Hardest Equipment to work with in Nursing

[hrtprncss]

So nurses with muscles and brawn and nurses with platinum backs, what do you think is the single hardest machine to deal with when it comes to difficulty of maneuvering and operating the equipment....for me the kci pronator bed for ards patients works me up and im usually sore after a twelve hour shift....what's yours

[Surgical Hrt RN]

hey erik

the ol' swanganz throws lots of people off because of all the numbers, waves and calculations. the trees get in the way so it's hard to see the forest.

the concept of heart failure is actually pretty simple: the heart fails to be an adequate pump. so stop imagining an icu pt with wires everywhere and lines and waves all up and down the monitor and a vent alarm likely going off and etc. simplify!!! make a cartoon in your head--imagine two little cartoon guys inside your pts chest working away at two bicycle pumps, ok? got that picture? one is a big guy working away at a big bicycle pump; the other is a little skinny guy with a little pump. they are working in tandem (we hope--lets assume normalsinusrhythm) rising and falling in unison as they work.

you see where i'm going, right? this heavy oily fluid comes into their workshop in a pipe and gets to the little guy's little pump. he sends it out to a system that fills it with oxygen and sucks out the co2. it's a really really low pressure system--which is why we gave the little guy that part of the job.

from the little guy and the oxygen tank, this heavy thick fluid cycles around to the big guy and his big pump. this guy pumps it around the rest of our factory where lots of work is done with the fluid.

we all watched these "scientific cartoons" in 3rd or 4th grade, yeah? not a hard picture to get.

now your the plant engineer, ok? and you get the report that there's trouble in the bicycle pump room. so you start looking at the pressure in the various parts of the system. but you don't have any guages along the pipeline or in the pumps!!! ohmygod!!! you can't shut the factory down. whatcha gonna do.

you take a looooong thin flexible tube and insert it into this system at some point before the fluid gets to the little guy's pump--and you put a pressure guage on the end of the looooong tube that you've got in your hand and it tells you the pressure at the other end. you can follow that, right? as you thread this tube along the system, you can see the pressure at each segment. ok?

that's really all there is to a swan. promise!! now you know pretty much all you need to--everything else is details.

if the problem that the pumpers have is with the big guy, the pressure will be way too high in the oxygen tank. (this will result in pulmedema.)

let's say that's what you find--the big guy is sick and pressures are high in the o2 tank and our fluid is oozing out of the pipes and making a hell of mess all over the place. what you gonna do about that? everybody is counting on you, ok?

first of all--you could give the big guy a burst of energy--make him pump harder. (you hang dobutamine.)

or you could vent off some of the pressure that he's working against--that would make his effort of pumping easier for him. (you hang nitroglycerin.)

or you could just take some of the fluid out of the system--which would reduce his work, too. (you give lasix.)

you could turn the oxygen tank up to higher levels so that even though less fluid in getting to the factory--it has higher o2 level and the factory goes on working. (you put a 50% vmask on your pt.)

eric--you're taking care of a pt in chf using your swan!! good work, my man.

thinking simply....

papaw john

papaw,

i sure hope that you are a preceptor! i love your analogy! as a preceptor myself, i am always thinking up "scenarios" to explain things to my patients and orientees! this one is great, nice job! i am sure you are an excellent teacher!

[mountain_rn]

The rotorest bed. Yuck, yuck............did I say yuck? Hatch care, getting up on a ladder to assess patients, hatch care, malfuntioning rotator,, hatch care.

[dorimar, BSN, RN]

yes yes yes to rotorest hands down!!!

[my2sons]

Yep, another vote for rotorest here. Also, the old Bard IABPs were a pain when you needed to transport--they had a mind of their own!

[CrunchRN, ADN, RN]

Papajohn,

If you aren't teaching - you should be!

[ER_RN21]

i really actually love the rotoprone beds by kci, what a life-saver (literally). in a year that i have been in icu, we are the 2nd in placement on the rotoprone behind mayo and i have seen ppl walk out that we thought would code and never make it. . wow.

but as for the bad, probably the rotorest as well. great for lungs and nurses' backs, until your pt poops and you have to take it apart again, and again, and again. . lol!!

[lifeLONGstudent]

papa - i am in school and i am saving your post for next semester (adult ii - critical care)...

may i im you for more explanations in the future :-)

lifelongstudent