ICU Float Nurse

[Ashley.Hop, BSN, RN]

I'm from Medical ICU, transferred to a float position. I'm a newer nurse with 2 years MICU experience. I'll be going to Cardiac, Neuro, and Surgical ICUs now. Do you have any advice, or tips on what I should be aware of, what I should re-learn, or even try to avoid? (IABPs, brain drain's, GSW/trauma care etc)

I want to make sure I have appropriate assignments.

Thank you! :)

[Charge200J, BSN]

We are grateful for the ICU float pool RN's and try to give them good assignments. We usually don't give them any cardiac devices (IABP, Impella, LVAD, Swans,etc) unless they are comfortable and trained on taking those patients. Some of the ICU float pool used to work full time on our unit so if we know who is coming then we know that we can assign them to patients with cardiac devices. If the float pool RN is comfortable with CRRT then we will definitely give them those patients. Usually they get a 2 patient assignment: one intubated pt ready to do a breathing trial/extubate and the other patient ready to get up in the chair, take out lines, and eventually transfer to the step down unit. We try to prevent them from having to admit, however if needed to admit we try to set them up with a good admission.

[jennycRN]

This is just an example from a neuro ICU, but we don't hesitate to give a float nurse a "stable" patient with a "brain drain," knowing that there is more experienced staff to answer questions if needed. But we wouldn't give the float nurse a patient who is experiencing increased ICPs and needs close management from that standpoint.

[Mini2544, ASN, RN]

If you go to a neuro ICU....always zero and level your EVD drain at the start of your shift! Also as far as drains go, ALWAYS clamp that bad boy when you are suctioning a patient and don't forget to clamp etc when you are moving them around in the bed. I'm sure you will do great!

[Ashley.Hop, BSN, RN]

Can you provide explanations please. What does EVD stand for? I had a spinal drain patient once, and there was no instructions to clamp while repositioning, or when he was dry heaving due to nausea. However he was to lay flat for the duration of the shift, but we'd log roll him on his side to spit up.

[Mini2544, ASN, RN]

External ventricular drain. These are places by neuro surgery in the patients head, most are subdural or subgaleal level. They drain out excess fluid and blood from the ventricles and decrease ICP and also measure ICP. Lumbar and spinal drains are usually always clamped, you just open them for a period of time to drain them. Say 10 minutes per hour etc. they are also at a lower level to start to that makes sense on the patient you had. When an EVD is open and draining, it always needs to be level with the patients tragus (I may have misspelled that) If a patient sits up in bed and the drain is way lower than that, they will dump a large amount of csf at one time. If it's way higher and they are laying flat, it could back up into the catheter itself and cause all kinds of issues. By clamping the drain off, nothing happens and it keeps the patient safe until you're able to level it out and re open it.

[Ashley.Hop, BSN, RN]

Thank you for the info, are those patients generally sedated then? Is the EVD drain opened per order, or always opened?

The lumbar drain I had was barely draining anything past the first two hours so that's why they wanted it open for the shift, they ordered it clamped the next day.

[Mini2544, ASN, RN]

Well... it depends. Generally the patients who have bleeds large enough for an EVD are intubated and sedated. Patients aren't usually sedated just for an EVD though, except for when they place it but to be truly sedated you have to be intubated so I guess I just answered that twice. For the most part they are though, due to the mitigating circumstances

[arnwest]

Most neurosurgeons I've worked with would not let us sedate our patients unless they had ICP issues or were seizing (we might get low-dose dex or prop). Patients can be awake with an EVD and even ambulatory with an EVD. (I had a guy trying to take calls for work with an EVD in!)

I feel like float pool is different for every institution. At my first job, the float nurses always got the low-acuity or annoying patients to allow unit staff to take care of the sicker patients. At another hospital we almost always gave them 1:1 patients in the MSICU, usually ones that were vented and pretty tucked in (no traveling/procedures). But I know that in the CVICU they got the sickies - fresh hearts, IABPs, ECMO. This hospital gave them a couple weeks orientation on each ICU. Bottom line, I'd say what kind of assignments you'll see depends on your hospital, and you'll probably have to prove yourself before they give you high-acuity assignments. I'd say voice if you're uncomfortable with an assignment, and definitely speak up if they try to stick you with the bad patients repeatedly.