Latest Comments by Double-Helix

Double-Helix, BSN, RN 32,086 Views

Joined Apr 5, '11 - from 'New Jersey'. Double-Helix is a Nurse, Children's Hospital. She has '6' year(s) of experience and specializes in 'PICU, Sedation/Radiology, PACU'. Posts: 3,353 (54% Liked) Likes: 6,555

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  • 0

    I suppose the other concern is that if you have a severe extravasation in the AC, you've compromised all IV sites distal to that AC. If a hand vein extravasates, you can still use veins above that site.

    Absolutely, frequent site assessments and brisk blood return are a must.

  • 0

    Your agency isn’t able to tell you? Or just call the hospital and ask.

  • 0

    Only the California BON can accurately answer this question. However, since you are foreign-educated and already received a degree and a license, I expect it may not be as big of an issue than if a California-educated student were applying for licensure for the first time.

  • 1
    brownbook likes this.

    What it really comes down to is depth of the vein and length of the catheter. Ideally you want at least 2/3 of the length of the catheter inside the vessel to avoid dislodgment from shifting of the tissues and skin above the vein. In an antecubital vein there is greater potential for movement of the catheter within the vessel related to bending of the elbow. For that reason, I always choose a longer catheter for an AC vein and don’t prefer them for long term use whenever possible. If it is an IV that needs to stay in for several days, some kind of arm immobilizer should be in place to help prevent this kind of movement. For a short term infusion on an adult patient that can be trusted to refrain from bending the arm, I wouldn’t worry about it- provided that it’s not a super deep vein and a short catheter.

  • 1
    caliotter3 likes this.

    I would not have asked the supervisor to remove the audit item, nor would I have removed it myself. Medication refrigerators that aren’t in locked rooms need to be locked. That’s a regulatory requirement whether you have it on your audit sheet or not and removing it isn’t going to help you if the JC comes to inspect your unit.

    The question is whether you’re responsible for that form beyond just doing the checks. If not, then it’s on your supervisor to come up with an action plan. You’re only job is to fill out the form and report the results. In my role, I’m responsible for establishing a plan for improvement/compliance and making sure it’s being done. This would probably include education, ensuring that there is an available lock, doing 1-1 reeducation with non-compliant staff, and/or getting a code-protected refrigerator that locks automatically. But again, if your job is not to ensure that the unit is in compliance, I would continue to fill out the form, report the results, document on the form when and who you notified, and leave it at that.

  • 3

    Quote from Renegade girl
    Its not a matter of trying different areas of nursing because I know I wont like it. In school I did not like any of my clinical rotations.
    It’s really way too early in your career and experience to be saying this. There are so many areas that a nurse can work- the great majority you never even hear about while you’re in school. There are nurses that work for insurance companies, pharmaceutical companies, nurses that work in law firms, nurses that work in research institutes, nurses that work in informatics and technology. There are areas of nursing where you would never have to touch a patient if you didn’t want to. There are plenty of ways to direct your nursing career into a job you find more fulfilling. Additionally, like others have said, you have plenty of opportunity to go back to school and pursue another degree. People start college programs in their 30’s, 40’s 50’s. You are way too young to be “stuck” in anything.

  • 0

    It’s unlikely that anyone on this forum will be able to help you. You’re working in Saudi Arabia, where the rules and processes are completely different than the US and Canada, where most of the members here are from. Are you a citizen of Saudi Arabia or another country? I honestly have no idea where to direct you for information because I’m not at all familiar with nursing or working in Saudi Arabia.

  • 1
    raindrop likes this.

    Quote from raindrop
    Thank you! Did your friend use your family member to help patent her device?
    No, they aren’t located in the same state so it didn’t really make sense.

  • 0

    I have limited experience. My family member does work as a patent attorney and a friend of mine recently went through the process of patenting a medical device.

    If you have any contacts at large hospitals- particularly those affiliated with universities or strong research ties, reach out to them. Those types of organizations may have 3D printers available for use if he request came from an employee. I wouldn't consider buying your own.

    FDA approval is a whole different ball animal. Without knowing what kind of device it is, it's hard to say what kind of trials and approvals you would need, and how much that would cost.

  • 1
    Sour Lemon likes this.

    In short, it depends on what kind of device you’re trying to get made. Is it metal, plastic, wood? If you know someone with access to a 3D printer, you could try that route. Or you can contact a company that can make you a plastic mold. Typically drawings are sufficient for a patent application, though, and it’s very likely your attorney will have connections for manufacturing as well. The patent application process can take more than a year. You don’t need the patent in order to manufacture the device. You need the patent to ensure that no one else can manufacture that design.

  • 8
    RainMom, brownbook, sevensonnets, and 5 others like this.

    I think you should have handled it differently. When a patient has a medication ordered, the nurse cannot simply choose not to give that medication without discussing with the physician and documenting appropriately. It sounds like you were concerned that she may have a transfusion reaction that you wouldn’t detect because of the fever, is that correct? If that was the case, you should have called the provider and discussed your concerns. They then could have given you further direction, ordered some pre-medication prior to the transfusion, or written an order to hold the plasma until the patient was afebrile. Simply not giving the medication without follow up or documentation of why would be considered a medication error.

  • 49

    Did you have any evidence that the medication was affecting her respiratory or neurological status in such a way that it was unsafe to give her additional narcotic? What was her RR? SpO2? LOC? If you have no clinical basis for withholding meds other than your opinion that she was drug seeking and really not in pain, then I’m sorry but you were wrong. If you were truly concerned you could have asked for the patient to be on continuous pulse oximetry. You are not going to fix drug seeking behavior over the course of a post-op admission by withholding pain medication for an hour. You’re right that patients with chronic opioid use require progressively higher doses to achieve the same effect and this patient very well could have been in pain that went untreated.

  • 4

    This needs to be addressed with whoever is documenting the inaccurate vitals. If it’s another nurse or an aide, bring them with you when you do your own assessment. Make believe you are giving them the benefit of the doubt by saying something like, “I wanted to bring you in here so we could look at this patient together. I noticed that you documented a RR of 18/min, but I just counted 40/min and it’s such a significant difference that I’m concerned he’s getting sicker. Can we check his RR together and can you let me know if this is how he was breathing when you did his vitals?” I’m almost certain that pointing out that you are actually doing your own assessment and explaining the importance of an accurate RR will help this person pay more attention to accurate counts- at least with your patients. If the incorrect assessments persist then I’d suggest writing it up and asking your manager to address it.

    Also, does your unit ever present safety stories at staff meetings or morning huddles? Most of the time RR are inaccurate because staff don’t realize the significance of accurate documentation. The case you described with the ICU patient should be presented as an educational lesson to all staff about the importance of noticing trends in vitals and the implications of inaccurate documentation.

  • 11
    JustMe54, WereBadger, MaleICURN, and 8 others like this.

    No one should care. And if they do, why would you? You’ve got better things to go in school than worry about someone looking up the price of your stethoscope. What you should worry about is someone walking away with it. Stethoscopes, especially nice ones, tend to grow legs when left laying around. Get it engraved, get a name tag that isn’t easily removed, and keep it in your pocket or your hands the entire time you’re in clinical. If you don’t need it for a clinical, leave it in your car or lock it up.

  • 0

    I didn’t work full time, but probably 30 hours a week. I still had some spare time, so I could have worked more. The biggest barrier will be finding a job that is flexible enough to work around your school schedule. Nursing clinicals can be evenings, weekends, different days each semester, etc. You have to have an employer who is willing to let you switch shifts as needed. You may have to adjust to working evenings or nights at times as well. If you study effectively and manage your time well, it’s doable.