Who does your IABPs

[TennRN2004]

I was suprised to hear that in some areas the respiratory therapists did the insertion and management of IABPs. At my facility, we have the perfusion department who set them up preop/intraop. As far as management, we have two different types. One is leveled to the patient by a fiberoptic catheter during insertion so it is never leveled or adjusted. The other has an auto mode that is set up by perfusion and according to the manufacturer the operator cannot get the machine to augment better than the automatic mode on the machine itself can do. Pretty big boast, but so far I've never seen it proved wrong. I know it is totally area dependend, we have some great RTs, but I could not imagine having them running the IABP on a heart.

Also, we are not allowed to touch the vents at my facility, even to titrate FIo2, which I think is silly b/c we titrate o2 in every other type patient, I don't know why that is different. I would never change the rate or mode of ventilation, but RT is very territorial about their vents, and we've had nurses get in big trouble even for going from just 40 to 50% for sagging sats until RT could get to the patient. We have a new nurse coming to work with us who did all of the weaning to extubate on the hearts where she used to work. How is the practice where everyone else works on things such as IABPs, vents, etc.

[JustMe]

I thought anyone monitoring the pumps had to be a certified perfusionist or an RN. Isn't there a school in Texas to train perfusionists? An RT managing the pump?? Our perfusionists run the bypass equip in the OR as well as the IABP and then make rounds daily on all pumps. They also dc the balloon cath for us when ordered.

Yes, the RTs can be very territorial but when they get to know us they realize we aren't stupid and can up the FiO2 if the patient needs it--then we CALL them--get them in there to help evaluate what's going on. I've been in critical care for nearly 25 years and started with the old MA-1's:roll (Boy does that date me!) My RTs know that I know what I'm doing with my patient. They know what they're doing with the vent. We get along great that way. But RTs on the pump?? Very scary!!:chair:

[ZASHAGALKA, RN]

I thought anyone monitoring the pumps had to be a certified perfusionist or an RN. Isn't there a school in Texas to train perfusionists? An RT managing the pump?? Our perfusionists run the bypass equip in the OR as well as the IABP and then make rounds daily on all pumps. They also dc the balloon cath for us when ordered.

Yes, the RTs can be very territorial but when they get to know us they realize we aren't stupid and can up the FiO2 if the patient needs it--then we CALL them--get them in there to help evaluate what's going on. I've been in critical care for nearly 25 years and started with the old MA-1's:roll (Boy does that date me!) My RTs know that I know what I'm doing with my patient. They know what they're doing with the vent. We get along great that way. But RTs on the pump?? Very scary!!:chair:

My first vents: Bear IIIs and Servos. Now, NPB840s and a few remaining PB7200's.

Boy, that's come a long way. I remember being happy about getting the 'new' 7200s (back when some of the 7200s had monitor displays and some you had to look on the machine to see the settings/pt efforts). Now, not only are the Bears a relic but we only have 1 7200 left without a 'heads up display'.

I'm hoping Arrow does the same thing for the Datascope Sys97s.

~faith,

Timothy.

[TennRN2004]

My first vents: Bear IIIs and Servos. Now, NPB840s and a few remaining PB7200's.

Boy, that's come a long way. I remember being happy about getting the 'new' 7200s (back when some of the 7200s had monitor displays and some you had to look on the machine to see the settings/pt efforts). Now, not only are the Bears a relic but we only have 1 7200 left without a 'heads up display'.

I'm hoping Arrow does the same thing for the Datascope Sys97s.

~faith,

Timothy.

I'm still relatively speaking a newbie ICU RN (little over 2 yrs exp), but man are we a spoiled bunch! I just take it for granted all the bells and whistles we have today until I hear some of the older nurses sit around and talk about how it used to be. You know, all my other new collegues tend to disagree with me, but in a way, I think it makes your generation nurse much stronger than us. We lean so much on technology that we don't always have to think about the hows and whys of what is happening. The older guys are much better about being adaptive and trouble shooting than we are. Is this your experience as well Timothy?

