Airway supplies stocking

[Hamhock]

Advertisement - Members don't see this ad

For folks who work in departments with residency programs:

Who is responsible for stocking and checking there are airway supplies always available in the critical care areas (ie sections of the ED where patients who are likely to be intubated are brought to)? Who ensures there are handles with blades? Who ensures that there are endotracheal tubes/BVM/etc?

And after supplies are used, who is responsible for replacing those used supplies?

HH

 

[deleted92121]

For folks who work in departments with residency programs:

Who is responsible for stocking and checking there are airway supplies always available in the critical care areas (ie sections of the ED where patients who are likely to be intubated are brought to)? Who ensures there are handles with blades? Who ensures that there are endotracheal tubes/BVM/etc?

And after supplies are used, who is responsible for replacing those used supplies?

HH

In the ED where I work, the medic techs stock most of equipment that stays in the room. In other parts of the ED, crash carts are littered about. Those are locked and tagged and are taken care of by the charge nurse.

 

[EMAirwayLuvr]

For folks who work in departments with residency programs:

Who is responsible for stocking and checking there are airway supplies always available in the critical care areas (ie sections of the ED where patients who are likely to be intubated are brought to)? Who ensures there are handles with blades? Who ensures that there are endotracheal tubes/BVM/etc?

And after supplies are used, who is responsible for replacing those used supplies?

HH

Where I am the techs stock it but we often find we have a whole bunch of 9.0 tubes and no 7.5 or 8.0 's !!

 

[Tiger26]

at our place the respiratory therapists restock everything--they do a pretty good job overall

 

[TysonCook]

Our 3rd year resident is responsible for making sure the cart is supplied (3 shifts/day). If an item is missing, they write it down and personally had it to the charge RN to get it immediately.

 

[Hamhock]

Our 3rd year resident is responsible for making sure the cart is supplied (3 shifts/day). If an item is missing, they write it down and personally had it to the charge RN to get it immediately.

TysonCook:

Is that after someone else has already tried to replace items? vs. is that after an intubation the 3rd year writes, "one handle, one Mac 4, one 8.0, one stylet, on BVM, one suction, one secure device, one syringe, one ETCO2, etc."?

HH

 

[EM2BE]

I'm not sure who stocks it (who is assigned to). I've seen techs and nursed stock it. I have also found many things missing when needing to intubate. Handles that don't work with the blades. No stylets. Inappropriate tube sizes. Syringes and lube aren't a big deal as they are in each room as well. I would love to hear better solutions.

 

[The right Path]

I don't know if the ED does things differently, but in our units our airway supplies are in a tacklebox/toolbox type thingy that has a standard list of supplies stocked (done in central processing) all that is ziptied with the plastic breakaway tab so you know if it's been opened. Once a box is broken into it gets replaced immediately by central processing. It's a good system- everything that you expect to be there is there. The crash cart, airway box, defib, etc, stuff is religiously checked q 24 (and whoever checks it signs/dates the sheet) and always immediately replaced when used.

 

[Hamhock]

I don't know if the ED does things differently, but in our units our airway supplies are in a tacklebox/toolbox type thingy that has a standard list of supplies stocked (done in central processing) all that is ziptied with the plastic breakaway tab so you know if it's been opened. Once a box is broken into it gets replaced immediately by central processing. It's a good system- everything that you expect to be there is there. The crash cart, airway box, defib, etc, stuff is religiously checked q 24 (and whoever checks it signs/dates the sheet) and always immediately replaced when used.

The right Path:

I have two questions for you:

1. If there is something missing, is there a way to track back to find out who sealed/ziptied the box as a form of QA?

and 2. Do the folks in central processing check to ensure the bulbs are functioning (not burned out) and the batteries in the handles work?

Thanks,

HH

 

[The right Path]

The right Path:

I have two questions for you:

1. If there is something missing, is there a way to track back to find out who sealed/ziptied the box as a form of QA?

and 2. Do the folks in central processing check to ensure the bulbs are functioning (not burned out) and the batteries in the handles work?

Thanks,

HH

Hmmm... Good question. I believe that the person who stocked the box is documented somewhere. There is a number printed on the tab on the ziptie that we write down when we do our routine check. I also think there is a piece of paper with a list of everything and who packed it in there- I'm not sure since I've not paid attention to paper stuffs in there.

About the bulbs/batteries- I don't know, but I would think that they're checked as they are packed. We always snap in the blade and make sure the light works before handing it over and I'm pretty certain we have at least two in each box. I've never been present during an intubation in which that's been an issue.

