I &O's, Blood Transfusions, TPN and all things Interventions

[GoNightingale, BSN, RN]

Hi everyone,

I'm a 2 1/2 year old nurse and I've had the good fortune of floating to different facilities and seeing the differences as to how each works. Could someone enlighten me as to the pros & cons of the following interventions- if someone can actually give me the evidence-based answer that would be really great. First, blood transfusions- some use a pump others don't and they calculate the rate by counting drips...don't kow -it would seem that using a pump would be more accurate and also more controllable; second, parenteral nutrition TPN and then a separate bag of lipids- some nurses use filters others don't- what's up with that? Then.. there's the important, but not much talked about measurement of I &O's.......I mean, the more I work and have witnessed some pretty poor patient outcomes consequent to I &O not being measured or measured inaccurately, I'm concerned because, well, nursing assistants are being cut down more and more and it also seems that the only accurate I & O is taken when there is an order for strict I &O's or the patient has a Foley. But you know in the short time I've been a nurse I have worked Med/Surg, Med/Surg Tele, and PCU and I can really see where a patient has alot of cardiac comorbities and can easily go into acute renal failure when that wasn't the admitting diagnosis. I don't know, I'm thinking of just putting a urinal or hat in toilet for those patients that are walkie talkies and just ask them to pee in there even if they're not Strict I & O. If I don't put the hat in the toilet or give them a urinal, they'll just go right into the toilet water and we'll never know it or be able to measure it.

Allright my dear colleagues.....I welcome discussion.

As always I appreciate everyone on this site. It's great to be connected to nurses outside of work.

[IndtrpRN]

I agree with you on using the pumps for blood ..I mean why wouldnt you use a pump if it is available? Also, at the facility I work at we hang alot of TPN which either has lipids in the bag or dosent. We always use filters regardless. Sounds like some nurses are just lazy to take the extra step to screw a filter on.

Also, on the I&O's..I beleieve these numbers are very important on med-surg floors. I work on the transplant floor with many kidney transplants and I&Os are essential. However with another patient population it may not. I just do I&O q4 with routine vitals or ask the tech every 4 hours what they emptied. But yes, its not hard to put a urinal or hat in the room and tell the pt it needs to be measured.