing, getting out of bed helps lift patient's spirits (not sitting in bed all day everyday), the number of ventilator and critical care days are decreased, and length of rehab after hospital discharge is decreased. And this is from what I have actually observed, not pulled out of the research articles.

umcRN, BSN, RN · Feb 19, 2012

not in my peds cicu...parents are lucky if they get to hold their stable, intubated infants.

I have seen a video though on a news website about a girl walking on ECMO to stay conditioned for a double lung transplant. That was impressive!

Ann Cannoy · Feb 19, 2012

I really dont know that much about walking vented patients. I worked in ICU at least 20 years ago and we almost always got our vented patients up in the chair. It appears to be a natural progression in outcomes.

canchaser, BSN, RN · Feb 19, 2012

Yes, I have walked a vented pt.,. I've even to the dismay of the intensivist extubated a pt sitting up in a chair that could be folded out to a stretcher. He said what would I have done if the pt didn't fly..... Lay him back in the stretcher position and u would have reintubated... Back In the day, we nurses scheduled Stryker chair time for our pts. Everyone got up unless to unstable. The body is not designed to be in bed 24 hrs a day

Verbatim · Feb 19, 2012

I appreciate the comments.

I use to work in an obscure hospital. The only people who have heard of said hospital are those people in the region. It is a teaching facility, a level one trauma center, and holds Magnet status. Patients who met the criteria, were indeed ambulated. I started working at this facility in 2008. Talk about progressive!

I now work at a hospital with a well known national name and reputation. A vented patient was ambulated for the first time in this facility last week: Feb. of 2012!

I guess that I am more amazed by the fact that an obscure hospital in the North is more progressive, in this regard and others, than a very well known hospital in the South. I am not down on this hospital as much as they are believers of their reputation. By the way, this facility is a teaching hospital, performs all solid and hollow organ transplants, including hands, and does not hold Magnet status. Just in case you all were curious.

Verbatim · Feb 19, 2012

not in my peds cicu...parents are lucky if they get to hold their stable, intubated infants.
i have seen a video though on a news website about a girl walking on ecmo to stay conditioned for a double lung transplant. that was impressive!

indeed!

Verbatim · Feb 19, 2012

yes, i have walked a vented pt.,. i've even to the dismay of the intensivist extubated a pt sitting up in a chair that could be folded out to a stretcher. he said what would i have done if the pt didn't fly..... lay him back in the stretcher position and u would have reintubated... back in the day, we nurses scheduled stryker chair time for our pts. everyone got up unless to unstable. the body is not designed to be in bed 24 hrs a day

i appreciate the reply.

you have a fan in me! :yeah:

Esme12, ASN, BSN, RN · Feb 19, 2012

Many years ago I worked with a great doctor. As early as 1982 he was feeding (custard consistency) and popsicles to his vented patients. We couldn't walk them but we got every vented patient up that could tolerate it, especially open hearts back in the day.....when we kept them intubated FOREVER.....would get up in the chair and eat their popsicles. Yes I have walked vented patients when the vents got small enough.