advandced monitoring in the ER

[phiposurde]

I was wondering how many of your ED have advanced monitoring in there department( art line, cvp, intra abdominal monitoring, ect)? Did you find that it delay the transfert your patient to ICU because you have such monitoring? Been part ICU part ER, yes a traitor in your list ,i'm trying to get my educator to get on board with the 21st century. Especially that me are one of the most acute trauma center, according to the news paper, in Canada. But the keep telling me the same: our RN are not trained, it will delay patient transfert, ect. They don't seem to undersatnd that the pt stay anyway and that we are throwing fluid like crazy and people withour knowing the cvp and just taking bloop BP. Thank you!

[mamalle]

If I worked ER id be opposed to Alines/CVPs/PA caths too. These are things that should be done in the ICU and doing these in the ER would only encourage boarding of these patients. If someone needs an aline/PA cath they should get it in the OR or the unit.

this is the exact reason we do not.

[traumaRUs, MSN, APRN]

Biggest concern for busy level one trauma centers is keeping current on the best practices angle.

In the 10 years I worked ER (left in June 06), we did put in art lines, an occas ventric and never ever any other type. Heck, even the ICUs don't use Swan Ganz lines like they used to.

[TXTraumaRN]

I've already had 3 pts this week with central lines that were used for CVP monitoring and one with an art line...and it's only Tuesday..lol. I work in a Level 1 ER and hemodynamic monitoring is a required competency. I haven't necessarily noticed that doing this prolongs the ER stay for an ICU pt; our problem is just having enough beds period. I may be wrong, but I thought the only thing you had to worry about when moving a pt was readjusting the transducer to the phlebostatic axis and re-zeroing. As far as putting them in, all we have to do is make sure the doctor has enough flush and sterile caps for the lines.

[neneRN, BSN, RN]

I don't think its a bad thing....we keep our ICU pts for up to 24 hours sometimes...makes it nice when you have a constant readout for BP or fluid status plus an easy way to get your blood for all the repeat labs.

I will say though, that our ER docs are not the best with draping and gowning up like they should...One of the intensivists joked to me the other day that they have to change out all the lines put in by ER docs "cause they just wipe the area down with a wet paper towel before throwing in the line"...exaggerating a bit, but we are trying to hold the ER docs to higher standards with the sterile technique.

[teeituptom, BSN, RN]

Occ we do art lines, PA lines, CVP. ICP just another toy to play with.

[phiposurde]

I've already had 3 pts this week with central lines that were used for CVP monitoring and one with an art line...and it's only Tuesday..lol. I work in a Level 1 ER and hemodynamic monitoring is a required competency."

** One of the argument that they give us is that we can,T maintien competency on those on our patient. How do you guys keep the training up to date?

[TXTraumaRN]

I've already had 3 pts this week with central lines that were used for CVP monitoring and one with an art line...and it's only Tuesday..lol. I work in a Level 1 ER and hemodynamic monitoring is a required competency."

** One of the argument that they give us is that we can,T maintien competency on those on our patient. How do you guys keep the training up to date?

Graduate nurses are required to complete a 3 month internship where they learn about different lines and monitoring; they have to have demonstrated competency before they can complete the internship. Every six months, staff nurses are required to complete a competency assessment. The nurse demonstrates that they know how to set up the line and monitor the readings. This is included as part of our "Medical/Trauma Competency Day" where everyone demonstrates competency on things from calculating drips to chest tube set ups, etc.