ktwlpn 29,264 Views
Joined: Aug 17, '00;
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So we are NEVER supposed to "make a mistake?" Physicians make mistakes...pilots and air traffic controllers make mistakes.....What an absurdly high standard...
You can be as obvious as possible but the sad fact is when someone in LTC wants something they usually don't give a crap about anyone else's needs.
Fistfight between visiting family members!Back before private rooms were the norm I was working a busy med surgery unit.The hospital was bursting at the seams.In one of my rooms I had two women,one was post op TAH and the other was close to a hundred.And a DNR.She died.The entire family just had to gather at the bedside for an impromptu wake.My post op and her hubby were giving them privacy and sitting down the hall in the chapel...I had two TURPs with CBI and was running my buns off all shift.Apparently some of the old ladies children and grandchildren were 5hours away.The husband of my post op got into a fist fight with a grandson of the old lady.Security came,my supervisor came.There was no other bed for the post op.We ended up moving the old lady to one of the exam rooms.She was still there at the end of the shift....
The OP is also an ADN and as we know that is limiting his options. (not trying to start a flame war-I'm an LPN and I know how that limits me)
I am a firm believer in leaving religion and politics OUT of the work place. We do have a group of staff in an ancillary dept who are what I call "holier than thou" and oddly enough they are mean as snakes. Mean to new staff,stirring up trouble between the rest-carrying tales and such.Talking back to authority figures.Go figure.
[QUOTE]Originally posted by angelique777
what is the difference b/w a PICC line and a Central line would like this helpfull information thanks
Angela [/QUOTE>>>>>>>>>>>>>>>> Alternative Names
peripherally inserted central line long-term intravenous catheter
A PICC line is a long, soft, flexible tube, or catheter, that is inserted through a vein in the arm. The PICC catheter is designed to reach one of the larger veins located near the heart. It is longer and thinner than a regular intravenous catheter. A PICC line is frequently used in the home setting.
When is a PICC line used?
A PICC line is used when a person needs intravenous medication, chemotherapy, or fluids for an extended period of time. It is also used when someone requires frequent blood sampling. The most common use for a PICC line is for giving antibiotics and chemotherapy through the veins.
How is the PICC line placed?
A doctor or specially trained registered nurse will place a PICC line in a person's arm. The procedure is done either in a hospital or in an outpatient facility. Using a needle or a guide wire, the provider inserts the PICC line into a vein located in the arm. From there it is threaded into a larger vein near the heart. Once the catheter is in the correct position, the needle or guide wire is removed and the catheter is left in place.
The catheter site is covered with a sterile dressing and the tubing is securely taped to the person's skin. Plastic tubing is connected to the end of the catheter. A chest x-ray will be done after the PICC line is inserted to check that it is correctly placed.
How long can a PICC line stay in place?
The PICC catheter can generally remain in place from five days to several months. In some cases, the catheter can remain in place for up to a year.
What type of care does the PICC line require?
The dressing is changed once a week by a registered nurse. If the catheter is not being used continuously, the nurse will flush the line with saline solution to prevent it from clogging.
What precautions should be taken after a PICC line has been inserted?
The catheter site must be kept dry. The person may bathe or shower as long as the insertion site is protected with a water-resistant covering. The person's blood pressure should not be taken in the arm with the PICC line. The PICC line site should be checked every day for signs of infection, such as redness, swelling, or pain.
What are the complications associated with a PICC line?
A PICC line is designed to stay in place for many months. However, the catheter can sometimes cause phlebitis, or vein irritation. If this occurs, a red streak may appear on the arm, and the healthcare provider should be notified. Infection is also possible, but rare. The nurse or doctor should also be notified if the person develops a fever, chills, or a rash.
central venous catheter, CVP line
A central line is a special intravenous line, called an IV. This type of IV is inserted through the chest and threaded into one of the large veins that lie close to the heart. A central line has multiple ports that can be used to:
monitor central venous blood pressure
Who is a candidate for the procedure??
A central line is used for:
gaining emergency IV access when the usual IV access into an arm vein is not possible
monitoring central venous pressure during major surgery or after severe blood loss from trauma or illness
giving fluids, blood products, chemotherapy , and other medicines, as well as for hyperalimentation
drawing blood samples
administering long-term IV therapy
How is the procedure performed??
A central line is inserted under sterile conditions. The person is usually placed in the Trendelenburg position, which means the head is below the level of the heart. The skin is cleansed, and a local anesthetic is injected to make the area numb. A healthcare professional advances the line until it reaches the large vein of the chest. The catheter is then sutured in place, and a sterile dressing is applied.
What happens right after the procedure??
A chest X-ray will be done right away after a central line is inserted to confirm that it is in the right position. The line should not be used until the X-ray is done . A central line can usually stay in place for up to 4 weeks.
What happens later at home??
If the person is going home with the central line, the family will need to learn how to care for the catheter. A visiting nurse can come to the home to help the family with the care at first. The bandage at the insertion site will need to be changed every 3 days. The insertion site should also be inspected closely for signs of infection. These signs include redness, warmth, drainage, and swelling.
What are the potential complications after the procedure??
While inserting the line, it is possible to puncture the lung. The catheter may irritate the heart and cause irregular heartbeats, called arrhythmias. Other complications may include:
blood clot in the tubing
Any of these complications may lead to the removal of the central line.
Little old ladies and gents who can't see,claim there fingers and hands are weak but insist on laying all twelve pills out on a tissue,examining them and then attempting to pick them up,one by one.Pick up the water,take a sip,put it down.Count the pills again. Take one.Pick up the water,take a sip,put it down......As the clock winds down .I love that they want to try to maintain independence but not during the med pass from hell.I am glad to review each pill,admin one by one on a spoon.Gladly.
he never pooped on himself ever again[/I]. After being forced to clean his poopy jeans, he started defecating at the toilet.
Why wouldn't anyone switch a Saturday with her,it is her baby shower....That's a pretty important occasion..
[QUOTE=Poochiewoochie;7129504]Yeah, so do I since my Mom has Alzheimers. These are your patients but it's a lot different if your loved one suffers from the disease. My laughter when she does these strange things is because if I didn't I would be spending my time crying.[/QUOTE)
I don't know of any other way you could cope--I'm sending a hug your way. A dear friend of mine lost her mom to the disease-she said it was like 15 year wake.
In defense of "visitors" who I prefer to call care partners, they often do not understand acronyms. NPO except Ice needs to be interpreted for them saying DO NOT GIVE HIM/HER anything except ICE! Also, post written instructions on the PCA medication. Never assume that they know these things just because you do and don't question their intelligence because they don't know "nursely" things.
Every patient needs a trusted advocate by their side while they are in the hospital, but they do not need droves of visitors including tiny babies and toddlers, who will exhaust them and disrupt everything. The designated advocate can be the note taker or the recorder of doctor visits, keeping a list of medications, special instructions, etc. Then they can relay pertinent information to the rest of the family/guests as appropriate.
There is a way to work out all of these things, and communication is the first step in all of it.
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