I realize this is a silly thing to post but here goes. Does anyone work at a place where RT's manage the vent, but don't do a vent/patient assessment with the abg draw.

GJ,
We have total Patient driven protocols here and part of that is ABGs. We assess the patient first so that we have cause to do an ABG. I used to work in a place that had standing orders for ABGs Q a.m. and it was o waste of time and expense.
A few years ago there was a study done on the over utilization of ABGs (I think it was in Respiratory Care). It was very insightful. Doing an ABG because the Dr. says so is very archaic and we need to be more proactive and do what is best and pertinient for our patients.
With protocols in place, assessment is one of the big keys to success.

Where I work the RN's do the pokes if there is not an a-line in place. If there is, we usually do them. That is just peachy with me. I never liked poking around for arteries anyhow

Bill
I 100% agree with you.

RTGUY
Glad I don't work at your facility, sound like a mindless RT department, if not I apoligize for my comment.

GJ,RRT

Time for a little tale.

Many years ago at a very large local county hospital it was decided that the residents and interns would do the ABG draws---instead of the RT's.

The volume of ABG's decreased by 75%.

Was the spo2/etco2 technology as good as it is now? Did the residents/interns do enough appropriate ABG's. I question any department's RT's where residents make more appropriate decisions with regards to respiratory then the repiratory therapists. The only exception would be the resident who was first an RT. I have seen pulmonary MD's order inappropriate ABG's.

I don't know the answers to your specific questions. It is a tale from a person whom worked there, one I trust alot for being truthful. It had to be back in the eighties or earlier. My point is that the residents and interns changed their tune about whom really needed ABG's when it became their task. If they really felt most of those ABG's were needed the drop-off wouldn't have been 75% when they had to do them.

Cool. I wonder how many fewer treatments would be ordered if Drs had to do their own. I bet it would be the same 75%.

quote:

GJ,RRT

I am glad you don't work here either. You sound like an self-important prick.

Sorry for offending you RT Guy. i was trying to make the point that if the RT's are not involved in the pre abg assessment with a vent check how do you know what to do with the vent once you get your results. I currently work at a semi mindless department, but am trying to get things changed. When i first got here Rn's did some of the pokes and a-line draws. The problem with this is the Md's the would make changes based on the results. Why would you wean the RR in CMV if the patient is consistantly assisting? This is what our docs were doing. We would have patients on backup rates of 6 and breathing 10+. This is OK, but what about when the RN's knocks out the patients RR drive to do a bath? The point is RT's and only Rt's should be drawing the Abg on a vented patients, but only after a full patient/vent assessment. Also, shouldn't the patient be well suctioned before you draw your Abg? I don't mean suctioned just prior, but 30"+- before. If it's a poke, do your Rn's take their time and then probe around looking for an artery, all the while your patient is making themselves alkalotic. If you don't do the Abg you'll never know, and may make inappropriate vent changes.

So if your hospital isn't doing 100% of the vented abg's, maybe it's time to push for change, like I am currently doing.

Oh, and yes I'm considered to be a prick by some, but some of those same people would rather look up and see me managing their vent compared to the 'mindless RT's".