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Discussion

Anxious pts!

Okay...so I had this 32 year old male pt in with a ton of bladder and bowel probelms ending up in a bladder repair, and the surgeons really wanting to put in a colostomy but the pt refused...and well...uhgggggg!

So I had him for two days, and boy oh boy was he anxious about everything! I mean, I would go in there to empty his foley and he would be in a panic asking me questions about output and color and why I had to do this! Any time I hung an IV (he was on TPN/Lipids/Abx and PCA) I got the 20 questions on why! Uhgggggg..I told him everything I was doing and why...

Then I got a paniced call! He was totally out of his mind with fear! What had happened is his picc line dressing has a small gap..and he was terrified that an air bubble would get in there and kill him! I reassured him that that was not going to happen and got some tape to seal it..then he was ticked that he had hairy arms and didn't want tape! UHG!!!!!!! So I got some op sites...tested one for him on my own arm to show it didn't bind as well but sealed well (I had him put it on me) and he felt better...but was concerned that I didn't panic, and that I found no probelm with air getting under the dressing for the picc (lets say I lost all my intellegence points with him!).

Okay...I am quite sure that it really isn't a big deal to have a loose dressing on the pic (just the cover...)...but he insisted that the infusion nurse that put it in said this! I couldn't find the infusion nurse to ask what the heck (this one is a jokester anyway...great RN but doesn't put up with too much with pts and could have said this! But it was his days off). Is it really honestly risky to have air in the dressing...I never thought it was...watch the line and keep an eye on the dressing and skin...reinforse PRN.....???????

If it is a risk then I learned something new..but I tend to reinforce those things anyway so they don't get damaged! In fact...I had to tell a new nurse not to push hard on three flushes she was blasting in on his picc lines so she didn't ruin them...and showed her the pulse technique!

Thanks!

Featured Replies

no it is not a risk the patient is watching too much TV.

I've never heard of it being a risk either. If it were, you would never change the dressing.

  • Author

I really thought so...but it did bring up the question as to why a nurse may have said it or if the patient was just hearing wrong..I mean he was scared to death!!!!!!! Almost hyperventilating!!!!!!! UHGGGGGG!

I have had some anxious pts before..but this one really takes the cake! A small bubble and he turns off his IV and freaks out...despite me telling him that that is not a probelm....even going medical anatomy info on him about gasses in the heart being a bubble of sorts and being okay..uhgggg!

Yeah...too much TV I expect!!!!!!!!! ANd if we find out what TV show said a small bubble in an IV line will kill you...I want to strangle that writer!!!!!!! LOL!!!!!

sounds like he needs a prn along w/alot of hand-holding, i.e., explaining procedures word by word....

leslie

  • Author

Yep..in report it was told he was a TLC to the extreme! LOL! I did that, and actually he and I had a great time together except when he was anxious. We talked about camping around Oregon and he was into that big time and we were talking about kid friendly places and fishing...we got along great!

However, I think there is an underlying psych issue there! He was not even towards normal when it came to medical Tx...beyond appropriate fear! Like I said..I have had anxious pts before..but this one went into hyperventilations!

And his family...the wife was funny and down to earth, and the kids...totally well behaved funny kids! So there was a large contrast! They seemed shocked at his demands for info...but I never waned on giving info, and assessed level of understanding and went by that..even using humor which seemed to help big time!

this guys sounds like he needs to be on an ativan drip!!!

I don't have any experience working with PICC lines in adults, so this may be different than my experience with neonates. But with infants, when a PICC line dressing loses its occlusiveness, it must be changed immediately. Not because of a risk of air embolus, but because of patient safety and infection control issues. In infants, the dressing is an important aspect of securing the line. If it loosens, there is a risk of the line migrating. The dressing also represents the only barrier to infection. So if the dressing comes loose, simply re-inforcing it is not acceptable. It must be changed, including cleansing of the insertion site.

Maybe this is what your patient was referring to. Kudos to you for your patience with him!

I am a nurse yet also one of these "anxious patients" lol. Something about being in the hospital can drive me to shake uncontrollably and be *really* scared, yet I work in one 3 days/week.

I was in about 2 months ago for a horrible stomach bug, or flu, anyway, I was dehydrated and had a lot of abdominal pain, n/v and diarrhea. They wanted to give me morphine for the pain and I *freaked* out. Both the nurse and doctor were so surprised, their faces were priceless. It's usually the opposite, people want that stuff, but I've seen some pts have adverse reactions, and I didn't want to be out of control. Finally they talked me into 1 mg of morphine and I made the nurse dilute and push slowly. She must have thought I was a nutcase!

In any case, I know I am a nutcase, and I apoligized to her in advance for it. Hey, at least I warned her that I was :uhoh3: right? lol

Also had 2 healthy babies and one stillbirth in the hospital. If a nurse comes at me with a foley I start shaking uncontrollably. I deny pain meds because being out of control scares the heck out of me. I question everything and really drive them crazy. I've even been in tears over the standard O2 they put on you when your in pushing phase of labor. Like - "why do I need this?! Am I okay? Is the baby okay?!" I really freak out.

Rebecca

There is absolutely no risk of air emoblus from a loose dressing. Only risk of loose picc dressing is infection. you were right to want it sealed. He had issues

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