sserrn 3,409 Views
Joined Feb 27, '10.
Posts: 141 (30% Liked)
What about the IO route?
It is a growing medical problem -- patients whose habitus, anatomy, medical and social histories and/or disease processes mean they have very poor venous access. You may recall recent state execution attempts hampered by venous access issues which were widely covered in the media.
I personally would probably not participate in continuing to stick this individual, if his access is already that poor. I continually teach my patients who get regular blood draws or infusions that the problem with repeatedly accessing the "go-to" vein is that it WILL eventually sclerose ... and then what do you have? On that fateful day when the patient becomes hypotensive, hypoxic, dysrhythmic, suffers trauma or some other EMERGENCY ... to have compromised their chance of successful resuscitation by sclerosing accessible veins without good reason is just not something I'm comfortable with.
Is he dry? Perhaps you should suggest lots of water prior to the visits?
My goodness, this patient needs a midline, a PICC or a port - STAT. Have these been considered?
Needless to say, this reminds me of several incidents that I encountered with the nursing staff that I managed and had to let go on my previous facility. Having said that, one in particular comes to mind a nurse on the 7-3pm shift no matter how many times I had a chat with her regarding coming to work on time, she would always walked in around 9:am or 9:30am. However, she would leave on time. Therefore, I change her shift to accommodate her schedule, since she was a single mother of 3, but she still manage to come in late after that. Then she began to miss work all together, so I had to let her go. Consequently, a month later she gave my name as a reference to a clinic nearby that was hiring
When I managed an apartment complex back in a previous life, a tenant I'd evicted for non-payment of rent (among other offenses) actually had another apartment manager call me for a reference! I couldn't believe it---this woman had trashed her unit, left a bunch of rotting food in the fridge, and let her teenager 'tag' the fence behind the apartment. She also left a scrapped car in the tenant parking area and refused to move it when she left.
Well, you can bet your bottom dollar that I gave him a string of reasons why no one with even an ounce of interest in their property would rent it to her......luckily there were no rules at the time saying that I couldn't do that.
I understand your concern regarding the patient's subsequent development of SVT. But I'm not understanding the initial hesitation about giving it, if the patient was without other history that made him particularly susceptible to lidocaine toxicity. This is an approved use of lidocaine -- if I was going to question the physician's order it would be for a specific reason.
SVT is not associated with lidocaine toxicity. Your patient likely has an EP issue.
But then again, I suppose a lot of us are capable of obtaining a nursing degree, but far less of us are capable of being NURSES. Here's some advice, if you are tired of trying to draw IV's on us "regulars", maybe it's time for you find a new profession.
Whoa, 53 units? What was the outcome?
And BTW, thank you everyone who responded! I didn't know about the rapid infuser.
How do you like the ED?
Thanks for everyone's responses! It gave me a lot to think about. I talked to my manager this morning & she said she understood. She even asked if I wanted to stay prn so in case things don't work out, I could always come back! I honestly think this is just too good of an offer to pass up. I mean how many times do you hear hospitals telling you they'll pay off your contract & pay for you to get your masters (I forgot to mention that earlier). I won't be quiting right away, that way my manager has time to find a replacement and train her. Thanks for everyone's input!
You made a deal. You signed the contract. There is a certain honor/maturity involved in owning up to ones responsibilities. If you do break the contract, even though the facility offering to pay for you to leave..... will never forget you broke your promise. The facility you left will not forgive you for reneging on your promise.....I am sure they will not give you a good reference nor will you be up for rehire.
Have you asked to move within the facility or department? That you want to learn all aspects and would LOVE to work the L/D area or NICU/nursery? Have you asked to go to the ED at the facility where you are?
If the working conditions were unsafe or you were in danger without a doubt...leave. Because you are bored? Not so much...... Sometimes as professionals we need to own our responsibilities then move on.
I wish you the best.
I will give a shout out to the poster who recommended morphine and ativan to palliate the symptoms of a person with an acute exacerbation of a chronic and life limiting illness.
SOB leads to anxiety which increases distress...so if we treat the anxiety we can impact the dyspnea. Morphine will slow the respiratory rate and allow a deeper breath while easing the work of breathing.
I have always thought that if a patient is satting fine but the H&H is in the toilet then the sat really isn't that helpful at that instant. The rationale is if the H&H is 1/2 of what is should be but all are saturated with 02 then of course your going to get a decent sat BUT they don't have enough RBC's to adequately oxygenate the rest of their body. Is that correct?
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