So I'm a new nurse on the SICU. I just graduated in December and I am 3 weeks into orientation. It is going well-ish (everyone says I am too hard on myself), but I worry a lot about things when I go home. I'm told that's normal. Anyways, one thing that I could really use guidance on from more experienced nurses is how to clean up lines. For example, last night we had a super sick admit on our floor. This lady had an Hgb of 4.0 and had multiple pressors; we were measuring CVP, PA, bladder pressures, the works. However, when she arrived from the PACU, the lines were an absolute disaster. She had two sets of shock pads on, tons of extra lines -- just so confusing. I was focused on doing our intake assessment, but one of the other nurses managed to sort that whole mess and make it workable.
Later, I was wondering: how did she do that? I know this is probably a dumb question, but I find that often its the dumb skills-related questions that are tripping me up because I'm worried to do something that seems basic in an un-safe way. So say a person is on lots of pressors and has a whole bunch of lines that are untangled. How can you disconnect and untangle them safely? What about the transducer lines? Can I unplug CVP, PA, and A-line cables to detangle them?
What do you guys do? Any tips on how to keep lines organized when your patient has a lot of drips? We obviously use labels in our ICU, but as a new nurse I still find it hard to keep track of every line when they tangle, and I worry that I may not know all my access points in an emergency situation.
Specializes in ER, STICU, Neuro ICU, PACU, Burn ICU.
Trace your lines one at a time and lable them (I lable the pumps also). Get rid of the ones you don't need (cound on anesthesia adding a couple you don't need). Check compatablity. ALWAYS have positive control of your lines when moving/turning your patient. Happiness is a manifold, a-line, and a triple lumen CVC.
It's called a manifold. There are some that are manufactured this way or you just screw together however many you need and attach to your lumen.
IF making your own, do use caution and check frequently that they do not become disconnected (lots of places to come loose when you make your own manifold). You can easily have your dopa gtt running into the patients bed and not have any idea why your blood pressure is sinking....
I definitely agree with everyone's advice! When I go into my room to do a gtt check at change of shift I always check my lines. I make sure they are all dated and labeled. I label my lines in 3 places: going into the pump, coming out of the pump, and at the port. We are also required to select a drug on every pump so that you can clearly see which pump is running what. If I need to look up any drug compatibilities I will just go ahead and input all of the drips my patient is on and print that off so that the next nurse has it. That way they don't have to spend time looking up what I have already looked up and if they need to change around the lines they can already see what is compatible. I always try to consolidate all of my lines right away as well. That just makes things easier later on if something needs to be changed or I need an open port.
I definitely agree with everyone's advice! When I go into my room to do a gtt check at change of shift I always check my lines. I make sure they are all dated and labeled. I label my lines in 3 places: going into the pump, coming out of the pump, and at the port. We are also required to select a drug on every pump so that you can clearly see which pump is running what. If I need to look up any drug compatibilities I will just go ahead and input all of the drips my patient is on and print that off so that the next nurse has it. That way they don't have to spend time looking up what I have already looked up and if they need to change around the lines they can already see what is compatible. I always try to consolidate all of my lines right away as well. That just makes things easier later on if something needs to be changed or I need an open port.
I agree but I am curious why you label the line "going into the pump and coming out of the pump"?
I agree but I am curious why you label the line "going into the pump and coming out of the pump"?
When I had kids with multpile drips I would walk the line from the bag to the pump, label the line, make sure the pump label was correct then walk the line from the pump to the patient and label again. Part of this habit came from being a nurse before pumps had drug libraries. We had to know which pump was infusing which drip. We had little cards on the actual pumps but they sometimes fell off and sometimes the labels on the patient side would too.
I get the purpose of labeling lines and even pumps if they aren't smartpumps, but I'm not getting why would label the tubing just above as well as just below the pump.
I get the purpose of labeling lines and even pumps if they aren't smartpumps, but I'm not getting why would label the tubing just above as well as just below the pump.
Because when you go to titrate it's quicker to look at a labeled pump than track the tubing back from the patient. The label I put on the patient side was at the manifold.
Because when you go to titrate it's quicker to look at a labeled pump than track the tubing back from the patient. The label I put on the patient side was at the manifold.
They get that, they are asking why NewGradNurse2014 puts a label on the tubing between the bag and pump (normal), then a label at the distal end of the tubing (also normal) but then a 3rd label on the tubing just after the pump (not the norm).
Managing your lines is something that will come with experience. I remember being a new nurse, and tracing my lines over and over and over to make sure I knew where everything was going. We do the 3 labels thing, with one at the patient, one by the bag, and one directly on the pump--our pumps don't show the drug name when they are on hold. I like to know at a glance that my pressor is running, not on hold!
Yes, you can disconnect just about anything for a few seconds, even your pressors, just make sure you know exactly where you are going with it before you disconnect it. Pressure cables can be unhooked, you will just have to re-zero them once you reconnect. You can disconnect your suction tubing (ETT, OGT, etc.), just make sure no secretions are going to come dripping (or flying) out. :)
There are a few reasons I label my lines in 3 places. 1. Yes, I will admit I am a tad OCD lol 2. I am a new ICU nurse and I have been a nurse for just under a year (which I think helps contribute to my OCD-like traits ). I am always double and triple checking everything. 3. I guess that's just kind of the norm where I work. That's how my preceptor did it and I see many other nurses do the same thing. It's just super easy to glance at the pump/lines and know what everything is. And often, like a couple people have mentioned when a patient is on multiple gtts and there are many lines it's easier to glance at them and know what they are in a few seconds, especially in an emergency. I guess I wasn't aware how abnormal some people view this to be? lol
Oh and as far as lines/tubes in general, the best advice I got as a new nurse was to put the most important lines on top and to try and keep lines on both sides of the patient balanced. For instance you would never put any cords above or tangled with your vent tubing as that is more important so there would be no reason for a vent to become disconnected due to other lines/tubes. And let's say you would have your vent tubing, IV lines and art/CVP lines on one side of a patient, then you would put your blood pressure cuff, pulse ox, and tele leads on the other side. Those might not be the best examples, but hopefully it made sense. I know it seems simple but it always going back to those basics really has helped me out.
Anyways, one thing that I could really use guidance on from more experienced nurses is how to clean up lines. For example, last night we had a super sick admit on our floor. This lady had an Hgb of 4.0 and had multiple pressors; we were measuring CVP, PA, bladder pressures, the works. However, when she arrived from the PACU, the lines were an absolute disaster. She had two sets of shock pads on, tons of extra lines -- just so confusing. I was focused on doing our intake assessment, but one of the other nurses managed to sort that whole mess and make it workable.
). I am always double and triple checking everything. 3. I guess that's just kind of the norm where I work. That's how my preceptor did it and I see many other nurses do the same thing. It's just super easy to glance at the pump/lines and know what everything is. And often, like a couple people have mentioned when a patient is on multiple gtts and there are many lines it's easier to glance at them and know what they are in a few seconds, especially in an emergency. I guess I wasn't aware how abnormal some people view this to be? lol
lakepapa
29 Posts
Trace your lines one at a time and lable them (I lable the pumps also). Get rid of the ones you don't need (cound on anesthesia adding a couple you don't need). Check compatablity. ALWAYS have positive control of your lines when moving/turning your patient. Happiness is a manifold, a-line, and a triple lumen CVC.