ICU tips?

Daytonite, BSN, RN · Jul 14, 2009

a very practical suggestion for the keeping all the tubings straight. . .put your fingers around where they start and gently run down them to see where they end before you do anything with them. i used to uncross and reorganize iv tubings all the time (i was an iv therapist for many years). any piggyback lines not in use i either disconnected and got out of the way and if they were unlabeled or outdated i tossed them out. know the hospital policy for how long tubings are supposed to be in use before changed. if you want to know the ins (infusion nurses society) standards i have a copy of the current ones.

there are weblinks for peripheral venous access devices, central venous access devices (cvads), picc lines, tpn (total parenteral nutrition), blood transfusion, and iv infusion devices/pumps on post #5 of https://allnurses.com/nursing-student-assistance/any-good-iv-127657.html - any good iv therapy or nursing procedure web sites. weblinks for oxygenation, tracheostomy/tracheostomy care, chest tubes, and mechanical ventilation/intubation are on post #13. post #39 has weblinks for basic ekgs and dysrhythmias, cpr and acls, hemodynamic monitoring, intracranial pressure monitoring, and the intra-aortic balloon pump

abg interpretation is on post #43 of this sticky thread: https://allnurses.com/nursing-student-assistance/pathophysiology-p-microbiology-145201.html - pathophysiology/ a & p/ microbiology/ fluid & electrolyte resources

there is also a sticky in the nursing student assistance forum with all kinds of icu information:

https://allnurses.com/nursing-student-assistance/critical-care-nursing-171767.html - critical care nursing: entirely free website materials...

also see:

http://www.ccmtutorials.com/
http://micunursing.com/ - micu/icu survival guide
http://www.medicineau.net.au/clinical/icu/procedures/home.html
http://www.4um.com/tutorial/index.htm

the first thing i remember learning as a student in icu. . .how to get air bubbles out of an iv line. . .no kidding! myself and another student somehow managed to get a bunch of air in an iv line and panicked. the icu nurse who had our patient calmly came over, took a needle out of her pocket, put it into one of the lower y-ports, opened the roller clamp on the iv, aimed the y-port at a trash can and we watched in amazement as the fluid and air bubbles shot out of the end of the hub of the needle into the trash can. that sure wasn't in our textbooks!

anoon · Jul 14, 2009

So in our nursing school we don't specifically do an ICU rotation. We do several different areas, some of which I found pretty intense and hectic. Here are some tips I picked up that you can hopefully translate over into your ICU rotation:

1. Keep the tubing organized. In my clinical last semester I had more than one patient with about 6 different pumps apiece (I was in neuro...). I used to color code my tubing with the colored tabs you use to date them (you know, the ones that you put the date it was set up and the date it needs to be changed). I used to very carefully arrange my tubing tags to match what was hanging (ex: potassium got a yellow tag ALWAYS since potassium reminds me of bananas, red always got a red one, etc).

2. Carry a note card. Yes you will look like a waitress, but it helps SO MUCH! When you have multiple patients that are high acuity, sometimes there are multiple things that needed to get done 5 minutes ago. I always carry a note card or Post-It note pad with me to jot down anything that really needed to be remembered.

3. Don't be afraid to ask help of the staff nurses. I know that I was sometimes afraid to ask for help since that would look like I didn't know what I was doing, but a lot of times those nurses are really willing to help you out! Scout out a friendly staff nurse that works near or with you and ask her things like, "so in this situation, how would you ___?" or "when your patients needs this, how do you ___?" I can promise you they know all the tricks to make your life and your clinical to much easier.

4. Carry a drug book or a PDA reference. When I worked in my neuro clinical, I was constantly calling pharmacy to double check compatibilities since there is NO way you can remember every single drug that interacts with say, Warfarin. Even if another nurse tells you that a drug is or isn't compatible, you can't legally go with that because your scope of practice says YOU have to check it.

5. Set realistic goals for yourself during the day. Example: I had 3 patients one day in my rotation, all 3 considered high acuity. There was no way that all the nursing care plus bed baths plus linen changes plus patient education plus family support was going to get done, or if I got it done, it wouldn't have been done well. Enlist support. If you need help from the CA, ask them to help you (but don't just dump it on them, they have enough to do already). Combine tasks and combine trips. Plan out your day at the beginning when you know what is ahead of you, but leave free time for those unexpected nursing problems that always arise.

6. MOST IMPORTANT - if you get time for lunch, TAKE IT. You will burn yourself out being super student nurse. No one will look down on you if you take time to go eat lunch and recharge yourself. It will make you more alert and energized for the rest of the day, you will definitely appreciate the break too.

HTH

Amber N. - Elsevier Student Ambassador