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New to ICU. What do you hate to see a new ICU nurse do?

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by IPMC15 IPMC15 (New) New

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Little over a year experience floating between PCU, med-surg, joint/spine/general surgery post op floors and ICU. I am transferring to full time ICU soon and am wanting tips! I would like to hear from you what the things you absolutely HAAAATE to see a new ICU nurse do because of lack of experience. Clinical tips only please. Things such as "never piggyback potassium riders, or always make sure to hang around for first 15 of new blood transfusion if possible, etc." Would love to hear from my RRTs as well!

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NICU Guy has 4 years experience as a BSN, RN and specializes in NICU.

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Not asking for help or clarification and hoping they are doing it correctly.

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Okami_CCRN has 4 years experience as a ADN, RN and specializes in Critical Care.

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Just out of curiosity, why wouldn't you piggyback K-riders... Many of us do it all the time. If I have an open line i'll just hang 40 meQ's/100ml over 4 hours and call it a day instead of priming a new IV, figuring out what to move around, etc. Plus you'll lose about 30ml in the primary tubing depending on manufacturer.

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9 Posts; 499 Profile Views

I've just always been told to not do it in case your pump were to fail and begin the primary infusion too soon and infuse your potassium too fast. Also if you are piggybacking it, you are at some point running straight potassium through which can make the "burning" sensation for the patient. I have piggybacked potassium before, but when someone told me that I always run it through another primary tubing and "Y" it in to a more distal port. This way, the pump cannot begin another rate too soon and you have saline infusing with the potassium which is not as hard on the veins. Just a little tip that made me think! Don't think its bad nursing practice, I just feel safer this way.

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Okami_CCRN has 4 years experience as a ADN, RN and specializes in Critical Care.

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I've just always been told to not do it in case your pump were to fail and begin the primary infusion too soon and infuse your potassium too fast

With that school of thought you would think pumps failed all the time. I piggyback K+ cause all of our patients have central lines so no burning sensation!

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9 Posts; 499 Profile Views

I'm not saying they "fail" like completely don't work. Just if they were to begin the primary infusion too quickly. Not all of our patients DO have central lines especially where I have been working on medsurg and pcu and it does burn them. I was giving an example of what kind of tips I wanted, not giving you advice. Please don't take thus any further. I'm not trying to start a debate.

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calivianya is a BSN, RN and specializes in ICU.

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My first job - KCL was considered a drip and running it as a secondary was against policy. My second job - if you ran KCL as a primary your coworkers would make fun of you for being an idiot. Every job's policies are different.

Anyway - I hate seeing new ICU nurses without a sense of urgency. If you hear an alarm, go see what it is. If a pump beeps and someone doesn't get it immediately, jump out of your seat and investigate. Just because it's not YOUR patient doesn't mean that patient wouldn't die without it. People on pressors can be really sensitive sometimes - even dropping their pressures and/or coding if the pumps beep for long. That O2 sat alarm could be because someone self-extubated and was in distress. Heck, if it's not normal lab time, even go check on an art line disconnect alarm - usually nothing, but I've walked into a room with a disconnect alarm to see blood gushing out of the femoral artery while the patient held the (formerly) femoral art line in his hand.

I hate seeing new nurses prioritize the tasky things that need to be done over the critical ones. Yes, that new admit is covered in stool and needs a bath. No, the patient does not need to be rolled if the systolic is in the 40s at the time. It can wait. Pick saving the patient's life first and doing the other things later.

I also hate seeing new ICU nurses not asking others about their patients. What's going on next door is absolutely need to know - especially, with the above example, if the patient is going to die if the neighboring nurse doesn't add volume to the pressor if the primary nurse is stuck in the other room when the pump beeps. You should know whether your neighbors' patients are okay or if they are circling the drain, at least.

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emtb2rn has 21 years experience as a BSN, RN, EMT-B and specializes in Emergency.

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The content of this thread applies very much to the ed as well.

ipmc15,

I have never seen a pump "fail" & simply dump fluid. I'll experiment tomorrow & see what happens if i connect a primed line to a turned off pump and open the roller. And no, it won't be connected to the pt.

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9 Posts; 499 Profile Views

Awesome reply! Thank you calivianya!

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Emtb2rn I'm not saying a turned off pump will simply free flow fluid. That's what I was trying to tell the other guy. I'm speaking about if your normal saline primary bag was set to infuse at 250 and you have potassium in to infuse at 100 and your pump begins the primary infusion before the potassium was finished . Thats all folks. Please stop acting like it's an idiotic thing to think because it could happen.

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149 Posts; 6,320 Profile Views

Don't be a know-it-all. Ask for help, but don't shop for answers. Do your own homework.

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Julius Seizure specializes in Pediatric Critical Care.

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Emtb2rn I'm not saying a turned off pump will simply free flow fluid. That's what I was trying to tell the other guy. I'm speaking about if your normal saline primary bag was set to infuse at 250 and you have potassium in to infuse at 100 and your pump begins the primary infusion before the potassium was finished . Thats all folks. Please stop acting like it's an idiotic thing to think because it could happen.

In PICU, almost all of my KCL is given via syringe pump, BUT if I was going to be hanging a bag, I would hang it as a secondary, and then I would set the primary rate and the secondary rate to both be the same. That way, when the saline "flush" from the primany bag was running behind the KCL after it finished, the KCL in the line would still be running in at the same safe rate. (And, if the pump DOES fail, the rate wont change.)

Not asking for help or clarification and hoping they are doing it correctly.

Yes, this! Please ask questions, or even ask someone to confirm what you are pretty sure is already correct. ICU nursing is tough, complex work and the patients are safest when the nurses work as a team.

What I "hate" to see in a new ICU nurse is when they are so caught up in the tasks that they dont take the time to think through the "why". Whether that is really understanding the diagnosis, or understanding why it makes no sense to run a 3ml med on a pump and then pushing the NS flush behind it by hand (the tubing is only 1.6ml). Smarter decisions are made with better understanding of what you are doing. But that stuff is a gradual process and takes time. There is a LOT to take in when you are starting out in the ICU. Good luck!

Edited by Julius Seizure

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