Q1: Can a PACU nurse extubate a patient? Must an anaesthetist always be present?

Association of Anaesthetists of Great Britain and Ireland [1]:

‘The removal of tracheal tubes is the responsibility of the anaesthetist, who may delegate the removal to an appropriately trained member of the PACU team who is prepared to accept this responsibility’.

Royal College of Anaesthetists  [3]:

‘The anaesthetist is responsible for ensuring that the endotracheal tube is removed safely.  Nurses who are trained in the management of supraglottic airways may remove them, although an anaesthetist should be immediately available.’

BARNA [Standards of Practice] [2]:

‘Both recovery and anaesthetic nurses must continuously update their knowledge and skills as new techniques and drugs are introduced into perianaesthetic practice.  Recovery nurses acting autonomously in the absence of the anaesthetist, must ensure that they work within their established and recognized scope of practice’.

BARNA comment :

Both AAGBI and RCOA state that it is the anaesthetist’s responsibility to remove the endo-tracheal tube.   However, the AAGBI statement includes the proviso that an ‘appropriately trained member of the PACU team’ may extubate the patient if they are prepared to accept the responsibility. While BARNA supports both statements as they stand, this appears to be an area of practice which requires further investigation in the UK.   The following questions must be asked:

  1. What is happening in units around the country?  Are nurses extubating patients with or without anaesthetic supervision?  A national audit on this would be helpful.
  2. If PACU nurses are allowed to extubate as a delegated task from the anaesthetist, the following measures should be set up locally: a) local policy stating that PACU nurses may extubate patients under certain conditions; b) extubation competency should be in place for all  nurses who wish to accept this responsibility

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Sources:

[1] Association of Anaesthetists of Great Britain and Ireland [2012,] Draft report of the AAGBI Immediate Post-anaesthetic Recovery Working Party. Association of Anaesthetists of Great Britain and Ireland, London
[2] British Anaesthetic and Recovery Nurses Association:Standards of Practice [reviewed 2012]  British Anaesthetic and Recovery Nurses Association, London
[3] Royal College of Anaesthetists [2009] Guidance on the provision of anaesthesia services, Chapter 4: Post-operative care. Royal College of Anasthetists, London


Barna. British Anaesthetic and Recovery Nurses Association