picu troubles??

  1. Hello all you fellow RNs!!

    I have been acquiring info from this site for weeks now and have finally decided to join the ranks!! So here we go... I am a new grad removed, which basically means that I graduated from nursing school in mid '08 then from personal, social, and whatever other issues I was having at the time, did not start working as a RN till December '08. I am always, always up for a good challenge and like the kiddies, so I decided for a possible career in the PICU. I can tell you sometimes I feel like I bit off more than I could and can chew!! I am in my 16 week of a 6 month orientation and in my aspect, things are coming along as they should for my situation, but to my educating coordinators, I am not progressing along as I should be... This truly, truly breaks not only my heart, spirit, and confidence as a new RN, but fortunately, my "angel on earth" preceptor. I have decided (for the time being until I can't take it anymore) to stay in the PICU and fight my way through... I know and feel things will come together in time, place, and space with a little help from my friend here...
    I need some major help w/ :stopcocks and which way to turn the stupid things:wink2:, drawing blood from both the artline where the VIA maching is attached- waste or not to waste, when to waste, how to waste, etc,, drawing venous blood gases off of central line where CVP monitoring is attached, thats all I can think of for now till next time. I feel sooo dumb for asking these things... I think I got it, but when I do these things I just seem to fumble this up and it is soooo not good for me at this point in time since I'm under such heavy scrutiny!

    Thanks so much!!!
  2. Visit aycrn profile page

    About aycrn, BSN, MSN

    Joined: Mar '09; Posts: 7; Likes: 1
    agency RN; from US
    Specialty: 7+ year(s) of experience in PICU, medsurg, step-down, ED, LTAC


  3. by   NotReady4PrimeTime
    What kind of stopcocks do you use on your unit? There are different kinds and the technique for remembering is different for each.

    Drawing VBGs when you've got CVP monitoring going on is not a problem, the expectation is that there will be an interruption in monitoring while you draw your blood. You have to remember to draw a larger waste because you might have things infusing through there, and use a bigger flush to ensure you clear the entire lumen.

    I've got to get back to work. I'll come back in a few hours and tell you more.
    Last edit by NotReady4PrimeTime on Mar 27, '09 : Reason: whoa, you can tell I wrote this in the middle of the night!
  4. by   aycrn
    Thanks for replying to my messages janfrn!

    Alright as for the kind of stopcocks we use, I really have no idea, but I'll describe them... They are 4 way stop cocks pointing north, south, east, and west, with one of these directions saying '"off". As for the CVP and drawing blood, do you turn the stop cock off to the transfuser or another direction? I've seen the CVP have a heplock on the hub. Hope this helps out. Any other info would be helpful too.

    Thank so much
  5. by   NotReady4PrimeTime
    Do your stopcocks look sort of like this?

    If you turn the "tap" so that the "off" leg is halfway between the ports (a quarter turn), it essentially locks off all directions. When you draw blood from your CVP you have to turn the stopcock off to the flush fluid, otherwise you contaminate your specimen with whatever you're using to maintain patency. (For example, if you're using a dextrose solution with or without heparin to prime your transducer and keep your line open, when you draw blood without turning the stopcock off to the bag and flushing the line with NS back to the patient, your serum glucose measurement will be artificially elevated. It's even more elevated if you draw from a multilumen line that has TPN infusing in one of the other lumens without turning off your TPN for a few minutes... If you're using a needleless port cap on your pressure lines, follow your unit policy and procedure for flushing pre and post.) Turning the stopcock off to your transducer is unavoidable and expected when you draw blood from the line. We don't use needleless port caps on our stopcocks (lack of appropriate education on how to use them followed by a kneejerk reaction so they aren't used on ANY central lines, we only use "deadenders") and as a result we have to ensure that once we've drawn off our waste no "contaminant" mixes with the blood we're going to collect for labs or gases, so we turn our stopcock tap so that it blocks off all three directions... the quarter turn, while we change syringes. In our situation if you turn the stopcock the wrong way and don't notice for a minute it can be REALLY messy!

    Last edit by NotReady4PrimeTime on Apr 16, '09
  6. by   aycrn
    yep sure do janfrn! when they are not connected to a manifold. anyway, since then ive messed w/ the stupid stopcocks and are trying to get the hang of the things which are still my nemesis, but thanks a bunch

  7. by   RNNPICU
    If you are comfortable with your preceptor, ask him/her to step by step help you, write it down and make yourself a reference manual.

    I had a hard time drawing up code meds quickly, so my preceptor gave my practice vials of sterile water and some needles and syringes and would time me. It helped a lot.

    I also wrote things down and now have a nice manual that I can reference gthings and when others have questions I open up my little reference manual.

    I realize this is generic info, but since some hospitals have different policies ...
    Hope this can help some