Question for adult ICU nurses

  1. Hi,

    I have a case of insomnia, probably because I work nights and this is my night off! Anyways I am full of questions and one just popped into my head. I know NOTHING of adult ICU practices I am a NICU nurse so please entertain my questions.

    1.) Do you ever use neostigmine to reverse NM blockade? And, if so do you administer it with atropine or glycopyrolate? What agents are used most common if you have a pt. that needs conitnual chemical paralysis? I know ROC is used for RSI and has quick onset and duration. Do you ever use Pavulon (pancuronium) we use itall the time in the NICU for CDH babies and babies on ECMO.
    2.) If you have a pt. on pressors like Dopamine (which can cause a horrible IV infiltrate, do you ever run dopamine through a PIV or does it go central?
    3.) What size ET tubes are most common with adults? What Larygoscope is used most common a GMAC, MAC, etc?

    Thanks for taking your time to answer my questions!!

    James
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  2. 6 Comments

  3. by   SouthernLPN2RN
    Quote from SFRN
    Hi,

    I have a case of insomnia, probably because I work nights and this is my night off! Anyways I am full of questions and one just popped into my head. I know NOTHING of adult ICU practices I am a NICU nurse so please entertain my questions.

    1.) Do you ever use neostigmine to reverse NM blockade? And, if so do you administer it with atropine or glycopyrolate? What agents are used most common if you have a pt. that needs conitnual chemical paralysis? I know ROC is used for RSI and has quick onset and duration. Do you ever use Pavulon (pancuronium) we use itall the time in the NICU for CDH babies and babies on ECMO.
    2.) If you have a pt. on pressors like Dopamine (which can cause a horrible IV infiltrate, do you ever run dopamine through a PIV or does it go central?
    3.) What size ET tubes are most common with adults? What Larygoscope is used most common a GMAC, MAC, etc?

    Thanks for taking your time to answer my questions!!

    James
    1. Not sure about that, haven't seen it yet.
    2. I've only seen one case where dopamine was run via PIV, and that pt quickly got a line.
    3. Not sure on the laryngoscopes, but I've only seen 7.5 and 8 ET tubes.
  4. by   cardiacRN2006
    1. I've never had to reverse NMB. We have used Nimbex for a paralytic when needed.

    2. Unfortunately, we have used Dopa in a PIV. I don't like to, but sometimes we have to (my pt had a very elevated INR and we needed to transfuse some FFP and give Vit K before we could attempt a line). Either way, a central line is a priority once we have pressors in PIVs.

    3. 7.0-8 seems to be common sizes. We don't intubate much in the ICU (mine anyway) so I don't notice what physicians use. Some curved, some straight-physician preference, not mine. That's about all the observation I care to notice on blades.
    Last edit by cardiacRN2006 on Feb 12, '07 : Reason: spelling of course
  5. by   burn out
    1. We do not reverse paralytic agents but the times I've seen it done they used neostigmine and robinal. For maintainence on the vent diprovan and or fentanyl usually work best.

    For intubation we use succ with 2 of versed however our RSI kit in the accudose also has etomidate and norcuron (never do we use those).

    2. We run dopamine in a PIV frequently. I always keep the bp cuff on the opposite arm to prevent infiltration. At the slightest sign of swelling or redness a new site is started and regitine the previous site.


    3.Most popular tubes 7.0 and 7.5 with which ever one you grab first , a curved or straight blade.
    Last edit by burn out on Feb 12, '07
  6. by   SFRN
    Thanks for all the information you guys are awesome!

    James
  7. by   AnnieOaklyRN
    I am not a nurse yet (graduate in May), but I am a paramedic.

    1. I see succs used a lot and that is what is used in the feild as a paraylitic becuase it is fast acting and only lasts for about 5 minutes.

    2. We run dopa on peripheral lines becuase we cannot insert central lines. The E.D. usually continues running it that route, not sure what happens when they get to ICU.

    3. We usually use 7-8.0 ETT on female adults and 7.5-8.5 ETT on adult males for oral intubation, for nasal well thats another story. Obviously this depends greatly on the size of the person and if they may have edema or mass in their airway. I prefer to use a mac blade. The type of blade is decided by the person using by personal preference. I will use a Miller blade for childer because of the big toungue and small mouth. Blades for adults are size 3 and 4.

    Hope this helps.
  8. by   Vich
    Quote from SFRN
    Hi,

    I have a case of insomnia, probably because I work nights and this is my night off! Anyways I am full of questions and one just popped into my head. I know NOTHING of adult ICU practices I am a NICU nurse so please entertain my questions.

    1.) Do you ever use neostigmine to reverse NM blockade? And, if so do you administer it with atropine or glycopyrolate? What agents are used most common if you have a pt. that needs conitnual chemical paralysis? I know ROC is used for RSI and has quick onset and duration. Do you ever use Pavulon (pancuronium) we use itall the time in the NICU for CDH babies and babies on ECMO.
    2.) If you have a pt. on pressors like Dopamine (which can cause a horrible IV infiltrate, do you ever run dopamine through a PIV or does it go central?
    3.) What size ET tubes are most common with adults? What Larygoscope is used most common a GMAC, MAC, etc?

    Thanks for taking your time to answer my questions!!

    James
    1) Neostigmine and Glycopyrolate
    2) Central Line
    3) 7-8

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