I never would have thought of that...

[OhioCCRN]

Gah! too many threads beating dead horses on this forum right now.(cough...nety...cough)..

So, i am going to beat a FUN dead horse! Lets get started!

Tips/ Tricks/Hacks for getting through your nursing shift... (hint: I never would have thought of that...)

1. Shaving cream for stinky areas that refuse to be clean (works for PANNI as well)

2. Flush and irrigate your fms to get rid of the chunks in the tubing that impede the flow (some people only irrigate and the chunks stay constant in the tubing)

3. when switching over lines with pressors, INCREASE the rate for a couple of seconds so that you do not have bottomed out pressures while you wait for the pressor to prime the new catheter hub/line(do not forget to change it back to the right titrated dose)

4. pesky radial A-lines? have pt hold a folder up towel/abd pads and it helps to keep the waveform constant while you track down the fellow to either rewire or give you an order to titrate via Nibp.

[jadelpn, LPN, EMT-B]

When moving and repositioning a patient, put 2 layers under them--draw sheet, pad, draw sheet, pad. Not only does the extra layer help when moving a patient up the bed--especially if the patient is immobile, but then you are not changing the entire bed every 2 hours....

And never underestimate the power of powder. On bedpans (oh, and a chux under the bedpan, then up over the patient--splash guard) so that the pan doesn't suction itself to the patient, inside a commode for ease of cleaning.

And talking about cleaning--if you have a patient on a commode, a patient who needs to have a stat bedbath (like in an emergency room and they have to be clean so you can even sense skin integrity) peri bottles ROCK!! LOVE them, Can be used to clean any number of things--like a shower in a bottle HAHA!!

[blondy2061h, MSN, RN]

Placing more than one linen layer on the bed is against policy at my facility. It can cause pressure points, and it prevents the air from flowing in the mattress the way it was designed to.

[annie.rn]

When I have a patient become unstable, I erase the white board and write the time and dose of all interventions preformed in a running list. As other doctors and nurses get involved, they can just glance up and see what has been done when. Then, later, I can go back and reference that list for charting. I've had doctors take pictures of it to reference for their charting (no identifiable info).

Awesome idea!

[annie.rn]

When emptying a colostomy bag, fold the bottom 1/2 inch edge of the bag up (so that outside of bottom edge of bag is against outside of bag) prior to emptying. After emptying, clean the end of the bag and then fold it back down. This will keep the bottom edge clean when you empty it so that you won't have that little bit of stool squeeze out of the bottom when you reapply the clip. A patient taught me this one :-)

[TiffyRN, BSN, PhD]

After emptying, clean the end of the bag and then fold it back down. This will keep the bottom edge clean when you empty it so that you won't have that little bit of stool squeeze out of the bottom when you reapply the clip. A patient taught me this one :-)

Yes this!!! Had a parent show me this and I try to show as many people as possible, really decreases odors.

[Hygiene Queen]

When I have a soiled brief in my hands, I can usually roll it a bit, and pull off my first glove over and around the soiled brief. The brief is now partially encapsulated in my turned out glove. Then I remove my second glove around the brief. Now the brief is totally encapsulated in my two gloves and it reduces mess and odor.

We have good stretchy blue gloves, so it kinda ends up looking like a wonky blue human heart... so I call it "my blue heart".

It's a great party trick.

Warning: Do not do this with cheap gloves! Do not try to stretch the glove around the brief too fast! Do not try this for the first time with a diarrhea-soiled brief... that is an expert move only!

[TiffyRN, BSN, PhD]

Do not try this for the first time with a diarrhea-soiled brief... that is an expert move only!

[/i]

Love, love, love!!!

I can see someone hearing about this and trying this the first time with a massively soiled brief!!

I've used a version of this trick with infant diapers. You can usually completely encapsulate it like a diaper genie packet. Really helpful for those kids with the super-fortified formulas that produce really foul poos.

[JenTheSchoolRN, BSN, RN]

I just learned about this the other day! after a complete bed change/ patient all fluffed and buffed, RT drew a blood gas and got some spots of blood on the sheet! (i have slight issues when i get my patient looking just so and was very irritated with the 3 drops of blood) A co-worker talked me from the edge and told me about the peroxide! worked wonders!

