Traveling in hospital with the patient - page 2
Any tips on how to make traveling to CT scan/IR/Nuclear Medicine within the hospital with an ICU patient who's vented and on all sorts of gtts? I have been a nurse for 1 yr, and have been on nights. I am switching to day shift... Read More
- 0Sep 26, '11 by BiffbradfordIf you feel that you need a defib along to make the trip in once piece, then DON'T GO! That patient is not stable. Fix the rhythm first.
The most support I've done road trips with is an RT, another ACLS RN, nursing assistant, and (always) an emergency kit with ACLS drugs and some volume (Plasmanate).
Oh Gawd, the broken IABP in the cramped elevator at 2am. What a night that was!
I guess my hospital also had a freight elevator that was real roomy that we could have used, but I don't think we could get to the CT scanner from there.
- 1Sep 26, '11 by nyrn5125[quote=Biffbradford;5672479]If you feel that you need a defib along to make the trip in once piece, then DON'T GO! That patient is not stable. Fix the rhythm first.
The purpose is to be proactive instead of reactive. Bringing the defib/codemaster along is not because you are transporting an unstable pt. It is to be ready because you are transporting a potentially unstable at any moment pt. VT/VF can happen at any time. Regardless of fixing the rhythm they have the potential, so better to have it there for peace of mind. That is our policy at my hospital
- 1Sep 27, '11 by StayLostQuote from BiffbradfordFrankly, I find it hard to believe that any prudent nurse who is caring for a patient with heart failure, so profound that they require an IABP, would feel that it's safe for this patient to leave the unit without a defibrilator. In fact, if I travel with a patient on a IABP, not only are they monitored, but I at times I will have them connected & transduced to a tram.If you feel that you need a defib along to make the trip in once piece, then DON'T GO! That patient is not stable. Fix the rhythm first.... [and while traveling always bring] an emergency kit with ACLS drugs and some volume (Plasmanate)
With this being said, what do you plan to do with your those ACLS medications if your patient is not connected to a monitor/defibrillator?
Just like nyrn5125 said, it's a standard and part of my hospital's policy that every patient must be connected to a monitor/biphasic defibrilator and a travel med box must be taken whenever traveling outside of the ICU. Cardiac arrythmias can happen anywhere at any time, especially when dealing with CCU patients!
- 0Sep 27, '11 by BiffbradfordWell, the patient did have an IABP, but was stable, there were no rhythm issues, and the pump was probably (I don't fully remember) on 1:3 or 1:2. Otherwise I wouldn't have gone! Certainly he (she) was fully monitored (he's got the balloon, + another radial art line). You are correct that *ANY* heart patient can go into a lethal rhythm, but there is no way I'm hauling the full code cart down to the CT scanner. That makes one less for the ICU and they've got one there anyway. If I don't think my patient can make 5 minutes without being shocked ... I AIN'T GOIN.
- 0Sep 28, '11 by NCRNMDMOne of the hospitals I'm familiar with (I did some work there before starting nursing school, and my mom currently works in the CVICU there) has a transport team that comes to assist the nurse in going on trips outside the unit. Say you need to take your patient to CT from CVICU, you call the transport team and they come help you. Generally, the nurse, an RT, a PCT (their term for CNA), and two members of the transport team go with the patient. The RT bags and manages the ventilatory support, the transport guys maneuver the bed, push, lift, and do the brunt of the physical labor. The nurse watches the infusions, the monitor, and all the equipment attached to the patient. The CNA is there as an extra set of hands (say to perform CPR if the patient codes, to retrieve supplies from the crash cart, to call the code while the RT and RN work the patient, etc). Before the nurse leaves the unit, he does a survey of the patient and then prepares all the equipment he thinks he may need. Generally, nurses take a syringe with a sedative, a syringe with a paralytic, a code box filled with Epi, Atropine, etc, extra IV fluids and medication (if a med is close to running out), a phone (usually the RN's own cell phone) to call a code or call the unit if needed, and anything else the nurse thinks may be needed. Before leaving the unit, the nurse calls the department that he is bringing the patient to, informs them of what shape the patient is in, how long it will take to get there, and what kind of help they will need once they arrive with the patient. The monitor that the patient is hooked up to for the trip has a defibrillator built into it, so if that is needed in a place where there is no crash cart (say the elevator) then there is no issue. Also, if the patient does code in the elevator, the code box is on the bed, and the nurse can begin pushing drugs while the CNA does compressions. Unhook anything you don't need, check to make sure that all your lines are patent before you leave, and start additional lines if you feel that you don't have enough. Also, if you do have meds infusing, make sure that you know what other meds are compatible with the drug that is infusing. You don't want to push a drug and ruin a line during a code because there was an incompatibility with the drug you pushed. It's mainly about planning ahead of time and being prepared rather than not planning and being caught off guard by an emergency.