Most Dreaded Procedures - page 2
I work Med/Surg and there are certain procedures that I dread performing and last night I had one that I dread: Inserting a foley catheter in an uncircumcised 81-year-old man. I have so much trouble... Read More
May 18, '02Occupation: Staff Nurse Specialty: Med-Surg, Long Term Care ; From: US ; Joined: Jan '02; Posts: 1,178; Likes: 21WOW! These are all wonderful posts and I'm learning so much about enemas and foreskin -- Thanks! I'll try some of the great ideas that disher, l.rae, semstr, and Cascadians suggested about foley cath insertion. And MPHkatie, I had recently learned about squeezing the lube directly into the urethra, and will consider trying that, too. I'll have to print out this page for future reference since I'm sure I haven't seen the last foreskin...
Ceecel.dee, I totally agree about the NG tube-- that I'm torturing an already suffering patient; however, the relief they almost always get from the NG tube makes it worth it.
How could I forget about fecal disimpaction? Again, not something I dread-- don't deal with it in Med/Surg as much as I did in LTC-- and the patient's relief makes it *almost* worthwhile.
I thought of something else I sort of dread and that's giving a heparin injection SQ when there's no fat in the abdomen. I HATE injecting heparin into a tiny, emaciated old man or lady with a practically concave abdomen. In spite of the small needle, I feel like I'm hitting a major organ when I inject it and they always act like I'm torturing them. Any words of wisdom when you can't "pinch an inch" (let alone a millimeter)?
Anybody have to do Peritoneal Dialysis on their floor? Not my favorite procedure-- time-consuming! At least we don't do the dressing change 3-11; somehow night shift gets to do that... another task relegated to the "quiet shift"
And the last (but not least) dreaded procedure: a bowel prep for a colonoscopy (Golytely or Fleets #3 prep) on an elderly, incontinent patient..
Otherwise, I like my job!
May 18, '02Joined: Jan '02; Posts: 5,673; Likes: 159I don't know why, but I dislike assisting docs with procedures in the room. Like Swans, temporary pacers, chest tubes, EGD's, etc. Unfortunately it's hard for me to get out of this in ICU...LOL!
I have no problem with nursing procedures....maybe it's the control freak in me...LOL....lovin to do 'my own thing'; plus the fact that so many of our docs are jerks... they go off on the nurse if the setup is not 'perfect' or if we don't fully anticipate their every little **X##! need.
May 18, '02Joined: Nov '01; Posts: 765; Likes: 14huganurse I am right behind you to digital removal of feces is not my plan especially right after my lunch hasn't really digested. :-)
May 18, '02Occupation: Re-retired Specialty: 42 year(s) of experience in NICU, Infection Control ; From: CA, US ; Joined: Dec '00; Posts: 12,419; Likes: 3,760I'm w/mattsmom--I hate holding pts for docs to do a procedure--it can take forever. You can see your entire life in replay before they're through!! And if you're really lucky, it's a med student doing his/her 1st. w/ an incompetent resident "teaching". The best example is an LP on a big, fat newborn who is drier than a bone--even if they're in, nothing comes out.
When I did adult nursing, it was LP's and line placements that drove me nuts (for me, a very short trip). Holding an often struggling pt in an uncomfortable position (for both of us) for an indefinite and extended period of time. As a final protest, the pt usually had diarrhea in the middle of the proceedings!! Yucko.
May 18, '02Joined: May '02; Posts: 1,022; Likes: 64Chest tube insertion! That is brutal to watch. They dig around in there!! I usually stand there holding my side making faces. I also hate anything to do with the eyes. My eye doctor has to pry my eyes open witha crowbar all the while I am sitting there insisting "THEY ARE OPEN!"
May 18, '02Occupation: Re-retired Specialty: 42 year(s) of experience in NICU, Infection Control ; From: CA, US ; Joined: Dec '00; Posts: 12,419; Likes: 3,760I'm w/you on the eye thing! EEEYEOUW!!
Every Friday the babies have eye exams to check for Retinopathy of Prematurity--some of the eye docs are brutal, but the 2 we have now are very gentle. I don't mind them. I used to have to hold the baby w/my head turned the other way.
May 18, '02Occupation: Staff Nurse Specialty: Med-Surg, Long Term Care ; From: US ; Joined: Jan '02; Posts: 1,178; Likes: 21fedupnurse said:
I also hate anything to do with the eyes. My eye doctor has to pry my eyes open with a crowbar all the while I am sitting there insisting "THEY ARE OPEN!"
