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Bag or Not To Bag that is the question

I am doing a survey on bagging ventilated patients and the pro's & cons could you tell me if you bag patients on a regular basis and do you use a self inflating bag or a mapleson C system ? I am linking this issuue with VAP prevention.

Regards
Ron

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Permalink Reply by ric mandanas on January 13, 2009 at 10:33pm
Thou no longer being implemented in most hospitals, here in the hospital where i am working, ( in PICU) not only we bag intubated babies (self inflating), we also instill saline, practice known to be debated. Even with supporting papers have been presented to proper authorities, the incidence of blocked ETTs as to the adverse reaction of this practice takes precedence. As an RT I do put this in my "damn if u do damn if u don't" category. I do follow hospital policy. Btw we also have close suction caths.

I have used mapleson C system in my previous hospital. Personally, I do think that the incidence of barotrauma caused by improper use of self inflating is avoided using this. The maneuverability in using mapleson is of absolute necessity (and you don't want to be in an awkward situation during emergencies, specially in neonates and pediatrics). Mapleson is definitely for those who knows how to use the device.

Self inflating? Mapleson C? Its in the user that's makes the difference. Nice discussion topic ray.
Permalink Reply by Ronald Taylor on January 13, 2009 at 11:30pm
Hi Ric
The reason why I am bringing this subject up is for issues surrounding VAP prevention recently I had a discussion with a physio as she wanted to bag a patient on an FI02 .70 and PEEP +14 using the mapleson C so I stated that it was not good practice for the following reasons : Circuit disconnection, Dispersal of bacteria from vent circuit to the surrounding area, Loss of PEEP causing de-recruitment with loss of the FRC, Loss of PEEP equalizes the pressure from above the cuff and below the cuff allowing subglottic secretions migrating to the lung, increaed PIP, and tidal volumes which are not controlled causing an increase in the intrathoracic pressure's followed by a fall in cardiac output, Possibility if dislodgment of biofilm from the lining of the et tube, and barotrauma and volutrauma caused by the stear stress. She did bag the pattient while I was not around and gas exchange got worse. The trouble here in the uK is that our Physio's are so outdated with modern trends it affects the quality of care to our patients. Today ive got a policy approved in which if the physio wants to bag a patient they will have to get my approval. She did dsay that alot of mucus was suctions up but as I stated that is in the peripheral bronchi. Mapleson C circuits do not have PEEP attachment as I am sure you know. look forward to your comments.

Regards
Ron
Permalink Reply by ric mandanas on January 14, 2009 at 12:15am
hey ron, just for inquiry, are you presently working in the UK?
In the previous hospital where i worked, my boss is a Chestphysiotherapist from UK/Ireland (she had written couple of books on PT). I think they are more familiar using the mapleson with pressure manometer connected on one end. If you would imagine they can manipulate the bag to maintain the peep as registered on the manometer. Another clash of techniques here. Ron correct me if im wrong, RT in the UK is rare.

Another thing I dont think you can be with the patient 24/7, do you have colleagues there?

And lastly, Again I hope i am wrong, They suctioned the patient on purpose to show you that what they believe in (weather old) works. This is sort of usual human mentality of refusing to change. Ron Im all for something backed up with sound principle and tried and tested as we say. In the end we all want the best for our patients. I leave the VAP to the infection control people as again I follow hospital policy.

Well I think you are having fun time there. Good luck.. ric here.
Permalink Reply by ric mandanas on January 14, 2009 at 12:34am
btw i prefer to use the self inflating bag and I can control the adverse effect of self inflating bag that they claim. Its in the user as I said
Permalink Reply by Ronald Taylor on January 14, 2009 at 12:47am
Yep I am the only RT in te UK working in ICU, but there are other RT's from USA working in PFT Labs, I will be recruiting another RT soon I hope and I she will,be chosen as she is also an RT from the Phily and at present working in Dublin Ireland. The trouble with trying to generate PEEP with a mapleson there is a drop in PEF. I am on the European Group for VAP prevention I was one of the Pioneers and the only Representative from the UK the www is www.vapaway.eu the rest of the group are professors from around Europe.
Physio's here do feel threatened by me being around. But as I tell people a physiotherapist is not a Respiratory Therapist in the UK, but around the world it is changing and Physio's in Italy South America are exemptions to the rule they support what we are doing and they attend the AARC conventions I wish the UK would wake up and smell the coffee. The physio's here distance themselves instead embracing the work I am trying to do.

Take Care
Permalink Reply by mckan3 on January 17, 2009 at 11:51pm
Hey there ron , nice topic it's nice to know that there is RT now in U.K. before when i was there i cannnot find RT's in any hospital there,well it's a long way for you to let them know what's the importance of RT's ....hope you can make them feel the coffee
good luck mate cheers
Permalink Reply by Ronald Taylor on January 18, 2009 at 12:42am
Hi Henry
Being an RT here in the UK is hard work because RT;s are not well known but where I work I get alot of respect but some other professions feel threatened by my presence. But when stressed drink a nice cip of tea.

Good to hear from you

Ron
Permalink Reply by Ronald Taylor on January 22, 2009 at 9:17pm
Good Day
There are many RT's here in the even in Dublin Ireland as I met her today as paid our hospital a visit she is from the Philippines but they all work in PFT labs and as far as I am aware I am the only RT working in critical care.
Permalink Reply by Prem on February 7, 2009 at 9:44am
Wow thats really cool man to have RT in United Kingdom.

Breath Easy .
Permalink Reply by Prem on February 6, 2009 at 12:00pm
Great Job Ron nice to here this.That nice of you to put on a policy.Guys can try a AMBU bag with PEEP Valve Adapter.But guys using them need to Trained.

Regards.

Breath Easy.

Prem.
Permalink Reply by Ronald Taylor on February 6, 2009 at 7:58pm
Manual Hyperinflation (BAGGING) is only used on very selective situations. Periodic bagging for so called mucocilliary clearance does not work you just drive everthing downwards. Instilling saline also not a good idea as you shift the biofilm which contains bacteria off the inside of the ET into the lungs. Blocked ET's well ive not seen one for many years as we perform early tracheostomies also we optimise our humidification. As we are living in an evidence based world these techniques need to properly studied and supported by that evidence.

All the best
Ron
Permalink Reply by Arlene B Ocampo on January 29, 2009 at 1:04pm
hi there ron,
yep, it is very rare to see actual RTs in the hospital in UK...as most of the RT jobs are delegated to the nurses and the physios... i am a Filipino RT who worked in saudi arabia for 8 years...i am now based in UK...i (unfortunately) have to work in a different area of speciality...as a HCA because they told me i still have to study nursing and become a respiratory nurse... (sad...)
all the best for the RTs in UK. regards...

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