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.
So, with the lines connecting the patient to the monitors, I unplug them one at a time from the monitor (beep beep! says the monitor), thread it out and around the other wires, and plug it back in. And then the next one, and the next one. Until all the monitor lines are nice and ordered. If it is a super sick or long term patient, sometimes I label the lines with blank labels. Some hospitals may not be able to do this I imagine. Never take things like defib patches off the patient and then restick them back on. Instead unplug from the machine and do it that way.
For the drugs, I look at the drugs and think "can i disconnect this?". If it is a no, I leave it. If it is a yes, but only for a short time, I do it last and quickly when the others have been disconnected and reconnected neatly. If its okay to disconnect, I disconnect it from the machine (never from the patient, as this would make a break in the sterile connection) and thread it through the spaghetti and back in. Ordered one after the other.
Honestly, I have had times when the patient has come in in such a mess, and then I have done initial caring and then taken a good 20 minutes making the lines and patient all clean and neat. It makes SUCH a big difference! I think I am a bit of a neat freak! Plus it looks so much better for family, and for doctors, and for when you hand the patient over. It also can be a time when you look at the bags and medicines and double check that everything is right, dosages are right, that the handover was right, or if there is any mess on the pumps.
Sometimes it can be hard when you have a really really busy shift or a really really intense patient to do it. Neatness isn't a priority, the PATIENT itself is a priority. So in those cases it's only when I am hanging up a new line that I keep it untangled from the spaghetti to not make it worse.
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.
canned_bread
351 Posts
Oh my - the dreaded spaghetti lines I call them!
So, with the lines connecting the patient to the monitors, I unplug them one at a time from the monitor (beep beep! says the monitor), thread it out and around the other wires, and plug it back in. And then the next one, and the next one. Until all the monitor lines are nice and ordered. If it is a super sick or long term patient, sometimes I label the lines with blank labels. Some hospitals may not be able to do this I imagine. Never take things like defib patches off the patient and then restick them back on. Instead unplug from the machine and do it that way.
For the drugs, I look at the drugs and think "can i disconnect this?". If it is a no, I leave it. If it is a yes, but only for a short time, I do it last and quickly when the others have been disconnected and reconnected neatly. If its okay to disconnect, I disconnect it from the machine (never from the patient, as this would make a break in the sterile connection) and thread it through the spaghetti and back in. Ordered one after the other.
Honestly, I have had times when the patient has come in in such a mess, and then I have done initial caring and then taken a good 20 minutes making the lines and patient all clean and neat. It makes SUCH a big difference! I think I am a bit of a neat freak! Plus it looks so much better for family, and for doctors, and for when you hand the patient over. It also can be a time when you look at the bags and medicines and double check that everything is right, dosages are right, that the handover was right, or if there is any mess on the pumps.
Sometimes it can be hard when you have a really really busy shift or a really really intense patient to do it. Neatness isn't a priority, the PATIENT itself is a priority. So in those cases it's only when I am hanging up a new line that I keep it untangled from the spaghetti to not make it worse.