Why does a hospital need RNs which are unable to do anything else but starting IV's?? - page 4
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Jun 18, '02Not only does it not burn when given slowly it really needs to be intradermal rather than sub q. The purpose is the get the angio through the skin and keep the vein from rolling.
Jun 18, '02The Rads I work with add 1cc of Bicarb to each 9cc of Lido to decrease the burning they say is caused by the pH of the Lido. It still hurts when ANY needle goes in, tho'. YES, YES, YES, SUB-DERMAL, NOT SUB-Q (OK, I get the dunce cap)!!! -- D
Jun 19, '02Thanks dianah I will pass the info on. Also, were you aware that heparin has been recalled by the company through the FDA. The only safe is the 100mg to 1cc. I read it on the FDA site. There are several common meds beign held right now. Also, I assume you are working with radilologist and could you ask a couple of questions for me. They are would an empty sella turcica show on a CT with contrast
Is an empty sella easy to miss? Or if found what type of follow up is there? Would the pituitary function be checked. I read it only happens in 5% of the population and a doc I know says he has several pts with it. If it is so prevalent than why aren't we hearing more about it. If you decide not to ask that is ok. Disabled
Jun 19, '02I happened across the FDA site a few weeks ago and got wind of the heparin shortage (from a recall, I believe); it just popped up at our hospital last week. Our pharm. is also having trouble getting Demerol, it's being rationed as well. We use the 1000u/cc 30ml vials A LOT; will just dilute the 1cc vials of 5000u/cc.
I'll ask the rads about the sella turcica and get back to you, disabled. -- D
Jun 19, '02Thanks, only by accident did I have an MRI done in March as I was falling and that was one of the diagnoses. The key is that it is empty and the pituitary is suppose to be in it. Well, my pituitary is flattened. As soon as my internist saw the report he sent me to an endocrinologist. My mom had taken me to them one after another and they would say if she would move away from the table. Well, mom made all the meals and I would gain on 800cal. The growth hormone was only being done on children and only started about 20 years ago according to what I have read. In 94 the same rad read the recent MRI. I had forgotten about the previous one and the report said to purge. I was a Max 23 and therefore was concidered outpatient. Anything in Florida that is more than 7 years old can be pitched. I went directly to Radiology and got the films as my internist wanted to see them and there it is clear as day. I asked my endocrinologist if she hadn't been one what would she have done. She said she would have recommended a Endocrine workup. Well in 88 I had the contrast CT scan and it was read as normal. I have been going through hormone tests and she said before any labs that I was lacking growth hormone. I had to have two suppression tests to confirm it. It should have gone over 10 or for me she said 5 and it went from .22 to .23. I am intouch with the pharmaceutical company as they are trying to supply me as I am now considered indigent. As a result of the reading I may not have had the depth of the clinical depression and having ECT that eventualy ended my career I would be working and not trying to scrape pennies together to have rent money. I may not have had the extensive pain from diabetic neuropathy. Growth hormone not only affects your growth but also protein, fat and carb metabolism, muscle size and strength. In taking GH it should improve my CV systemas there is a hx of cardiac in family, decrease blood sugar, decrease cholesterol. increase muscle strength so that I may not fall as much. The doc said the classic sign of low growth hormone is to gain large amounts of weight during puberty. I went from 127 in the 8th grade to 283 graduating from high school and another 100 in college. I ended up having gastric stapling and gastric bypass because of complications of the previous. I know also have chronic nonmalignant pain and have been on Duragesic for nearly 2 years. The doctors said that my entire life could have been different. I think anyone who has the empty sella turcica should have an endocrine workup. Or it should be done before bariatric surgery as you may be taking away the present issue but there also may be an underlying cause that will only come back again. I had my stomach hanging to my mid thighs when the weight was coming off and I donated it to the burn center at the hospital I went to. A teen had torched herself while free basing. I didn't want to know ahead as I had a young neice and nephew and I did not want to imagine them burnt. Then I had to leave my abdomen open for nearly nine months as I had MRSA. The upper abdominal wall and the wall itself would not adhere and I wouldhave to put saline dressings between the walls to try to stimulate granulation. I ended up back in surgery to close the abdomen. So I really appreciate anything you can find out as I want to learn as much as I can so I know what I am dealing with. I also don't want it to happen to anyone else. I was thinking that the bariatric surgery would still have been done for the immediate but if prior there is an endocrine work up that can also help. It should be required prior to surgery. My mom after coming home from the docs would cry as she knew I wasnt cheating as I wasn't a sweet eater. I wish she was here now to see that the glands really were the culprits after all. If anyone else can find out any info I would appreciate it or knows someone who has it.
I can be emailed at my home at firstname.lastname@example.org and the name is Enabled.Marian Thanks for listening
Aug 20, '02Of course I am part of an IV Team but feel that this is a great service to the staff as well as the patient. We do the majority of the starts in the facility with exception of the ER, OR, L&D. Those areas are responsible for their own. They may call us for assist with the difficult sticks. The nursing staff has enough to worry about without doing IV's. We also provide the service of appropriate line selection. We will place midlines or requests PICC at admission based on the drugs ordered or the diagnosis. This saves the patients needless and repeated sticks in attempting to maintain a peripheral site that is not appropriate. The general nursing staff is not trained is the specifics about which line is indicated and when.
