Procedures performed by pediatric transport nurses: How "advanced" is the practice?

Introduction: Pediatric interfacility transport teams often rely on advanced practice nurses as primary care providers. These individuals may be required to transport patients without the presence of a physician. There is, however, little information in the medical literature regarding how frequently advanced practice transport nurses perform advanced procedures, how often these procedures are successfully performed, and the rate of complications associated with nurse-performed procedures. Purpose: The purpose of this study was to determine how frequently advanced practice transport nurses were called on to perform advanced procedures and to determine the nurses' procedural success and complication rates. Design: Prospective convenience sample of consecutive pediatric interfacility transports. Methods: Transport nurses collected data on 336 pediatric interfacility transports that were performed during a 4-month period beginning in May 1997. All patient transports occurring during the study period were included. Data regarding procedures were recorded on data collection sheets. This data included the type of procedure performed, the outcome of the procedure, and the complications associated with the procedure. The number of attempts required to successfully complete the procedure was not recorded. During or after the patient's hospitalization, the medical record was reviewed to identify potential complications related to the transport that may not have been recorded on the data collection sheet. Results: Nurses performed 95.2% of transports without the presence of a physician. Twenty-six patients (8.8%) required advanced procedures. Nurses performed eight tracheal intubations. Personnel at the referring hospital performed the remaining procedures. All tracheal intubations by transport nurses were successful. There were no complications related to these procedures. All patients were transported to the receiving hospital without incident. Conclusions: Although they had considerable training for advanced procedures, the transport nurses rarely used these skills. All tracheal intubations performed by transport nurses were successful, and there were no adverse consequences related to intubation by a transport nurse.