Respiratory therapists (RTs) at Madonna play a key role in the recovery of many of our patients. Last year, Madonna cared for an average of 26 patients on ventilators every day, and helped 157 patients wean off of tracheostomy tubes. With the COVID-19 pandemic, an RT’s role in health care is heightened, as the virus attacks the respiratory system.
To highlight the role of RTs in rehabilitative care, two Madonna respiratory therapists are sharing their experiences: Tia Tellgren, lead RT for the Specialty Hospital on Madonna’s Omaha Campus, and Amy Armintrout, lead RT for Madonna’s ventilator assist unit (VAU).
1. How many years have you been in the profession and why did you want to become an RT?
Tia Tellgren (TT): I have been a Respiratory Therapist for a little over 5 years. My interest to become an RT was when my son was 3 months old and diagnosed with RSV. While we were admitted to Children's Hospital he saw an RT hourly. I was very intrigued with all of the different modalities they were doing with him, and it inspired me to apply to RT school a few months later!
Amy Armintrout (AA): I have been an RT for 7.5 years. I worked as a paraeducator at a high school and we had a student that had a tracheostomy tube. Everyone called me to help him if he coughed something up, and I was always interested in helping to manage his trach. Later, I was talking with a friend about how his son was an EMT and then went to school for respiratory therapy. It was then that I decided that going back to school to become a respiratorytherapist.
2. What do you like best about being an RT?
AA: I love working with my patients and getting to know them. They become like family. I also like the fact that I can educate patients, their families and others.
TT: What I like most about being an RT is the satisfaction of being able to see a patient who is admitted on a ventilator go HOME! Whether that’s them walking out or leaving in a wheelchair. I know the amount of strength, courage and hard work they have put in to get to go home. It isn't always easy, but these patients have the determination to meet their goals to get back with their family!
3. RT’s at Madonna are part of an interdisciplinary team of doctors, nurses and therapists. How do RT’s contribute to that team in a way that is valuable?
AA: I believe that respiratory therapists bring the knowledge of the respiratory system and how it can affect other systems to their interdisciplinary team. If a patient can't breathe, other therapies may also be impacted, which may limit the patient’s progress. I like working with my interdisciplinary team, we all see different things and are able to work together to find the best solutions for each patient.
TT: RT’s are able to offer different suggestions and problem solve with the interdisciplinary team. For instance, if we are having issues with weaning a vent patient because of the patient’s anxiety, we can ask the physician to prescribe a medication to counter the anxiety. Not only does this help with vent weaning, it will also help the patient when he/she is working with PT and OT.
4. How do RTs help patients learn how to breathe on their own again?
TT: A big role we play is providing the tools and encouragement for our patients to breathe normally again. Our vent and trach patients have not had “normal” breathing in a while, so having that sensation again with tools like the Passy-Muir Valve—a valve that helps with speaking while a person is on a ventilator or has a tracheostomy tube—is a little nerve racking for them.
AA: We can help them with their breathing by helping them take deep breaths throughout the day by working with technology like the Incentive Spirometer, a device that measures how deeply you inhale, or the EzPAP, another device that helps with lung expansion. If the patient is on the vent to begin with, we work on decreasing the vent support so that the patient will have to initiate the breath more until we get to the point where we have the patient initiating all breaths while the vent just provides support. Once a patient can tolerate that, we start to wean them off the vent. If a patient is struggling to breathe and has COPD, we can teach them pursed lip breathing, a technique that helps create more pressure inside the lungs to open them up and make it easier to exhale more of the air in their lungs.
5. What special technologies/techniques do RTs use at Madonna?
TT: One that I think is a HUGE step in patients recovery is the Passy-Muir Valve (PMV). The joy patients have and the look of their faces when they are finally able to have food with their initial speech/RT evaluation is priceless. One of my favorite memories with the PMV is when I had a patient who was really trying to communicate with us but was unsuccessful. I decided to place a PMV so he could better communicate with his nursing staff. Then, he asked to call his wife, and it took us 5 minutes to convince her that it was actually him. It had been 3 months since she heard his voice and she was in tears. These little things mean the most to patients and families.
AA: When I am training patients I will use Trach Tom, a tool we use to educate patients and their loved ones about tracheostomy and the proper application of the PMV. This model is helpful to explain how the trach cuff up and down works and how the air will move past the cuff once it's down. It also helps to explain how the PMV and cap work when on the patient’s trach. We use a device called the MetaNeb, a system designed by a respiratory therapist, to help patients with lung-expansion therapy (also called positive expiratory pressure, or PEP, therapy) to move their secretions and to help with supplemental oxygen and aerosol therapy. Prior to MetaNeb, we would use an EzPAP and a vest (called chest physiotherapy) to wrap around the patient. The vest can be difficult to get on the patient and can be bothersome if it is rubbing on tubes or lines while running. It also shakes the whole chest and sometimes the stomach. The MetaNeb essentially shakes the lungs from the inside, giving you better secretion movement, and easily switches back and forth to PEP therapy.
6. What’s it like for you to see a patient weaned off of a ventilator?
TT: It is extremely rewarding to see a patient weaned from the ventilator! Weaning from the ventilator does not always go as planned and more often than not we take 2 steps forward and 3 steps back. Sometimes you have patients that require you to think outside the box to wean them, and those are the most rewarding—especially when you feel like you have exhausted all options and feel defeated but still don’t give up. As an RT, I serve as a patient’s biggest advocate to get off the ventilator. Sometimes I go to my interdisciplinary team and suggest trying something different and it is so rewarding when it works! It’s important to remember not every patient is going to be textbook or wean per protocol.
AA: I get excited when we are able to wean a patient off the vent. It is an exciting thing to help them get off the vent and get back to "normal," be it their old normal or their new normal. Patients are also excited when they are able to get off the machine and be able to be free of it.
7. The need for RTs has become more prevalent lately with COVID-19, what advice would you give someone who is interested in a career as an RT?
AA: It is a very rewarding career and there are lots of possibilities. With respiratory therapy you have several options to choose from: working in the ER, doing floor work at a hospital, labor and delivery, NICU, ICU, rehabilitation hospital, long term vent unit, pulmonary rehabilitation, home health care, sleep lab, pulmonary function testing and many more. You have the opportunity to help a tiny baby take their first breath, help someone take their last and everything in between. You see people at their worst and are there to help them get better.
TT: My advice for anyone who is interested in becoming an RT, especially during this COVID-19 pandemic, is that your skills and training are needed and recognized more than ever! It is a demanding, yet rewarding career.