Posted on 03/30/2020 11:38:23 AM PDT by NoLibZone
How many ventilators can an Inhalation Therapist manage in a shift?
Thank you.
“How often do those tubes have to be cleaned?”
Time to order 30,000 SoClean machines!!!
Better make it 60,000...we're waiting for the apex!!
It’s actually moot to worry about organisms growing in the tubes, because apparently 86% of ventilated patients with CV19 die in the end. Being put on a ventilator is usually a last resort anyway, not to mention the severe impact the virus has on the lungs of the victims. These patients face an uphill battle any way you look at it.
Thanks.
In the US they are single use and they are removed ASAP. They might need to change them every few days for hygiene (except the one in your wind pipe) but it’s not critical to do so in time of scarcity.
Thirty years ago we might’ve removed them from the patient, clean them and donate them to third world countries. That got nixed by the legal people. “Liability” they said. They were re-sterilized prior to re-use.
Thanks for your reply.
My wife and daughter are Nurses - with ICU specialty - and both completed the premier certification for ICU work - CCRN (Critical Care Registered Nurse)...which can add anothr $1 to $2 per hour of salary with the CCRN certification.
FIRST - Ventilator are NOT used on regular med/surg floors - so many nurses are not familiar with vents - and don’t use them.
SECOND - ICU nurses have assignments based on patient acuity - some extreme cases like a patient post-op heart surgery like a bypass...is likely to be 1 nurse to 1 patient. Less serious - 1 RN might handle 2 patients. If patients can be say 25%...1 RN handling 4 less serious patients - that is about the lowest that the ICU ever goes. Typical average- per my reference experts - is 1 RN has 2 patients. SO - if a patient is on a Vent - are there other problems that require more oversight - or just the vent? Usually - the patient is in there for more problems than just respiration.
SOMETIMES- if breathing is the only serious problem - the patient might be moved to the step down unit - Progressive Care Unit (PCU) - if there are nurses on staff familiar with ventilators.
BUT - for this exercise - assume 1 RN could safely monitor 2 vent patients unless there are other serious problems. A Respiratory Tech can provide oversight of just ventilator operation.
BUT - you need that coverage 24/7 for every operational ventilator - so for a week of ICU ops with 20 patients - all on vents - 10 nurses per shift - and be 14 shifts in a week. A full time nurse might be working 3 shifts/week. So - you need 5 nurses for the week. (And - with time off - vacations - etc. - you might have 6 or 7 available)
SO - if you doubled the vents from 20 to 40 - you would need to double the staff available to provide the additional coverage....
ALSO note - most hospitals will select sharp RNs with experience - to try to train up for the ICU - and it can take 6 months or more to be fully trained to be an ICU nurse.
Thank you!
A well thought out explanation for us non medicals types like me.
Thank you again.
Okay. How in the world did I miss this one?
BTW - my wife posted something to FB to inform non-medical friends of something else interesting. BTW - JCAHO is “Joint Commission on Accreditation of Healthcare Organizations”
HERE GOES -
This pandemic has shown light on something that has been a sore spot for many of us in medicine: the waste and irrelevance of JCAHO and JCAHO’s interference with our daily lives in providing medical care.
For those unfamiliar, JCAHO is an accreditation organization that inspects and accredits hospitals and medical organizations. JCAHO was formed in the past to help ‘clean up’ shoddy unsafe practices in medicine. It had a role, an important role, and made a difference in transforming the quality, reliability, and safety in medical practice.
Fast forward to today, and JCAHO has, like most government or government-like organizations, morphed into a swollen, self-serving, irrelevant, non evidence-based cancer that inhibits patient care on a daily basis and whose number one influence on the practice of medicine is to help generate massive amounts of waste, inefficiency, and administrative burden and cost.
Take, for example, the fact that hospitals are running short on simple things like face masks. For the last year or two, I’ve been routinely going through at least a box of masks every day I’m at work! Why?! Because the JCAHO inspectors threaten hospitals with fears of failed inspections and financial implications if they see someone walk out of an OR and keep their mask on or hanging around their neck. Yes, that’s right. I can walk into an OR for a 30-second check on a patient and I’m mandated to trash the face mask I just put on. Enormous cost and waste. Multiply this by the numbers of people and numbers of ORs around the nation and the waste and trash generation is almost difficult to imagine. There is no evidence that me wearing a mask for more than one encounter or throughout a portion of the day has any bearing on patient infection rates. In fact, for anesthesia providers or circulating nurses, there is no evidence to show wearing a mask at all makes a difference in surgical infection rates.
Another example: there is a little plastic device we call a Christmas tree. It’s a tapered plastic connector that threads onto the oxygen supply on the wall. It allows the soft plastic end of oxygen tubing that goes to a patient to be connected to the oxygen supply. Well, JCAHO has recently been on a mission to force hospitals to follow manufacturers’ guidelines to a T for everything! Somewhere along the way, the manufacturer of this plastic connector stated it’s a single use device. So JCAHO has gone on a mission to force the removal of this plastic connector from the wall after each patient. Sometimes this plastic tree is connected to a plastic supply fitting. Where does one draw the line as to which plastic piece should be changed? What about the plastic-based pipeline in the wall to which the plastic valve and tree are connected? So, now, we have boxes of hundreds or thousands of these little Christmas trees so that we can change them for each patient. I mean, by this rationale, why wouldn’t we need to change the light switch or the TV remote? Why not the faucet handles and toilet seat?
At the time of a recent inspection I witnessed nurses throwing marking pens, lotion, salt packets, alcohol wipes in the trash. I inquired as to why...because JCAHO says anything that is ‘expired’ according to a date, or that has no date, should be thrown away. At least that’s how they interpret and behave with the inspections. Yes...salt packets. Salt...could be thousands of years old...but no expiration date so let’s throw it away. Hand lotion...you know, it might turn into poison if it’s over an expiration date. Marking pens!!!??!!! Really?!! A whole tub in the trash because some JCAHO inspector couldn’t find an expiration date on them.
Where is JCAHO now? They are showing us how important and relevant they truly are.
Thank god for common sense and resourcefulness in the time of this crisis. Because if you think JCAHO would allow daisy-chaining a ventilator to treat more than one patient , or allow an anesthesia ventilator to be used on an ICU patient , think again.
And, I haven’t even scratched on the numbers of nursing administration positions that have been created to handle the workload of complying with JCAHO demands.
If you want to know where the expenses are in American Medicine, look no further than the government bureaucratic red tape and the administrative burden it causes. They are stealing dollars that could go to actual patient care!
The most awful experience in my life. The surgeon's assistant nicked my lung when sawing through my sternum. Definitely gives you more compassion for those who have to be on a vent for extended periods. Ugh.
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