[hrtprncss]

Same here, only balloons i worked with up to this point are datascope 98, and 95(but i haven't seen those in a long time). The Arrow one Tenn is describing sounds nice. Tenn, when you say fiberoptically zeroed in the OR, does that mean you don't have to zero the balloon periodically anymore, for instance at the start of your shift? PB7200 was my first vent...For some reason even if they were much bigger than the dragers I see now, I seem more "at home" with it.

For some reason i like this... http://www.pulsebiomed.com.au/images/7200.gif

than this http://www.ovc.uoguelph.ca/news/images/ventilator_2c.jpg

[TennRN2004]

Same here, only balloons i worked with up to this point are datascope 98, and 95(but i haven't seen those in a long time). The Arrow one Tenn is describing sounds nice. Tenn, when you say fiberoptically zeroed in the OR, does that mean you don't have to zero the balloon periodically anymore, for instance at the start of your shift? PB7200 was my first vent...For some reason even if they were much bigger than the dragers I see now, I seem more "at home" with it.

For some reason i like this... http://www.pulsebiomed.com.au/images/7200.gif

than this http://www.ovc.uoguelph.ca/news/images/ventilator_2c.jpg

That's exactly right, the arrows are zeored with the patient upon insertion. The fiberoptic catheter continuously reads off the patient, so there is no need to zero at all for it to be accurate. The problem I was talking about with having crappy numbers happens rarely, but if perfusion doesn't calibrate it correctly during insertion, then you will have good timing, good augmentation, but not the best numbers, and you can't zero it to fix your numbers, since the fiberoptics function is constantly reading off the patient and leveled during insertion.

[pickledpepperRN]

We are out of date.

We use the transport System '91.

I first learned with the System '83 with the "magic "8" ball"

Who remembers the MA-1 vents? The bellows would stick causing vistiors to panic.

[ALCCRN]

They must teach RT's to be territorial in school...Most RT's that I have come in contact with do as little as they can get by with. So I could never imagine that they would manage an IABP. At my facility they are not trained to do this, although I always heard they were taught how to perform a CO/CI in school. Where I work the IABP is placed in the Cath Lab, CVOR, or in the unit in dire circumstances. Insertion is always assisted by nursing staff and removal is done by the physician with nursing help.

We do some titration of vents, but only with RT personnel that I know and trust. I would never touch someone's vent that I didn't know. If settings on vents need to be tweaked, we ususally put our heads together and decide what needs to be changed. If I don't agree with their suggestion, I always let them make the decision. And there have been times when I've said "I told you so".

I dare say that I would take the heat for a patient going down the tubes because the RT didn't get there in time. I would definately suggest a "planning session" (let's be tactful) to decide what our plan would be for instances such as that.

[chaosRN, ASN, RN]

They must teach RT's to be territorial in school...Most RT's that I have come in contact with do as little as they can get by with. So I could never imagine that they would manage an IABP.

I agree - we are not allowed to touch the vents. Occaisionaly we have a very familiar RT who we can just call if sats are low & tell them we bumped to o2 up. other than that---DON'T TOUCH THE VENT!!! haha

RT managing IABP - oh no..not at my hospital. We use the datascope 95 & 98 and we have been told the "auto-pilot" IABP is comming soon (Just when I'm finally comfortable adjusting the timing). I don't know what model or who makes the one we're getting.

[HawaiiRRTRN]

I'd like to share my experience. I was a RT who worked at a hospital where the RT managed the IABP. Basically, upon insertion of the IABP by the MD, the RT would stay with and manage (adjust/troubleshoot) the IABP from the cath lab to the OR and finally to the SICU where the patient and the IABP would be turned over to the SICU nurse. The RT's and the SICU RN's recieved additional training and inservicing and maintained yearly competencies in the IABP. There was a core group of RT's who had this training and they were the ones who managed the IABP. There was usually a RT supervisor in-house who could start the IABP on most day shifts but for other shifts, the RT's took call. It was never expected that a core group RT would be pulled from their regular assignment to cover the IABP. The RT's took IABP call on their days off. Nice way to pick up a little OT!