May 18, '02Occupation: ED staff nurse From: US ; Joined: Nov '01; Posts: 1,150; Likes: 232For foley placement in a male...I always use the lidocaine jelly..I can't think what it's called (dental work , lortab), comes in a syringe type thing with a special tip on it..Uroject is the name. I always use a coude tip too. Insert the tip of the Uroject into the penis, I squirt some onto the catheter itself too. Lay the penis flat with glans up, grip with one hand, we're assuming all the cleaning of the area has been done. Gently pull the penis up but still parallel to the body, insert catheter. For ederly women.. sometimes the meatus slides down into the roof of the vagina. If you cannot see the meatus, this trick often works. One finger in the vagina, slide a well lubricated coude tip catheter with the tip pointing up over the top of your finger. If that doesnt work and you gotta have a foley. Take a vag speculum, insert it sideways, then you can see the roof of the vagina and hopefully the meatus.
For relieving constipation/impaction. Red rubber cather bout a 14 french. 60 cc cath tip syringe. 30 cc olive oil and 30 cc glycerin heated in a cup of hot water. Put the O&G in the syringe. Very gently insert into rectum as high as you can go. Very slowly push the ingredients into the rectum. Works like a charm
NG tubes..let them chew a little cracked ice. Tell them to hold the ice in their mouth after you have anesthetized the back of the throat and the nares with cetacaine or lidocaine jelly. I like soaking a couple of qtips in the jelly and then inserting a Qtip in each nare, let them stay there for a few minutes. Take them out and look up your patients nose to see if they have a deviated septum. Using Lots of lidocaine jelly as a lubricant, I insert it into the larger of the nares. Once you are to the point that the NG has to make the turn down the back of the throat, ask your patient to put their chin to their chest and start swallowing. Give more ice as needed, you're only going to suck it right back out. Auscultate for placement and hook to suction.
Heparin does NOT have to be injected into the tummy, it's SQ... you got SQ everywhere!
Hope this helps PA-RN Wendy
May 18, '02Occupation: Public Health Joined: May '02; Posts: 109; Likes: 8You know when you have to pull back the foreskin of a newborn after the cir. and the skin dosen't want to let go. You have to rip it off the penis in order to push it back. The mom doesn't do it right because it's "gross" and it gets stuck. The doctor really enjoys delegating it to you, after he teaches you how. yuck! So you have to educate the mom again on pulling the foreskin back. Apply neosporin and a stick proof guaze. Poor little penis. It's so red and swollen and you know THAT's got to hurt like hell. Newborns go through a lot of agony.
May 18, '02Occupation: Staff Nurse Specialty: Med-Surg, Long Term Care ; From: US ; Joined: Jan '02; Posts: 1,178; Likes: 21LilgirlRN said:
Heparin does NOT have to be injected into the tummy, it's SQ... you got SQ everywhere!
I love all your great foley, NGT, and O&G tips-- Excellent!
May 18, '02Occupation: Level III NICU Specialty: NICU ; From: US ; Joined: Oct '00; Posts: 1,605; Likes: 929I absolutely hate having to assist with LP's on a preemie. The little whimper that a preemie baby can utter in that curled up position is so pathetic. And of course they have trouble breathing curled up so they desat and brady too.
May 18, '02Occupation: RN, Inpatient Hospice Specialty: 17 year(s) of experience in Hospice, Critical Care ; From: US ; Joined: Oct '00; Posts: 1,664; Likes: 177I used to do Peritoneal Dialysis a good bit when I worked on our Med-Surg/Renal floor. PD, although not complicated once you knew the steps, was quite time-consuming. And in those days I had a minimum patient assignment of 9. You throw a PD patient into that mix and you have the day from hell. Especially if they are on Q4Hr exchanges! Or more! Ewwww! And I ALWAYS seemed to get the dressing change.
May 18, '02Joined: May '02; Posts: 1,022; Likes: 64Sometimes it's not so much the procedure, it's the doctor doing the procedure. We have a pulmonologist whos nickname is Dr. Pneumo. That one calls to say she'll be in to do a line you had better get the pleuravac and chest tube try ready! I also love it when the arrogant ones say"I can get this line in in no time flat. Piece of cake." As much as they respect my knowledge and compassion for my patients, they hate it when I am the nurse assisting them because I have no fear of being sarcastic with them. "Hey Doc, we only have 2 more kits in the hospital, should I call security to get some more from one of our sister hospitals? Funny thing is they say it's my fault! Guess I make 'em nervous! HAHAHAHHAHA.