There should definitely be a standard way of packaging airway equipment and accountability for it to be properly stocked and functional. From other posts, it sounds like that's not necessarily the case? I'm a little surprised, because that's such an avoidable vulnerabily.

 

[SoCuteMD]

The residents used to be responsible. It didn't go very well, though. I felt like every time there was a patch for a code/resp distress I'd look in the bag and it'd be missing something, which was mostly MY fault because it meant I hadn't checked it when my shift started. Now we get a kit from central supply with everything. Feels a bit wasteful when really the residents should just be doing a better job of stocking the airway kit.

 

[doctorFred]

i have to show up 15-20 minutes early for my core shifts and re-stock all of the airway gear in 2 trauma bays, 2 airway boxes, and a difficult airway cart. it can be a pain, but it means you (presumably) know where everything is and know what's missing before you need it. all of the 2nd year residents at my program have similar responsibilities.

 

[CraftyMed]

Where I went to residency, the 3rd year resident was responsible for checking and restocking the 3 airway tackleboxes at the beginning of their shift. Each box was labelled with what it should be stocked with and where it went in the box. The replacement supplies were in our ED core supply area. The RSI drugs needed to be pulled from the PIXIS by the charge nurse. The boxes were then locked with the disposable red tags. There was a note on the top that you signed off after you'd restocked. If an airway box was used during the shift, it was restocked by the person who used it. If there was something significantly wrong with equipment, the one piece would be sent to central supply for repair. There was usually enough to still stock the 3 boxes even if something had to go to central supply.

 

[pseudoknot]

I thought this thread was going to be about keeping a laryngoscope, blades, and ET tubes in a sock.

 

[deleted109597]

Feels a bit wasteful when really the residents should just be doing a better job of stocking the airway kit.

I beg to differ. Residents should not stock jack. They shouldn't transport, they shouldn't draw blood (unless doing femstick). They really shouldn't be putting in IVs, but I can see where sometimes it is better than starting a central line. The more nursing tasks (or even lower) we perform, the less learning about medicine we do. I can't remember a recent shift where I had 30 minutes to wander around stocking the airway supplies of the 3 trauma bays we had. I do remember frequently arguing with charge nurses about the lack of pediatric otoscope covers and being told that I can stock them myself or "just carry some around with me."

Yes, you should know where everything is, but you shouldn't have to stock it.

 

[EM2BE]

I beg to differ. Residents should not stock jack. They shouldn't transport, they shouldn't draw blood (unless doing femstick). They really shouldn't be putting in IVs, but I can see where sometimes it is better than starting a central line. The more nursing tasks (or even lower) we perform, the less learning about medicine we do. I can't remember a recent shift where I had 30 minutes to wander around stocking the airway supplies of the 3 trauma bays we had. I do remember frequently arguing with charge nurses about the lack of pediatric otoscope covers and being told that I can stock them myself or "just carry some around with me."

Yes, you should know where everything is, but you shouldn't have to stock it.

There is one advantage / disadvantage. I do not have access to the stock room, so they can't expect me to stock anything nor know exactly where things are in there. However, when you need something and no one is available, this does become problematic.

 

[Arcan57]

In residency, the R2s were responsible for keeping the airway trays in the 3 resuscitation bays stocked. It took about 3-5 minutes at the beginning of the shift depending on what had been used and whether you rechecked the cuff on every ETT (we had the tubes preloaded with stylet and then covered with a chux). The plus side was that you knew before the crashing trauma patient got there that the 3 Mac blade bulb worked until you put pressure on the blade. Although at my community gig there is a tacklebox stocked by central supply and I've only had one time when the bulb didn't work (we use the single-use blades) and I just grabbed a Miller instead. So I might have wasted hours of my life in an ultimately pointless ritual.

 

[deleted77919]

…

 

[erin682]

Where I trained we had airway trays that were sealed in plastic. The had a handle plus all typical sized blades for adults, tubes from size 5-0 to 9-0, stylets, bougies, nasal and oral airways, tongue blades and a syringe. They were at the head of every bed. We had a very sick population and intubated in every room in the dept. When a a tray was used all the unused packaged stuff got place into another tray. We also had bvm's in each room. A separate difficult airway cart with LMA's, king airways etc was available in each pod. It was great. Tech's supervised by the charge nurse were responsible for making sure each room was stocked.