If you are assessing this patient, no boundaries are violated as long as you
explain what you are doing and its in the best interest of the patient. You
can also speak to the Drs. about replacing the tube with an oral tube. This
could alleviate your problem. Prolong nasotracheal tube can lead to other
complications.
-----Original Message-----
From: Bryan [mailto:bgm2002@...]
Sent: Sunday, February 23, 2003 7:59 PM
To: nursebob@yahoogroups.com
Subject: [visit nursebob.com] ETT Tube Cuff Air Leak


I recently had a patient who was nasotracheally intubated and on a
ventilator who would drop his SPO2 down into the 70s without explanation.
No
ventilator alarms sounded and his pulse oximeter probe was functioning
properly.
The respiratory therapist was called to assess and could not find an
immediately recognizable problem. She put her ear down close to his mouth
and could hear a small air leak around the cuff. The leak was not
significant to trigger a low exhaled volume alarm on the ventilator, but
it
was significant enough to drop his SPO2. It was also not audible without
putting her ear down close to the patient's mouth.
From that time on I would frequently listen down close to his mouth in an
attempt to detect any leak.
In your professional experience and opinion, would it be considered
acceptable and necessary practice for me as his nurse to frequently assess
his airway for this leak as I have described to you above? Do you consider
it violating this patient's boundaries by putting my ear down close to his
mouth to assess his airway for a leak? I have been accused of a boundary
violation for this reason and I can't see where I have violated any
boundaries here. I need a professional opinion from a neutral, objective
professional and would appreciate your input.

Thanks,
Bryan Mildenhall
Salt Lake City, UT



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