grrrrrrrrrr.........

Nurses General Nursing

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:madface: :madface: My dad is in the hospital and is getting IV antibiotics...the cannula became dislodged, so he needed a new IV. This "nurse" (and I use that title loosely with this person) came in and made several errors...first, she chose to restick my dad BELOW the original site...then, she put the tourniquet on and THEN decided that it was time to set up (open her needle packaging, get the tape/tegaderm ready, etc). At this point, I was seething, but I held my tongue...then, she sticks my dad (abbocath was a needleless system) and pulls out the needle with HALF OF THE ABBOCATH STICKING OUT, AND SHE'S TRYING TO FLUSH IT!!!!!!! :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire :angryfire

So, after trying that for a minute, she finally decides (hello!?!) that it's not going to work, and that she needs to restick him. I whispered under my breath "I'll do it"...she must've heard, because she asked if I was a nurse...I said I am...she asked if I wanted to start his IV, and I said "sure", and that my instructor had told me that I was one of the best IV starters in my clinical group. She procedes to insert another IV (again, distal to the other sites) and does get it in this time...only, she doesn't bother flushing the cath/port after insertion, which had blood in it...oh, did I mention that she wasn't wearing gloves during any of this? She ended up getting blood on her hands...talk about stupid. Luckily for her, my dad is "clean", but the next person may not be.

After all was said and done, she was about out the door when she turned around and said "IV starts aren't anything to brag about...I've been a nurse for 27 years". I couldn't believe that she said that...first of all, I didn't think I was bragging, second of all, with all of the errors she made, there's no way I would have imagined her being a nurse for 27 years! I am really PO'd at how unprofessional this person was and I am very tempted to report her.

Thanks for listening, just needed to vent :madface: :madface: :madface:

~Lori

Good post but I'm going to disagree with the NPO statement. Anesthesia will still cancel your surgery if you have had food or water past midnight because of the risk of aspiration pneumonia. We have had to cancel a hip surgery on the weekend because the patient had orange juice that morning. Bad for the patient and it was a financial waste as well, due to supplies that couldn't be reused(sterile field technically shouldn't stand idle for more than an hour) and the call people they had to pay for nothing(if you get called in and sent home, they still have to pay you for 3 hours).

I think caroladybelle was saying that, despite the anesthesia rule (and they all seem to still do it), there's no clinical rationale for keeping people NPO after midnight. IOW, it's just an archaic rule that they should re-evaluate. Not that they've bothered. It might be a good QA project for someone. What do you suppose the risk of that hip patient aspirating his orange juice really was?

What do you suppose the risk of that hip patient aspirating his orange juice really was?

I used to think the same way, until a few years ago. One of our FP docs came into the ER and mumbled to me, "I don't feel good." Several tests and CT scan later he was shoved into surgery with a ruptured diverticulum. He was so sick that he went straight to surgery in spite of having tried to drink fluids that day. He came through the surgery fine but vomited and aspirated after extubation. He ended up being flown out and spent nearly two months in a tertiary ICU and then stepdown unit because of setbacks.

I will never again think that anesthesia is being anal about a pt's NPO status.

Specializes in Oncology/Haemetology/HIV.

Evidence based research has identified a only short period of true NPO before most surgeries is adequate for prevention of aspiration in most cases. Depending on the researcher and study, most patients may safely have clear fluids until about 3-6 hours before surgery. Solid food is withheld from 6-8 hours. For children/babies the time periods of NPO may be lower.

Again, as in the prior post, some bowel procedures and some patients may require more time, due to other medical issues. And people can aspirate on fluids produced in the gastric track, even if they have been NPO.

This post was not to say to completely disregard orders for NPO, but that they are not necessarily as strict as previously believed. Often MDs will permit a "light breakfast" and nurses will make the patient NPO, because of a previous practice that has been proven to be incorrect.

Now many surgeons like to play the fitin game, of let's make the patient NPO every morning for several in row, "just in case" they can get a procedure in early. That is not always in the best interest of the patient's overall health.

I used to think the same way, until a few years ago. One of our FP docs came into the ER and mumbled to me, "I don't feel good." Several tests and CT scan later he was shoved into surgery with a ruptured diverticulum. He was so sick that he went straight to surgery in spite of having tried to drink fluids that day. He came through the surgery fine but vomited and aspirated after extubation. He ended up being flown out and spent nearly two months in a tertiary ICU and then stepdown unit because of setbacks.

I will never again think that anesthesia is being anal about a pt's NPO status.

If they knew that the patient had taken fluids, why didn't they drop an NG tube and aspirate the gastric contents?

Don't know. All I'm getting at is that it can happen. I've sent many a pt to the OR for emergency surgery and I've never heard of any of them being drained.

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

We only drop an NG on emergent cases when someoen ate recently (i.e. MVA that occured on the way home from dinner). One rationale i've heard from an MDA is that letting the stomach empty on it's own is better than suddenly sucking out the contents (that's what HE said, i'm just offering it as an idea of why, and not as an arguement).

