Anyone else have trouble with RT's while in hospital

[Aboveallislove]

Actually our 5 year old was doing it for a bit and was fine with it...it pushed him but he tolerated it fine. (He's much tougher than I!) He couldn't do the huff coughs yet. We stopped because DH wanted to stick with what we were doing since he hasn't had any lung issues yet and why mess with what's working. (I'm always looking for the next best thing and read about it on here, so a few our definitely using it) [added that] We now do 12 at 50 for 10; 14 at 40 for 10; 12 at 60 for 5 and 12 at 70 for 5. I'd love any feedback on that as we get very little guidance from our RT on it (that sounds fine and we're fine with Minnesota protocol.)

 

[The Dot]

Actually our 5 year old was doing it for a bit and was fine with it...it pushed him but he tolerated it fine. (He's much tougher than I!) He couldn't do the huff coughs yet. We stopped because DH wanted to stick with what we were doing since he hasn't had any lung issues yet and why mess with what's working. (I'm always looking for the next best thing!) We now do 12 at 50 for 10; 14 at 40 for 10; 12 at 60 for 5 and 12 at 70 for 5. I'd love any feedback on that as we get very little guidance from our RT on it (that sounds fine and we're fine with Minnesota protocol.)

He really sounds like a tough fellow! On our VESTs (Hillrom) we have the frequency (which can be set between 5 and 20) and the pressure (I think I called it intensity before - this can be set from 1 to 10). So, looking at what you posted, I am assuming first that you are using a different system and next that the first number is the frequency, the second the pressure/intensity and the third the time. But, basically, if it works for you, then those are the perfect settings for you. Nothing is carved in stone and nothing will work for everybody every time. The ideal settings are the settings that you (or your child) can tolerate while reaping the maximum benefit from treatment.

 

[Aboveallislove]

He really sounds like a tough fellow! On our VESTs (Hillrom) we have the frequency (which can be set between 5 and 20) and the pressure (I think I called it intensity before - this can be set from 1 to 10). So, looking at what you posted, I am assuming first that you are using a different system and next that the first number is the frequency, the second the pressure/intensity and the third the time. But, basically, if it works for you, then those are the perfect settings for you. Nothing is carved in stone and nothing will work for everybody every time. The ideal settings are the settings that you (or your child) can tolerate while reaping the maximum benefit from treatment.

Yes he is! And yes, I'm bragging!! ;-) Yes, we use the Smart vest and that how the numbers translate. But augh...that's what our RTs tell us too. I just like specific instructions!!! (Thus, I loved the Minnesota protocol!!), but I think it works well so we'll stick with it. Thanks for your time.

 

[Gammaw]

What great feedback you're getting Dot! I have to say that I watch the RT's every move with my little guy. It seems that most of them are not from the same RT group that does the testing/vest fitting/ etc during CF Clinic days. Instead they seem to be a group of RT's that work with all the children in the hospital instead. So their gloving/gowning and basic infection control measures are sometimes lacking. They also show up at all hours which is pretty tough on a stressed kid. In addition, they don't usually understand what they're supposed to be doing with the nebulizers (they always want me to take the disposables home and are proud to suggest it to me!) And they have difficulty understanding, for example, that my guy had a meconium ileus, and therefore has scar tissue that makes vest therapy painful without the foam inserts. They always want to use the band type on him and he absolutely cannot tolerate it. We have a Respirtech vest fitted with foam inserts for his belly pain. So, I've given up on the hospital's RT's despite the fact that some are very nice and try very hard to do whatever I tell them. I simply let them know when I come in that his vest is coming too, have it approved by the treating physician right off the bat, and put the dang thing on him myself - usually pretending to show the RT how and why, etc. Really, I'm pretending. Because the next time he's scheduled for treatment, it will be a different RT.

It really makes sense to me that the RT's working with the CF kids should be more knowledgeable than they are. Doesn't it make sense to have a smaller group that is more familiar with CFers? Teach infection control and all the nuances needed for RT on a CFer to them once and get it done!

Thanks for asking!

 

[The Dot]

What great feedback you're getting Dot! I have to say that I watch the RT's every move with my little guy. It seems that most of them are not from the same RT group that does the testing/vest fitting/ etc during CF Clinic days. Instead they seem to be a group of RT's that work with all the children in the hospital instead. So their gloving/gowning and basic infection control measures are sometimes lacking. They also show up at all hours which is pretty tough on a stressed kid. In addition, they don't usually understand what they're supposed to be doing with the nebulizers (they always want me to take the disposables home and are proud to suggest it to me!) And they have difficulty understanding, for example, that my guy had a meconium ileus, and therefore has scar tissue that makes vest therapy painful without the foam inserts. They always want to use the band type on him and he absolutely cannot tolerate it. We have a Respirtech vest fitted with foam inserts for his belly pain. So, I've given up on the hospital's RT's despite the fact that some are very nice and try very hard to do whatever I tell them. I simply let them know when I come in that his vest is coming too, have it approved by the treating physician right off the bat, and put the dang thing on him myself - usually pretending to show the RT how and why, etc. Really, I'm pretending. Because the next time he's scheduled for treatment, it will be a different RT.

It really makes sense to me that the RT's working with the CF kids should be more knowledgeable than they are. Doesn't it make sense to have a smaller group that is more familiar with CFers? Teach infection control and all the nuances needed for RT on a CFer to them once and get it done!

Thanks for asking!

