first shift of preceptorship: told that my IV priming is wrong - page 4
by seks 10,243 Views | 53 Comments
The hospitals in this city use the Alaris pump and this kind of Alaris infusion set: Prior to my preceptorship, I've always twist that end cap a little bit so that the IV solution can dribble out while priming. However,... Read More
- 0Oct 15, '12 by jadelpn GuideIf you are uncapping to attach to the IV when you get at bedside, I am not sure what the difference is.
If the goal is no pockets of air in the tubing, then practice priming, as if you are not getting the fluid to flow through the cassette correctly or completely, then you will have air that needs to come out of the end of the line.
I would ask this preceptor how she primes the line. Maybe there's some trick to it that she can show you.
Precepting is all about learning. And don't get defensive, all nurses have a different way of doing things.
I have seen other nurses literally take the cap off to have the fluid run through when there's a big pocket of air in the line, and then use a male sterile cap. (BUT DO NOT DO THAT......THIS PRECEPTOR WOULD HAVE A COWWWW!!!!! LOLOLOLOL)
A lot of information from different sources can be really overwhelming and frustrating. Or it can be a chance to get a number of views so that in your practice, you can problem solve really well.
And don't be afraid to ask "what is the rationale behind this, there's an air pocket, and I was taught this way. Can you show me how you prime so that doesn't happen??" Because if the preceptor did not like the way you primed the line, she started over and got a new set, right?? If she did not, then she must not have been too concerned about the sterility issue, and was pointing out best practice as opposed to outright wrong practice.
- 5Oct 15, '12 by IVRUSAs an Infusion Educator, I can tell you that I agree with the instructor in that there is usually know reason to loosen the tip off of the IV set when priming. And... Doing so can create a contamination possibility moreso than if the cap weren't loosened. 99.9% of the time, the fluid will flow without incident to the tubings end. The other 0.1% the tubing appears "air-locked" and won't flow to the end without the end being loosened. Therefore, keeping the end on until the time to hook it up to your IV catheter or IV injection cap will aid in decreasing the possibility of the cap accidently falling off before its time, and a subsequent touching of its sterile end. Sometimes its just about what pitfalls can you avoid to ensure patient safety and the efficacy of this process.
- 6Oct 15, '12 by samadams8I have had plenty of times when priming air out was not thorough without losing or disconnecting the cap. As long as it doesn't touch anything, what is the deal? What's next. In order to thorough prime a line, we all have to take laminar hoods to the bedside? Come on already.
I can't believe the preceptor made a big issue out ot this; but this shows a lot of the ridiculousness in nursing.
The OP is sweating the small stuff b/c the preceptor is being a control freak over this kind of thing.
The ideal of aseptic technique is to keep sterile to sterile, period. If it flows for priming with the cap on--depending upon the particular line and system, fine, do that. But if there is still an issue of air, you need to clear it out as much as possible. This becomes a bigger issue with kids--babies. Sometimes you can achieve this with the cap on; but there are times when you can't.
The bigger issue to me is when people don't scrub ports long enough with the particular antiseptic used and don't allow it to dry.
Nurses can be so ridiculous about things it's utterly amazing.
Bottom line OP, you have to bite the bullet and not argue with the person in that role--often people that take on these roles are so far into control freak mode, it's utterly ridiculous. What are you going to do?
I have seen nurses argue at nauseum about angel's on the head of a pin kinds of issues. Who has time for it? If they have a policy and it's evidence-based, great. Follow that. But if all the air doesn't get out of the line, then take it to her, and have her do it or try what she is suggesting.
Sometimes you can get all the air out that way, and sometimes you can't. The goal is to get the air out and maintain aseptic technique. If loosening the cap helps fine. Again, I have seen a stoppage of flow preventing all the air from getting out of the line--including removing air from the attachment ports, which is an issue too for some places and clients. Those side ports can hold on to air.
I don't know why anyone has to be a buttcheek about this. The questions are these: What's the goal, and what is policy. If there is no strict policy on it, you're back to what's the goal? Um, well, the answer is aseptically priming the line, whereby you remove all of the air out so you can begin or continue the infusion.
Why do so many people take great pleasure in making things needlessly hard?
Just freaking do it her way, and if you have problems priming the air out, let her know.
Whatever you do, don't argue with her; it's so not worth it. So many people in nursing have this mentality that they just have to be right. It's often a big insecurity thing, and you probably aren't going to change that; b/c that's a bigger issue in the preceptor. You aren't her shrink, and she's just going to back a big damn deal over for you.