We only drop an NG on emergent cases. One rationale i've heard from an MDA is that letting the stomach empty on it's own is better than suddenly sucking out the contents (that's what HE said, i'm just offering it as an idea of why, and not as an arguement).

Oh, I agree, too, that you wouldn't want to drop an NG on everyone. But if you have an emergent case and you know the patient just sucked down a Big Gulp, you might possibly think about it. But I don't know; I admit I haven't done the research. I do agree with the previous poster who said that sometimes people keep getting made NPO for days at a time because nobody's paying attention. First it's for a diagnostic, then it's for a procedure, then it's for a surgery that might or might not happen. Before you know it, they're nutritionally depleted and the docs wonder why they aren't healing up so well from that surgery.

Specializes in OR.
Evidence based research has identified a only short period of true NPO before most surgeries is adequate for prevention of aspiration in most cases. Depending on the researcher and study, most patients may safely have clear fluids until about 3-6 hours before surgery. Solid food is withheld from 6-8 hours. For children/babies the time periods of NPO may be lower.

Again, as in the prior post, some bowel procedures and some patients may require more time, due to other medical issues. And people can aspirate on fluids produced in the gastric track, even if they have been NPO.

This post was not to say to completely disregard orders for NPO, but that they are not necessarily as strict as previously believed. Often MDs will permit a "light breakfast" and nurses will make the patient NPO, because of a previous practice that has been proven to be incorrect.

Now many surgeons like to play the fitin game, of let's make the patient NPO every morning for several in row, "just in case" they can get a procedure in early. That is not always in the best interest of the patient's overall health.

I figured you meant that they shouldn't be completely disregarded. My one pet peeve, though, are patients coming down to the OR not adequately prepared for surgery(not being kept NPO), coming from the ER dressed and being told by the nurses there that they could keep their underwear on for abdominal surgery:uhoh21: etc etc. With all due respect, its not the nurses call as to who should be NPO or not. That's the doctors call and quite frankly, I'm going to trust anesthesia on this one. I have assisted in intubating someone who had "just a few sips" of liquid and it does make the whole process trickier. My "evidence based practice" is what I see and I've seen aspiration-it ain't pretty. It's not fun to be NPO but I'll take that over spending time in an ICU because myself and/or the nurse thought we knew better than the people who intubate patients on a daily basis. Just my 2 cents.
Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

I've seen disasterous results from "NPO fibbers" and "just a sip or two" as well.

How do y'all feel about "NPO except meds," which of course requires sips of H2O?

I think this is a really interesting subtopic. I might use it when I have to pick a research topic for school. :) I'm learning a lot right now.

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
How do y'all feel about "NPO except meds," which of course requires sips of H2O?

I think this is a really interesting subtopic. I might use it when I have to pick a research topic for school. :) I'm learning a lot right now.

Should be done with as little of water as possible.

Specializes in Oncology/Haemetology/HIV.
With all due respect, its not the nurses call as to who should be NPO or not. That's the doctors call and quite frankly, I'm going to trust anesthesia on this one. I have assisted in intubating someone who had "just a few sips" of liquid and it does make the whole process trickier. My "evidence based practice" is what I see and I've seen aspiration-it ain't pretty. It's not fun to be NPO but I'll take that over spending time in an ICU because myself and/or the nurse thought we knew better than the people who intubate patients on a daily basis. Just my 2 cents.

And my research is from the Department of Anesthesia at Johns Hopkins - conducted by anesthesiologists (not by nurses/plain MDs) - you can review it yourself on the website. in fact, if you use google, the vast majority anesthesia departments agree that based on facts and percentages of surgical related aspiration, there is NO statistical advantage re: aspiration episodes or complications between regular patients (barring certain comorbidies, clearly delinated in the studies) being completely NPO 8-16 hours and those that were merely off solid food (limited clear fluids permitted) for 6-8 hours and NPO for 3-4 hours prior to surgery.

Interestly enough, in one study done by an anesthesia department (not JHUH), there were no cases of aspiration in either group, less or more restrictive fasts. However, the group that had the stricter fast (8-16 hours of strict NPO) had substantially more vomiting after surgery than those with less restrictive fasts (clear fluids up to 3 hours preop and light solids up to 8 hours prior).

These are studies that have been done at numerous facilities and has consistantly demonstrated the safety of this within certain guidelines.

Again, aspiration can occur even in patients that have been NPO for days. But data clearly indicates that there is no difference in the numbers.

While we can all relate to the unforeseen happening (especially with 9/11 at our heels), and we all can tell stories about this, that and the other that happened because of....., we need to start encourage practices based on research and proven ideas. And while we cannot change anesthesiology practices in our hospitals, we can be accepting of practice change when it is accompanied by well documented evidence.

Again, I never claimed to know better than "the doctor"....this is research done BY THE ANESTHESIOLOGISTS...the doctors themselves. I like to think that maybe they do know what they are doing.

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