You are correct - it is not the same bunch of RTs. In our situation, there is one RT at the clinic who is employed by the clinic to do education and one RT employed by the clinic who does testing. I believe they use an RN to measure for the VESTs. The RTs at the hospital are employed by the hospital. We have given special training to everyone in the department, but some excel and these are the ones we try to assign to the CF patients. Unfortunately, there are days when there just are not enough of the "good ones" to go around. What do you do when a third of your staff calls in sick?! And, too, RTs spend 2-4 years in highly specific training - specific mainly to the respiratory tract. They are not taught all about the nuances that you mention that go along with CF. I have learned a lot as I go along, but I am fortunate that I was picked out to provide specialized care so I have more time to learn those nuances (and I am still learning!).

Thank you for being patient with the RTs that you deal with - you will help to educate a few and that will help someone else down the line have a better outcome.

 

[regina65]

My hospital stay went great this time around. The RT's were great let me do my nebs on my own without them standing over me. Their food wasnt great but plenty of it. The nurse's were awesome, all of them. It was weird this time though they took out my pic line an day 10 and let me go home. I was on Zoysn, Vanc, Levaquin. The Cepacia was the culprit this time around my dr said the MRSA did not show up in cultures. She said she didnt trust that so went ahead and treated with Vanc. I have been on oil of oregano for months now and it has been shown to kill MRSA. My last 2 cultures did not show MRSa. Makes me wonder. I stopped the oil of oregano when on iv meds. I have started it back as it helps a lot with inflammation in my lungs

 

[cnsky54RRT]

Ugh, found this thread while browsing and it makes me cringe. I'm sooo sorry for some of the experiences you have had!

My old school training makes me more inclined to do hand CPT unless the patient arrives with a vest because we don't have those in our inventory, just little air-powered vibrators that they call percussors. I'm not much convinced that they do anything other than relax muscles...

And the infection prevention. Where I work we gown and glove and mask for CF kids, but on adults it depends on what is going on with them. I feel weird when I'm dressed up in a room and a doctor breezes in with nothing extra on and does an exam. Gawd, will our industry EVER get this right?

Scheduling - the doctor orders say when we must do treatments and so on, we don't always have much leeway to change things. My adults have their own schedules, and I change when I come see them to when they want, especially if they want to sleep in. I sometimes get in trouble for this from the higher up food chain, after all, we have doctors and insurance companies to make happy, not necessarily in that order. The system is not friendly to actually doing what the patient wants. Oh, we have seminars on how to meet the need of our 'customers', but I fear that they really mean the companies that pay. It's a hard place for those of us who care to fit in, especially in the USA. I found it easier in Canada before I moved south.

On behalf of those of us who hate this disease and want to help you, my deepest apologies. Tell us where we fall down because we need to know!

 

[GoryLori]

I go to a major medical center for CF care in the US BUT...they are so lacking in getting Adult CF care right when it comes to inpatient admissions. The RTs are generally the pro's and they know their stuff, but they also are so burned out they would hardly go the extra mile for you....they just aren't thrilled to be doing the same old repetitive tasks for 12 hours every day...period. The RT's do NOT do CPT here..... Nope. Don't even ask them. You are told ONLY the Physio Terrorists (PTs) do chest physio and even that is so rare as every CFer is loaned their own, personal one time use EnCourage Vest machine while admitted. Then it is sterilized for the next person....and so on. If you prefer manual, hands on CPT, bring your own person to beat the snot outta you cuz here, it doesn't happen unless YOU supply the manpower to do it. Another rule that I HATE and REBEL against is that the RTs must set up and witness you nebbing all your nebs. How stupid is that?? They believe left on our own, we DON'T INHALE!! They waste 30+ MINUTES JUST VERIFYING THAT i DID INHALE THE Albuterol/Pulmozyme/Tobi/Caystin/Colistin, etc.....There are a few RTs who have known me for 15+ years and let me get away with setting up my own nebs AND inhaling them un-monitored...and I deserve that, but the other newbies are steadfast in the rules that they alone must load up my nebs and invigilate (witness) that I inhaled them all down. It hardly forms a bond of trust.

 

[The Dot]

We have that rule about having to witness the self-administration of any medication here where I work too. It was set up by a pharmacy committee and it is hard and fast/set in stone. HOWEVER, we do get around it a little bit. We require that the CF doctor specify which patients may self-administer. (Honestly, they do not want everyone to self-administer because they want the RT to have time to get to know the patients and it takes time to find those tiny flaws in technique, which we discover while conversing with and administering treatments to our patients). The doctor writes an order stating "OK for patient to self-administer RT medications", or something similar. Then, we go by and see the patient to find out when they plan to do their treatments. We come back around that time and scan the meds into the computer and give them to the patients. Then, we do an opening assessment of breath sounds, pulse, pulse ox, and respiratory rate. After an appropriate amount of time, we come back and do a closing assessment. (This is an exception to our self-administration rule and is only allowed with CF patients). At that time, we dispose of the nebulizer(s) which was/were used for Albuterol, Saline, Budesonide, etc., and either wash and cold sterilize the other nebs or go over the patient's cleaning and sterilization technique to be sure that they are going to be able to adequately clean and sterilize their own equipment.
Unfortunately, the RTs here have a full load plus the CF patients that are on their floor. (We have 2 primary pulmonary floors, so this is where the CF patients will be located.) We send other RTs to help out when they are through with their rounds, but 1st rounds are killer for everyone because all of the Q3, Q4, Q6 and Q12 treatments are due first rounds and you cannot be everywhere at once! Fortunately, most of our CF patients would rather we wait until 2nd rounds (11am) to see them and that is easier.