New SICU Nurse... Any advice

FOCKER0014 · Aug 21, 2009

Well although vasopressors are good to know, the fact is that I would say 95% of the time you will be giving fluids instead of pressors in a Surgical ICU. Surgeons (non-cardiac) like to keep their patients tanked up whereas most cardiac patients are kept dry to decrease the work of the heart. So with that in mind the best thing you could "brush up" on is your hemodynamics. Know when vasopressor is warranted. Far too often the inexperienced critical care nurse looks to start a pressor when a fluid bolus or some other sort of solution is the answer would correct the imbalance first.

If your SICU uses SWANS, don't MEMORIZE the normal values, instead KNOW what they mean and indicate. This will take you farther in your practice than you can imagine. I work with a lot of people who can spit out the normal values but when asked what they "actually" mean, they don't have a freaking clue.

Finally, remember the key rule in the ICU....keep em alive till 6:45!! (little humor)

meandragonbrett · Aug 21, 2009

icufaqs.org is a good place to learn some foundational things in nursing that you need to know to work in the unit (i.e. drugs, emergency situations, vents, swans, a-lines, CVP, etc.)

Working in a surgical ICU you will likely have a lot of abdominal and vascular surgeries on sick old folks with major comorbidities (i.e. previous MI, CHF, DM, HTN, COPD, etc.) that will make their ICU stay very difficult and complex.

Drugs that you will give on a regular basis include: morphine, hydromorphone, fentanyl, midazolam, lorazepam, alprazolam, propofol, diazepam, heparin gtt, argatroban, integrilin, insulin gtt, cardizem, amiodarone, nipride, cardene, vasopressin, dopamine, isuprel, epi, norepi, dobutamine, digoxin, metoprolol, labetalol, dilantin, keppra, lasix, bumex, vanc, imipenem, meropenem, cefazolin, and all kinds of other abx.

Find out if your unit utilize pulmonary artery catheters. Learn your hemodynamics. Know the various hemodynamic profiles of various shock states (sepsis-->warm vs. cold, cardiogenic, neurogenic, hypovolemic). Know that using epi or dopamine in an old person is not necessarily a first line of treatment for hypotension (when speaking of pressors) and why. You'll do a lot of fluid boluses in these folks and sometimes albumin (depending on the surgeon's beliefs). What's the normal CVP? What factors alter your CVP? How does PPV change your CVP compared to yours or mine? What is considered an adequate CVP in your unit population? KNOW what receptors your drugs antagonize or agonize and you will be far ahead of the game. Know the mechanism of actions will help you to understand which drugs are desirable in different hemodynamic states.

Does your SICU recover their own patients straight from the OR? Ventilated only or all? Be aware of various advanced airway management techniques. Know how to use oral and nasal airways.

Learn your ABG values and KNOW what the numbers mean. Learn what your base excess/deficit means in your hypotensive shocky patient. Learn how various ventilator setting changes alter your gas. Oxyhemoglobin disassociation curve is another thing that's important. How does monitoring serum lactate come into play in the ICU? What are you looking for with it?

One GREAT way to learn and prepare for what you'll see in the ICU is to get you PASS CCRN! by Robin Dennison. It can be a difficult book to read because of the volume of the content and it's format but it's a great resource. The ICU Book is another great resource. I always advise new folks to start studying as though they were preparing for CCRN. It's the best way to gain the textbook learning that will help you and your patients.

A SICU is a GREAT place to learn. It's high tech, fast paced, and has very sick people. Learn everything you can during your orientation and pick your preceptors brain. Be open to being taught new/better/easier ways of doing things that you might not previously have done before. Some of us ICU RNs can be pretty crazy and can easily start spinning around the unit like tops at the drop of a hat. Just be flexible and experience as many things as you can while you're in orientation.

Some links of interest:

Surgical Critical Care

Good luck! Let us know if you have more questions.

I_See_You_RN · Aug 21, 2009

Thank you so much for the advice,.. and I LOVE that quote,..lol. I will definitely get working on those things :)

I_See_You_RN · Aug 21, 2009

MeanDragonBrett: THanks a ton... I think I'll print out your post and definitely start my study plan as well as go see if I can get a copy of those books. :)

aroze · May 13, 2010

@I see you RN- Hey I'm gonna be graduating in December 2010 and I've been looking for nurse fellowship programs in critical care. Which hospital do you work for that has this type of program. Thanks in advance.