Some of the posters in this thread have mentioned they cannot see a RT managing a balloon pump and give some valid reasons why (workload, interest in doing IABP's, etc.). Sometimes I think there may be some misunderstanding about the education RT's go through. I recieved far more cardiopulmonary A&P education in RT school than I ever did in nursing school (BTW-I am currently a RN, working in critical care, finishing my RN-BSN program) and my RN education only touched on the basics of cardiopulmonary A&P. If you think about it, how many IABP's were you exposed to as a nursing student? Not many, I bet, unless you were fortunate enough to do an externship or some clinical time in a CVICU. Most of your critical care skills were learned after you were hired into a unit and completed a critical care class and orientation. My point is, if you can train a nurse to manage an IABP, you can train a RT to do it, also. Yes, it comes down to staffing issues, politics, and of course, money when determining who manages these things and sometimes I feel RT's are underutilized given their education and training. However, I understand that the job description for RT's is determined by many factors, including hospital politics and budgets.

There have also been some interesting comments on the territorality of the RT's and the vent. Now that I am on the "other side of the bed" so to say, I have a better appreciation for the nurse's concern when the patient is crashing and the RT is not around, whether they are busy with another patient or are just not around. I will make vent changes now in emergency situations only, but I'm sure to communicate any change to the RT right away. Changing a FiO2 setting if a patient is desating is appropriate, but I leave all other vent changes and weaning up the the therapist. I am quite busy as it is doing my nursing duties, why would I want to do the work of the RT, too?

Just thought I'd add my perspective.

HawaiiRRTRN

[rninme]

I started out as an RT...many, many, many years ago. I was trained as an IABP tech when I started working in adult ICU. Our staffing ratio was 1 RN, 1 RT to that pt. The RN managed the drips, the swann, etc...I managed the balloon pump and the vent. We worked together. I didn't touch the drips....s/he didn't touch the vent....both of us were certified in IABP. Win-win situation.

That was over 20 years ago....and yes, I remember the MA-1.....I remember the monahan vent....it looked like ET. I also worked NICU....and was trained in ECMO......and I remember the old "baby vents"...who could ever forget the BP 200??

As an RN...I make vent changes if RT doesn't happen to be right there....and I let them know the minute they walk into the room. Never had a problem....but again, I am NICE to them, respect their knowledge and expertice and they know that I am more than competent in ventilator management. Having an attitude gets you nowhere. It's not about turning a dial....it's knowing the potential problems/complications of making that change. Just my

[augigi, CNS]

Very funny to read this thread - it is SO different to Australian CTICUs! We manage IABPs - often they are inserted in the cath lab or OR, but just as often inserted in the ICU (as well as peripheral ECMO). All IABP patients are 1:1. The RNs manage the timing. We used Datascopes.

When I was in the US I got a chance to use the Arrows (fiberoptic) and they are MUCH better. They are never zeroed after insertion as the fiberoptic lens is zeroed to atmosphere prior to insertion. As they read real time numbers, they are almost flawless, even in tachyarrhythmic situations.

In Aussie CTICUs, we don't have respiratory techs, or balloon techs. Unless a patient is stable and not ventilated, they are 1:1 and the RN manages everything - NO, ventilator, IABP, VAD. Perfusionists do round on and adjust ECMO settings, although nurses are also allowed to do that now since we had an ECMO course.

I would HATE having techs doing stuff to MY patient!

[begalli]

Wait.

What exactly does "manage the iabp" mean when the RT is managing it? Does that mean timing, charting, etc? Can someone explain.

If the patient with an iabp needs intervention who decides what needs to be done (fluid bolus, titrating trips, etc) the RN or the RT or is it a collaboration between the two? I mean does the RT manage the machine or manage the machine and the patient? I just can't imagine separating the two?

Pardon my ignorance, but if a patient has a balloon pump is a nurse who is not certified in iabp permitted to take care of that patient as long as there is an RT to manage the pump? How can a nurse properly manage a patient if s/he does not have a clearly demonstrated understanding of what the pump does and how it's manipulated?

I've learned so much over the years from RTs. But I've never heard of them managing iabp's.

RT's do all things respiratory where I am. That includes the vent. If we value our well-being, we don't touch it and neither do the docs. If a patient is desatting there's a button to give supplemental O2 (100%) that can be hit without changing any settings. I appreciate and count on them to manage the vent. While I comprehend every aspect of our ventilators....that's what RT's specialize in.

RT's are not the only ones who are passionately territorial.