Sadly, it's almost like you have to play little automaton-robot on orientation. And you can't let them see any questionably incongruent attitude with that. You have to smile and make it seem like you just LOVE being the automaton and following every little things she says--not sarcastically. I hate to say it, but so many times on orientations/precepting, I have seen the reality to be that the orienteed is so & so's b!atch. Whatever. Your ultimately goal is to do well and then get off orientation. Don't let someone's issues become yours. People love to use other people in order to feel worthy and powerful. Take it with a grain of salt, rise above it, and move on. When it's your turn to fulfill such a role, remember and be better!
If I was at the higest levels of nursing leadership, I'd make it my business not to let insecure types teach and precept others. Such people allow their psychological/emotional crap to get in the way of effective teaching, guidance, and leadership. It's just that some people are so good and hiding or redirecting their insecurity. Sigh. What a pain.Last edit by samadams8 on Oct 15, '12
- 3Oct 15, '12 by NicuGalThis a little fish in a big ocean of things you are going to learn. Usually when a preceptor shows you how to so things it is based on what their protocols are. You have to sometimes go with the flow. If this has you up in arms, you are in for a long orientation .
- 2Oct 15, '12 by redhead_NURSE98!Quote from seksIt doesn't matter! She's the drill instructor! Just do it her way and then when you're on your own do it your way. Ask infection control and make sure what you do is okay (I really can't understand what you're describing and have never seen that blue piece before...it seems to be a waste to me but I'm far from an infection control person.) But DO IT HER WAY...for heaven's sakes! lolSo are you all saying my past clinical instructors are incompetent and don't know what they were thinking?
So who is right or wrong or too anal or giving unecessary steps in this situation? My current preceptor or my past clinical instructors/buddy nurses?
- 1Oct 15, '12 by AheleneLPNQuote from seksFor goodness sake, do it the way your preceptor says. Your clinical instructors are not the ones signing off on your orientation. Your preceptor is in charge not your clinical instructors. When you were in school, you learned according to how your clinical instructors taught you. BUT you are no longer in school so why would you go against the person that could make a difference between staying employed after your orientation or back to looking in the classifieds?! Do it his/her way and then develop your own way once you're done and have your own patients. Just my two cents. Good luck to you...So are you all saying my past clinical instructors are incompetent and don't know what they were thinking?So who is right or wrong or too anal or giving unecessary steps in this situation? My current preceptor or my past clinical instructors/buddy nurses?That is my MAIN question.It really is frustrating when you get different opinions on a technique and I don't know who to believe or abide by. Guess that is part of the so-called "reality shock"
- 1Oct 15, '12 by pamelalaynQuote from seksIt really doesn't matter either way. I am amused at your preceptor thinking she's "miss sterile". If it was you'd have a sterile field and sterile gloves etc. Washing your hands and putting on clean gloves, yes of course. But her thinking is ridiculous. If you are using your clean technique and always wearing gloves (also to protect yourself from the cancer causing agents possibly in the bag) and not touching the garbage with with the tip, you're fine. I think it's a great question and the other people commenting and acting nuts is crazy. I think it's very narrow minded of her to tell you that you are not not doing it right. I wonder what other things she will demand for you to do.The hospitals in this city use the Alaris pump and this kind of Alaris infusion set:
Prior to my preceptorship, I've always twist that end cap a little bit so that the IV solution can dribble out while priming.
However, during my first shift of my preceptorship, my preceptor didn't agree with my method. She said just to let the IV solution flow to just before the end of the line, put in a threaded cannula (http://static.medshop.com.au/images/...ula_303369.jpg) and then let the solution dribble out. She mentioned that my method would cause the end to be non-sterile?????
Can someone shed some light on this as my previous clinical instructors have seen me prime IV lines and they never had a hissy fit about the way I do it.
- 1Oct 15, '12 by samadams8Quote from pamelalaynIt really doesn't matter either way. I am amused at your preceptor thinking she's "miss sterile". If it was you'd have a sterile field and sterile gloves etc. Washing your hands and putting on clean gloves, yes of course. But her thinking is ridiculous. If you are using your clean technique and always wearing gloves (also to protect yourself from the cancer causing agents possibly in the bag) and not touching the garbage with with the tip, you're fine. I think it's a great question and the other people commenting and acting nuts is crazy. I think it's very narrow minded of her to tell you that you are not not doing it right. I wonder what other things she will demand for you to do.
Oh thank goodness you replied. I thought it was just me. Seems a bit silly to me too, and I have worked in NICU, where they try to be ultra careful with every little thing.
After I've carefully primed, I carefully recap--making sure of course the cap was never contaminated on the inside.