20 min checks

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Specializes in GI, Outpatient Surgery.

The twenty min check consists of the initial intro and washing of hands in addition to verifying iv and enteral feeding solutions are correct, rates are correct, site check and recording of the types and rates. I then plan on going into vital signs. My question is- what if the pt has an IVAD or no IV?

I had my 20min checks under fluid mgmt but now ive divided it into two different mneumonics. Fld mgmt is one and the other is just for the 20 min checks.

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Beachnurse, would probably know more, but I thought you check their skin turgor, and go in to fluid management(which is part of fluid management), you cant check something that isnt there. I think I'd make note of any tubes found on body, if none state that to ce verbally.

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Specializes in GI, Outpatient Surgery.

The sg shows skin turgor as pt of the phase but is NOT listedunder the "within twenty mins of implement phase" headline. Im unsure what to go with but i would rather be safe than sorry! Beachie- any help on this???

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to be 100% i would send an email to them, don't take any chances :)

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Specializes in Tele/Neuro/Trauma.
The twenty min check consists of the initial intro and washing of hands in addition to verifying iv and enteral feeding solutions are correct, rates are correct, site check and recording of the types and rates. I then plan on going into vital signs. My question is- what if the pt has an IVAD or no IV?

I had my 20min checks under fluid mgmt but now ive divided it into two different mneumonics. Fld mgmt is one and the other is just for the 20 min checks.

For my 20 min check I have it all combined together with fluid management because for me if something is not applicable or not assigned I will just cross it off my grid, and on your PCS recording form it is important that you have addressed these things incase the CE asks to see your form after 20 mins, and that form includes both hydration status and parenteral/enteral fluids. Even if you are not assigned intake/output or your bag will not run out during your PCS I would still make a quick note of it in pencil and erase if you don't need it--better than forgetting.

So my 20 min check would be:

WIIGAS: Wash hands, Introduce Self/CE, ID Patient, Glove, Assess IV Site, Safety check (which is your SCABBS: Side rails up x 2, Call bell in reach, Ask if they need something, Bed locked and low, Brakes on, Socks if needed).

HIDGSGT: Hydration status, Intake/output (Explain to patient), Drip rate/Device, Glove, Site check, Gel, Tubing

If the patient has no IV access you're off the hook and I would just put N/A :-) If they have a heplocked IVAD you can always make a note of it when you are checking your hydration status and put it in a narrative if you chose to... but the way I look at it is if it's not assigned, don't bother it, you gotta save your time for something unexpected.. if you get there and it looks gnarly you can tell the primary :-)

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Specializes in Tele/Neuro/Trauma.
The sg shows skin turgor as pt of the phase but is NOT listedunder the "within twenty mins of implement phase" headline. Im unsure what to go with but i would rather be safe than sorry! Beachie- any help on this???

It is required on the PCS recording form so I would say just go up the arm, check skin turgor, glove up and check the IV site, gel, check tubing and get it out of the way. The way Rob says is to say something like "Are you drinking enough fluids? I would like to check the skin on the back of your forearm to make sure you are getting enough hydration." Then explain to them, I am assigned to measure all of your intake and output today and what you would like them to do... Just tie it all into one and then move on with your 20 min checks, get that hydration status done and documented and put it on your PCS recording form... then say the pt is drinking coffee or they have a cup of water make a quick note of what they have drank on your recording form in pencil so you don't forget about it later. Unless you have an enteral feeding, I would assume it prob takes like less than 10 mins to do all of it. I am under the impression the CE will explain what kind of measuring we need to do as far as use hat, urinal, etc...

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Specializes in GI, Outpatient Surgery.

For hydration status I was going to check oral mucous membranes.... you will be checking FA turgor?

Ok so I will just go with doing the whole Fluid Mgmt for the 20 min checks....how did you become so smart and awesome Beachie?!?

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Specializes in Tele/Neuro/Trauma.
For hydration status I was going to check oral mucous membranes.... you will be checking FA turgor?

Ok so I will just go with doing the whole Fluid Mgmt for the 20 min checks....how did you become so smart and awesome Beachie?!?

Well I think I am going to go with the skin turgor on the forearm for like a healthier adult or an older child....unless it's a baby under 1 then I will do the anterior fontanel as required....and if it's an old person with paper thin skin I will do the clavicle or the mucous membranes... and for a younger peds that can follow directions I may just go with the tongue so they don't think I'm pinching them... I guess it just depends what kinda luck I have LOL :-)

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Specializes in GI, Outpatient Surgery.

You amaze me beachie! What material are YOU studying with!?! Lol

Having a hard time with the iv push- getting push to last the full min and even a 15 sec piece. Not sure what to do but practice more!!

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Specializes in Tele/Neuro/Trauma.
You amaze me beachie! What material are YOU studying with!?! Lol

Having a hard time with the iv push- getting push to last the full min and even a 15 sec piece. Not sure what to do but practice more!!

What method are you using for your push? I have had the best success with the twist method, and I find that I usually get it to where I am about 4-5 secs over, you have a grace of like 8-10 secs over time but never under.

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Specializes in GI, Outpatient Surgery.

I was doing the sheri method of putting it in the "meat" of your hand. The twist may be the one i go with since i find tat easier. The only part i dont like about it is whn u have to let go to start the twist again and the possibility of the ce saying you werent pushing the entire time.

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Specializes in Tele/Neuro/Trauma.
I was doing the sheri method of putting it in the "meat" of your hand. The twist may be the one i go with since i find tat easier. The only part i dont like about it is whn u have to let go to start the twist again and the possibility of the ce saying you werent pushing the entire time.

That is originally how I was doing it because that's how I do it on the floor... but when my friend who went to the workshop came over and we practiced he really dinged me on it because I was unevenly pushing the med by each quarter (I underestimated my strength LOL... even if I primed the syringe first), so once I got the twist method down I did much better :-)

I don't ever let go I always keep twisting... even if it's not moving more than a nanometer LOL... but I hope I get something simple like 1ml over 1 minute or something... one of the ones in the EC practice labs they give you 1ml in 2 minutes and it's very difficult to only push 1 line every 15 secs!

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