Latest Comments by ajwill

ajwill 687 Views

Joined: Jan 15, '01; Posts: 5 (0% Liked)

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    Does anyone have experience using a 500cc bag of normal saline kept at the nurses station or med room with a Braun dispensing pin to draw all flushes(central and peripheral lines)for a 24 hr period? I worry about cross contamination, and what about immunosuppressed patients? Everyones technique different and replacing the cap on the dispensing pin doesnt seem sterile either.Am I making a mountain out of a molehill? I'm sure cost containment of single use vials is the motivating factor as well as reducing use of needles. Thanks for your response.

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    I work at a small community hospital about 200 beds. We have 2 IV RN's on days and 2 IVRN"S on 3-11. Our night shift position was recently eliminated. On weekends, we go down to one on each shift. I feel it is a great benefit to staff as well as patients. We are responsible for site checks, starts and restarts(not in ER) Central line care and troubleshooting, PICC, midlines insertions. We also spend about 40% of our time with staff education, inservices, orientation, community programs, etc. I would be interested to know if there is anyone getting reimbursed for this specialty, and how. I didnt think staff nursing could generate a fee for service. I agree that I will always ask for an IV RN if I ever need to be 'stuck" and hope that there is one. I agree we are a dying breed, but with the more specialized lines in todays facilities, a few of us should remain.

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    Regarding the use of the Seldinger method for PICC inserton, we are currently looking at the Site Rite from Bard. It requires the use of the Seldinger technique.This is basically insertion of a microintroducer to cannulate the vessel. A guidewire is then threaded into the vein. The microintroducer is removed, a small nick made into the skin with a blade to allow for introduction of a larger catheter into the vessel through which the PICC can be threaded.The Site rite actually guides your puncture as far as location, depth, etc. This technique is used frequently by physicians all the time for insertion of central lines. Might it be that the MD's toes are feeling stepped on? It never occured to me that an MD would object or that a ruling from the State Board would be needed. As long as the person doing the procedure has been trained with documentation to support that. Of course there will be a learning curve with our IV RN's as they learn this technique, but I feel overall,this technology will allow RN's to provide user-friendly,cost effective and better tolerated IV procedures to patients.

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    Help! I've been taught that Dilantin was only to be administered with Normal Saline. I've seen cloudy tubing with it was mixed with concurrent fluids of D5LR, D5NS etc. In fact I believe drug precipate from mixing these drugs caused port occlusion a few years ago. To prove my point, I tried injecting Dilantin in a line primed with D5W and guess what..nothing happened. Have I been misled? The books say precipate may occur. Taking a chance on losing a port is not worth it in my opinion.

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    Help! We are beginning to discharge more patients with PICC lines back to long-term care facilities. Many do not have IV certified staff and have to contract with home health care to come in weekly and do PICC dressings. What is everyones practice regarding how often PICC have to be flushed? daily? or weekly? or monthly? What concentration of heparin are you using? We are thinking about 3cc of 100u/ml heparin weekly. Has anyone tried this? and will it keep the lines open for our frequent flyers?



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