**I should say not about students as all the interns will be experience nurses.**

I am heading up a new program for ICU interns in our hospital and I was wondering if any seasoned ICU nurses have any tidbits I can compile for them. I'm not talking the usual ICU knowledge type stuff, but the offbeat things that slips the mnd until a situation comes up.

Thanks in advance!!

You might have more luck posting in the specialty section under critical care nurses.

Here are a few that quickly come to mind. As I think of others, I'll post them as well.

• Some tasks have many ways in which they can be done. Do it the way your preceptor wants it done. It doesn't mean other methods are wrong, but you need to learn one technique well before you try others.
  
• Don't interrupt report with questions. Wait until the end and then ask if they weren't covered.
  
• Never be afraid to ask for help or a second opinion if you are not sure or anything. I would much rather answer a simple question or provide an early second opinion than code the patient later.
  
• Always be willing to assist a coworker with a hard/busy assignment. One day, you'll be the one who needs assistance.
  
• Label IV lines near the distal infusion port. This way you know what's in the line when before you use it for intermittent meds, etc.
  
• Clean and stock your room/bedside throughout the day rather than the end of the shift when you are trying to get out.
  
• Empty the Foley bag, and any other drains that can be emptied at the end of your shift. Make sure chest tube drainage is appropriately noted/marked as well.
  
• Always check your resuscitation equipment (BVM, suction, code meds, etc.) at the beginning of your shift.
  
• Check all of your infusions at the beginning of the shift with the off-going nurse. This will allow an opportunity to address any discrepancies.
  
• If you contact the pharmacy regarding IV compatibility, leave a note for following shifts stating what is/isn't compatible.
  
• Always answer ventilator, ECG, etc. alarms; regardless of whether it is coming from your patient or not.
  
• Never silence an alarm without looking to see what it is.
  

I hope this information was helpful.

don't defibrillate a prisoner wearing shackles.

never infuse anything through the pa distal port.

always check blood against the patient armband -- even if they're in isolation, smelly, the family is obnoxious and the preceptor insists it's ok to check it in the hallway. really.

you really can get "numbers" off a balloon pump without an aortic root line. honest.

don't shock anything that looks like vt/vf if your art line is perfectly pulsitile -- unless, of course, your patient has a pulsitile ventricular assist device.

we leave those blackened, dead digits to fall off on their own, so be careful when changing sheets, dressings, etc.

"are you sure you really want to do that, doctor?" is icu-speak for "you really don't want to do that, you frigging idiot!"

never give "just a little pavulon" to a patient to "help him hold still" for a procedure. especially don't give it if he's not intubated and ventilated.

the best place for an intern -- any intern -- during a code is on the chest doing compressions. or bagging.

i'm sure i'll think of more. you did ask for 'offbeat", didn't you?

Thank you for the replies. These are definitely the type of thing I was looking for.

****NOTE: I have another thread regarding this in the MICU-SICU forum for better exposure.****

never give "just a little pavulon" to a patient to "help him hold still" for a procedure. especially don't give it if he's not intubated and ventilated.

:smackingf oh. my.

along those lines... never let anyone convince you it's ok to run nmbd drip with no sedation. got a pt from another hospital like that once. they couldn't figure out why his bp was high.

know the names of all the unusual, rarely needed devices in the difficult airway cart. because when the dr asks for an airtraq, bougie, or intubating lma.... we needed it yesterday. it sucks when the only nurse who knows exactly what they want is on the wrong side of the bed in a crowded room. it hurts that nurse to bump her back crawling under that bed looking for the quickest way out. for that nurse to say "the long green thing... no the thin looong one" just won't cut it. you pass that cart every day. you never saw those thingies and wondered what they were???