2 embarrasing bone head questions

[ohbet]

1. In giving care to trach patients the ties need changing,we do it the one nurse method,and we use the velcro ones,but it takes me forever to get the procedure done.Do you have any speedy "tips" for changing the ties,or do I just keep practicing until I pick up speed.

2.If a drug in 200cc of NS

is to given over 60 min.but you only have 250 bags,whats the formula to figure how long to give a drug in 250cc of NS?

I can do this simple problem in my head but when a situation gets more complicated I was wondering if there was a formula,is this solving for X?

Thanks.

[Glad2behere]

ohbet,

Just get a large sterile syringe and aspirate 50 cc.

Divide quantity by time 250 divide by 60= 4.16cc per min the X your Gtts per cc. : 15gtt per cc= 62 gtts per min

I am like you, if I do a specific formula it ends up making no sense.

[2ndCareerRN]

Another reason why working the ER and having the doc there is so nice.

ME: Hey doc, this drug is supposed to be diluted in 200ml of NS and given over an hour. We don't have any 200 bags but have plenty of 250 bags. How 'bout I go ahead and mix it in the 250 bag and run that in over an hour. Pt is young, healty and the extra fluid won't hurt him.

DOC: Sure.

Pt gets prescribed drugs in prescribed time. And then OTD or admitted.

bob

[NRSKarenRN, BSN, RN]

Aaron's tracheostomy website has a fountain of info re trach care.

Trach change procedure:

http://www.tracheostomy.com/change.htm

If needed, I always suction patient first to prevent splatters/minimize cough reflex when doing tie change then clean stoma and inner canula. Ties changed last

With the Dale velcro holder, I place the large side under the neck and guesstimate when to attach small side, remove and place together. Always attach velcro large side of holder first above old holder, then place new one under neck. Check to see if I need to make any adjustment. Then detach short side old tie, attach new

short side, detach old long side tie, remove old tie entirely; make sure one fingerwidth is able to fit under holder to allow for neck swelling/ movement.

In homecare we would wash in laundry bag or handwash in soap then soak in 1:10 bleach solution and reuse especially if payment an issue.

Practice does make perfect! You'll get the feel for it.

[fab4fan]

Here's how I did the fluid one: If 200cc goes in over 60min, then 50cc goes in over 15min, so a 250 bag would run in over 75 min.

If it's one you have to mix yourself, you could just take 50cc out of the bag before you mix.

But I also admit to pulling the "ask the ED doc" option from time to time.

[ohbet]

cool,thanks

[Allison S.]

When we have a trach patient, I always hang a sample tie behind their bed that is sized. Then I size the new one against the model before I start. It saves all those adjustment steps.