Miscellaneous
Nursing Intubation Checklist - Yes, Really. Over the years I’ve developed a personal Nursing Intubation Checklist that I have for myself when preparing for RSI, DSI, or an awake intubation. This has saved my ass while working on very sick patients. Some of my checklist items cross over with the provider’s checklist. I’m sure it will evolve and I will update as needed. You may still be scrambling, but you can save yourself from going into a panic mode if your patient starts crashing and you’re trying to do everything so you don’t need to start compressions - tall order. Generally, I don’t hand over the intubation meds to the doctors until MY checklist is complete. There’s almost always time with DSI and awake intubations. With RSI you may not have as much time and you may need to hand over the intubation meds before finishing your checklist - the patient needs the airway NOW. Do you have a Nursing Intubation Checklist? Looking forward to having feedback and a discussion as to what should be added or taken away. Intubation has 4 main Parts The Decision to Intubate Setting Up for Intubation Intubation Post Intubation Care Some of my thoughts on Intubation Communicate with your provider as to what the plan of care is: BP low - do we need push dose pressors or vasopressors before and/or after intubation? Are we anticipating central line or A-line? Post Intubation Care is the most critical part of intubation (in my opinion) and it's VERY NURSING HEAVY. Providers should stick around and watch the patient. Patients like to crash right around this time. If your provider is not your ED Provider, they really need to stick around and not go upstairs. The more you have set up PRIOR to intubation, the SMOOTHER your post intubation care. Soooo Nursing Heavy that there will be a separate episode on Post Intubation Care...stay tuned! Here’s my Nursing Intubation Checklist 2-3 IV lines I prefer 3. Sometimes I even put in 4 or 5. Just depends on what I need or anticipate. Especially if they are very sick and you have a sneaky suspicion that you will need a NE drip for a crashing BP. You may need PDP but if you already have a drip ready to go - even better! Mentally think which medications and how many lines you need. Not all medications are compatible through the same line. Pet Peeve Alert! If a provider tells you, don’t worry about the extra IV line, we’ll put in a central line afterwards - don’t listen to them! If your patient is sick enough that the provider is already anticipating the need for a central and/or A line - you betcha you will need those extra IV lines while it takes them 20-30 minutes to put in that central line. Your patient may not have 20-30 minutes to spare if they are that sick because remember, you are doing a lot of medication adjustments for post intubation care. Make sure these are actually good lines. If they are not, this is the time to put in an ultrasound guided peripheral IV line or two. Traumatic Arrests or Hemorrhagic Shock may require 18 gauge or larger IV lines for massive blood transfusion. Pet Peeve Alert! But my rule of thumb is, if you can DEFINITELY get a 20 gauge in - I’d rather that you get the IV line rather than trying to only go for an 18 gauge or larger and then blowing all of your lines. This is not the time to have your ego in the way of patient care. The larger IV lines, if still required, can be placed after intubation with ultrasound guided peripheral IV placement in this situation. Your provider should also be thinking about inserting a cortis so you can rapidly infuse blood products through that line. If you're the provider - communicate this thought process to your nurse. Verbal Orders of Intubation Medications AND Post-intubation sedation. Both set of orders PRIOR to intubation - you will have a smoother transition for your patient during...