How many times have you seen a 24g catheter threaded in someone's knuckle of the hand and given phenergan or dilantin and have you seen the effects of infiltrates of these medications. What is the defense in court when sued following infiltration and permanent nerve damage, skin grafts and loss of the extremity. An IV is an IV is no defense.
We provide staff education in IV issues as above that many staff members are not aware of.
I believe also that in the new CDC guidelines regarding central lines that it states that it has been proven that IV teams are of benefit.
Aug 20, '02IV therapy, several months ago my sister a nurse was admitted to one of the local facilities. Almost immediately the IV team was there to put in what they call a med line. She has no veins whatsoever. You can not use her left arm as she has RSD from a patient pulling her down with her stethoscope trying to bite her. They have tried using her feet and all and there is just nothing there. I believe that anything other than a routine iv at kvo is the only thing that should go through a small guage or for emergency meds. I have had Benadryl IV and had a 24 even with that it was no picnic. When I first started in nursing I had a wonderful charge nurse who showed me some tricks and I had been able to get in the most difficult IVs that a respiratory floor can have. I could get 18s in most of the time. I have never worked in a facility with a team and I also agree there is enough other stuff going on that the other staff nurse can do as IVs especially difficult ones can take time. I never knew why also that the lab could use the small packs that warmed the site but we couldn't. We were allowed to give a Xylo pop as it was called. I had just one and the start was less discomforting than the pop. I agree that there should be teams also who are more aware of technigue and even dressing a site. I don't know how many times I would come in and on walking rounds find an iv leaking or pulled out. I have heard too many times that it just happened. Sorry, not with what is on the sheet and it isn't running fast as most of our drips were aminophylline and you can't run that fast. Or that the patient just got here and you look at the floor admission board and the secretary has the patient on the unit several hours before. If I had a patient come in at 10p on 3=11 I would do the admission, start the iv and try to get in the first dose of antibiotic or have a special drip hanging. IV teams I feel are worth their weight in gold. Unfortunately, since we get paid much lower than the rest of the country I am unable to compensate monetarily.
Oct 15, '02I don't know about the patient acuity where you all work that say an iv team or resp techs or any of the others aren't necessary, but I WISH with all my heart we had an iv team. My day gets so far behind having to stop and go to the stupid Pyxis and charge out all the stuff and drag down to the room and try to start an iv on a little old lady dehydrated beyond belief with threads for veins. This has never been easy for me even after 18 years!!!! And if I had to do all the resp care, I have 6 pts a day and most are on o2 and mininebs and suctioning and cont pulse ox and if I had to be in charge of all that too, I would throw up my hands and SCREAM!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!
Oct 16, '02KaroSnowQueen, most of my patients should be 4s out of 4s but since that isn't permitted on any floor outside the specialized units we get 7 to9 3s instead. Patient acquities are always downgraded so that it reflex adequate staffing on the floors. I to wish I had an IV team but I am it and if I can't get it then I must ask someone else on the floor to try and then I am permitted to call the super who might, I say might come prior to the shift ending if not I am stuck for it and the next shift BIT__ ___ES. Most of the patient's meds are still in drawers in the med carts except for prns. The IV supplies are on a cart and usually by the middle of the shift we are out of IV supplies for starting and capping for ints. Believe me I would love to have less patients so I could actually maybe learn their first name and for that matter anything other than what their lungs sound like etc. I go into a room intro myself and begin an assessment and on my worksheet I make some notes as we are not permitted to have the charts in the rooms to make it easier on the docs. They should have to walk nearly 5 miles on a given day. I work full time which turns out to be 2080 hrs a year without OT. I don't enjoy the OT as I am exhausted physically and emotionally for the next day of the same thing. My days off are usually spent catching up on sleep and home. There isn't any time for any social activities. It has been literally years since I have seen a movie and it was a kid flick the "little Mermaid". Suctioning, is usually done by the floor nurses as there are too many patients as we are told for respiratory to cover as they can't go over budget either. We lost an RT as she continued to smoke as the stress was to much. Ironically, she ended as one of the patients on my floor and passed away. I work a chronic floor of respiratory and these patients don't even have strings for veins or even thread as that is even thinner and more resistant to angiocaths. We have had to use feet as some of the patients do have minimal veins there as the are edematous to a certain extent. Life is definitely not easy on the floor as their so much more physically demanding than the unit as they have a 1 to 1 or 1 to 2 ratio. I never said I didn't appreciate ancillary staff or wish that more was available. Many times the charge nurse is forced to take a team with the decision making for the unit during a shift. It is always that way on 3 to 11p. The charge for the time being on 3 to 11 if the only one outside the super who is certified to put Pic lines in. That can take a great amount of time and we have to split her team only to find out she hasn't had time to assess. the patients as she has been on the phone to admitting saying we can't possibly take another patient so that they call the super and the super says we can't refuse the patient but she doesn't come up to the floor to help out as she is usually found in ER or ICU or CSU. Then a patient or two calls for Tylenol etc for a headache but they don't know what a real headache is. But once again we paste on the smile and do what we must. I too have done this for more than one patient as the patient in the other bed in the rom so it was my turn and I had to take a tech and go to the ER as they never have enough staff to transport. This also happens when a patient has been admitted and the ER never did a chest xray and now has to be transported at 10:30p and the doc rights
I can not wear the powdered gloves as in two seconds I have a wonderful itch and the tech can't go to central to pick them up as the person that they are going to have to sign for them. I hope and pray with all this leaving of the floor that one of my patient's or more don't code or something.