Rubbing an ice cube on the spot will do the trick as well when it is a fresh blood stain. I've gotten out more than a few drops of blood with it...

I'm a school nurse. All my tricks are designed to make my limited budget work and stock work. I don't have an ice machine in my office and ice pack are expensive. Towards the end of the year, I turn to my clean sponge-in-a-baggie. I purchase cheap sponges from the dollar store, soak 'em in water, place them in a zip lock bag and freeze 'em. They work great.

[Sugarcoma, RN]

For me, probably the most time consuming tasks are dealing with incontinent patients, bathing, bed changes, and dressing changes. I have developed a few strategies to make these faster.

For bathing and bed changes I grab everything I need and then use the patient's bed side table to make a bed roll. Place the bottom sheet over the bed side table like a table cloth where the middle covers the table and the rest hangs over the table equally on all sides (make sure your linen doesn't touch the floor!) Next place your draw sheet on top of that, then your chux(if your facility allows them) roll up all three together lengthwise until you reach the middle of your table. Do the same with the other side in the opposite direction until you meet in the middle. Next take the top end that is hanging off the table and fold it over to the middle, do the same with the bottom end. When you turn your patient, you simply place your bed roll in the middle unfold the top and bottom, unroll the one side and fit it onto your mattress, then turn your patient the other way and do the same and your done. Saves time compared to waiting for someone to place the sheet on one side, then the draw sheet, then chux, etc. while you hold the patient. This is especially handy for those unstable patients that don't tolerate turns well and you need to move fast!

For dressing changes I lay out my dressings and pre-tape them. This way when I remove the old dressing all I need to do is slap the new one, tape and all on and I am done. This works especially well for chest tube dressings.

My favorite tip of all time: Wound Vac drape! If you have access to it, it is amazing stuff.

For those irregularly shaped pressure ulcers around the sacrum where you can never get the bottom end near the patient's rectum taped down well or else you would end up taping over their orifice: Wound vac drape is fantastic for this! You can cut slits into it to fit it around irregular spots so your dressing remains completely closed and your wound remains free of stool. It is also very gentle on skin and stays put! You can also use it to cover your entire dressing for patient's who are incontinent of stool to keep the dressing clean. You just wash the drape really well and then change it with your dressing changes. It is amazing how much quicker these difficult wounds heal when you can keep the dressings intact.

It also works extremely well to help protect skin from heavy drainage. We had a patient who was trached who had Pseudomonas with crazy secretions that would bubble out of the trach. You would literally have to suction her all day long to keep her chest dry. Her chest skin got really excoriated no matter what we did (ABD pads, towels, chux pads, Tegaderm, various specialty dressings etc.) Nothing could hold up to the heavy drainage. A little bit of wound vac drape to cover the area and voila! I am so grateful to the wound care nurses who introduced me to this!

[Sugarcoma, RN]

Another tip:

I am HORRIBLE at IV's! Like embarrassingly so. New grads on their 3rd IV start are better than me. I keep plugging away but after 5 years of effort and instruction from nurses with stellar IV skills, I just resigned myself to the fact that I would NEVER be any good at it.

I recently received a tip from a coworker who is amazing at IV's. He is the type who could start a 16 gauge on the coding, 20 year IVDA HX, dialysis patient! Pick your spot, uncap the catheter, pull it out about 1/4 of the way, then push the catheter against the cap bending the needle just a tiny amount, like maybe 5-10 degrees, then uncap and proceed with the IV. I am not sure why this works but in the last 2 shifts I have managed to start 4 IV's using this method, which is amazing for me.

[annie.rn]

Thank you Sugarcoma for the wound vac drape trick. Sounds awesome! I'm definitely going to use that one!

[annie.rn]

Wow! I'm totally hogging this thread but I just remembered a really good one:

TED hose application made easy:

Get a small plastic trash can liner. Place over patient's leg. Apply TED hose over the bag. Once they are applied, pull bag out through the hole in the toe. The bag provides a slippery surface for the TEDS to glide over.

If you don't have access to a plastic bag, you can use the bag the TEDS come in, just cut across the top and bottom and slide it up the leg in synch with the TED hose. Remove the plastic bag from the top of the TEDS.

Makes things so much easier for nurse and patient!