Please Help!!

Specialties MICU

Published

I am a new grad, orienting in CVICU. Things are going okay and I am doing most of the work on my own now and asking my preceptor or another nurse if I have a particular problem. However, certain things get me confused. For example, I have had 3 different nurses show me how to change pressure lines in 3 different ways. I learn by repetition, and when I see something 3 different ways, nothing "clicks" for me.

To get to my question, is there a step-by-step manual written with pictures illustratiing how to use the latest equipment in the ICU?

Thanks,

Cube, RN

Specializes in ER.

Try the AACN website. They have a bookstore that may offer what you're looking for.

Good luck!

Chip

P.S. Remember, everyone does things differently, based on how we were taught. So each of the three ways may be acceptable. It doesn't help you as a learner, but do keep this in mind!

Hey Cube

OK, it's hard to be a newbie, when you really want one sanctified, holy, blessed way of doing things and suddenly there's all this ambivalence!!!

But hang in there, now. Stop and think. What is the GOAL of this activity?

In changing out pressure lines, there are two simple objectives. First--we end up with new tubing, transducers and pressure bags so that we don't have infections setting up in our equipment. OK? That's the reason we change all this stuff out. You dig? But in changing all this out--we run the risk of: 1) introducing infection. (Cause you're opening a closed system.) and 2) losing your central/arterial/PA line. (Cause you're taking it off the pressure system and letting it back-fill with blood--which can clot in the cannula.)

There's also the issue of site care--which you didn't mention--but which I always do at the same time, cause why leave a job 1/2 done?

My particular trick is to spend lots of time setting up a complete new pressure bag and tubing system for each pressure-monitored site (have it just hanging there from a spare IV Pole), open a site care kit on the over-bed table, and start at the skin and procede outwards with new dressing, new tubing, new everything. Then I zero the new set-up and toss the old and go on from there.

Different Nurses may have different ways of doing all this. You are required to find your own way. Think of the reason we go thru this to begin with. Then think of what can go wrong--and how you can prevent it. Then make an orderly plan--and carry it out. If your plan needs refining, improve on it.

And finally--your hospital has a procedure manual. Lacking that, there's the AACN procedure book--a damned good resource!! That's the place to start.

If those three nurses have been in error--putting the Pt at risk in some way--first find a better way, then politely speak to them (with your own experience and the procedure manual or AACN procedure book behind you).

In the meantime, keep your head

Papaw John

turn your stopcock to the off position on the A-line extension set, unhook your line and deflate the pressure bag, hook up your new tubing to the new NS bag, insert the bag into the pressure bag and inflate this bag over 200 mmhg while holding it upside down to purge all of the air from the line and drip chamber.

Once you have your new bag prepped hook it up to the a-line extension tubing open up the stop cocks and get the a-line at heart level and zero the line with the monitor.

Do the same thing with the Central line bags except use a 1 unit heparin to 1 ml NS solution in a 500 ml bag of NS.

Specializes in ICU, Education.

i have to agree woth Pawpawjohn. Always remember the WHY in every thing you do and let that guide you. You will find this to apply to eveythign in your practice.

Specializes in Vents, Telemetry, Home Care, Home infusion.

check out:

critical care nurse hemodynamic monitoring course

hemodynamic setup

[color=#330033]nurse bob's micu/ccu survival guide

http://rnbob.tripod.com/#section_5_hemodynamics_in_critical_care

mark h. icu faq's

http://icufaqs.org/

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Thank you so much, you guys. You've been a big help!!

Cube

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