Most people are not aware that once the ER doc says attending says admit that he/she can not touch that patient as the responsibility has been transferred to the attending and they want them out of the ER. They can't even give them something for pain, etc once the ER doc tells the nurse or admitting to admit the patient per the attending. Then the staff nurse on the floor picks up the patient and has an admission to complete that the prior shift should have done but heaven help the day shift as they can have some type of social life.
Mar 17, '03we do have 1 IV nurse that works durning the day, but I have to say I like starting my own IV's.
I love teaching students how to start IV's. I had a student with me for a while and she got really go at it. Her roation went to another unit to work and her patient needed a new IV in, she said she would do it but the nurse she was with said the pt was a hard stick and they would look at it after lunch. The student didn't take a lunch break and went and did the IV with 1 stick. The nurse was shocked that she did so well and ask where did she learn that, she told them on the Med/Surg unit rotation. Which made our unit look a little better for the moment since we are talked about being the worse unit in the hosp?
Mar 19, '03In the 3 hospitals I worked over the past 20 years only one had an IV team and it was primarily to check of new hires or incase of an emergency and the floor had already tried. Then the last facility I worked they were pulling charge nurses who wanted to learn how to insert a pic line. That made it worse if the charge had a team. Then there were times when they were called to insert them and by the time they returned it could be quite some time later. I also wonder what they charged the patient if the nurse placed it. I bet since a doc ordered it that the charge would be at his rate. I was in the hospital in December and I am a diabetic T2. I am on oral meds. Well, I got the summary bill and fingersticks alone were $24 each time. The hospital made $400 on fingersticks that the unit staff did but it comes as a pharmacy charge. If I have to go back then I am going to get an order to use my own. I could have had months of supplies at that rate and I was just one. Usually, the unit would have several diabetics of both types.
Jul 17, '03excellent thread! I'm a new grad and the hospital I'm starting at doesn't have an IV team. This thread has given me tons of ideas and hints to be able to start a line!
I was only able to start 5 IVs during school,
I like the BP cuff idea, and the gravity ideas.
Also, I don't know how I'd feel about an IV team, it sounds super! but as a new grad, I think I need to perfect that skill.
Thanks again for all of the advice!!!
Jul 19, '03Only one hospital of four in the county have an IV team and they end at 10p as they come in early for OR cases to be started if they haven't been. There is a special line called a Pic line that requires additional training. This type of line gives continuous access so that a patient can be taught to give themselves antibiotics at home. The only requirement is that the dressing is changed by a nurse every 3 days according to the policy I had. Another trick is to warm a towel and place it over the side to be used. This will increase the circulation. rate. They also have little pressure packs that get warm when they are activated. They are a one time use. We were also allowed to use a lidiocaine pop. That is 1 tenth of a cc of lidocaine given sq near the vessel to be used provided there is no alergy. This helps to stabilize the vein and cause less discomfort. I have had this done on myself and found that I would rather not have it as it stings more than the entering of the skin is less uncomfortable than the pop. Also, when haning any med ask the patient each time if they are allergic to any med. Sometimes patients remember later but fail to notify the staff.
A word of wisdom is "When in doubt wash your hands" If you are unsure of how to do something even if you have done it before washing your hands gives you time to pull the thoughts together and the patient thinks your washing your hands. OR if you don't recall tell the patient that you forgot an item needed and go look up the procedure quickly or ask a colleague you trust. Then with some item in your hand return to the patient's beside with your new found knowledge. You could also ask your patient if someone else can observe and have a regular staff member present. Most patient's don't mind especially if a teaching facility. Some argue whether or not you should tell a patient it is the first time you have done something. That will be for you to decide in each situation when it is the first time based on the patient. Some patients do not want someone making them the guinea pig.
A warm welcome to the profession that so many of us have come to love. With all you hear about the shortage and all read or listen to with a grain of Na Cl. The shortage of numbers are real but it will be up to employers to come up to the plate and make some overt offers to make nursing a priority and not just an expense and numbers of people. Here in Florida the teachers are now getting a salary at entry level, considerably higher than that of nurses. You will be able to choose the position you want and where you want it for the money you want.
If you are eligible for tuition reimbursement related to the shortage legislation take full advantage of it. I would recomment working a year before going onto the next degree level. Get all the education you can. The more educatiion and experience will allow you to go many places unheard of previously with nursing as a possibility. Nurses are doing case management, outpatient surgery staff so that there is every weekend off. Take your time to decide what is best for you and your family if you are married.
Good Luck and Welcome to a wonderful professioin.