auzzieneuronurse

It is a bit scarey that they have left someone to look after an EVD with no theoretical background knowledge of how it works and how to look after it!! If you are after more practical, specific info I'd suggest you search for the company that produces the drains in your specific unit as they often have good diagrams. e.g.Johnson and Johnson EVD's will come up with www.codman.com

I've never irrigated a subdural drain or heard of them being irrigated. ???fairly uncommon practice. Post evacuation of SDH the pt would be lying flat for 24-48/24 with the drain tube on thumb print suction and lower that the patients head. Once the drainage has slowed/stopped its generally time for the medical staff to remove them. Surely instructions to irrigate every hour would dramatically increased the risks of infection opening up a sterile system each time????

Our GCS criteria must be slightly different as if the pt does not obey commands or localise to central pain (sternal rub) we apply nailbed pressure bilaterally to elicit a withdrawl/abnormal flexion/extension response.

In my experience the only drains that nurses can remove are sugaleal/scalp drains/JP drains. EVD's and subdural drains are always taken out by the medical staff as they require a suture to close. The residents are also the one's to instil intrathecal medications.

You are talking about very different procudures here and lots of complications can affect patients recovery. Craniotomy + e/o tumour are generally up and about day 1 post op depending on their deficits. Recovery depends on the type, size and site of the tumour. Some people will need rehab due to physical/cognitive deficits and others will go home approx 4-5days post op. Crani and clipping of aneurysms are a different story and depends if it is an elective clipping or they have had a SAH - the common complications after a SAH are hydrocephalus and vasospasm. Our aneurysmal SAH pts usually come back with an EVD in situ and need very close monitoring they can be with us for a week to over a month depending on their progress and the majority require rehab. Laminectomy patients vary quite a bit. Their pain and symptoms are obviously relieved but there is alot of post op education and precautions required re body mechanics. Their hospital stay is normally from 3days to a week. Generally the older population do need a short spell in rehab.

Matt - Neurotrauma is awesome. Being a bit scared is healthy helps keep you on your toes. But just enjoy it - be keen and interested, learn the art of neuro obs and assessment (takes time to perfect and pick up subtle changes) and get a hold of a the neurosurg bible Joanna Hickeys textbook great place to start. There are loads of tips on this forum ie common drugs to brush up on, good resources/websites and general questions. Good luck!

Hmmm, very interesting, I'm "just" a ward nurse intruding to add my two cents. The wards and ED are vastly different worlds and it takes different nursing skills and strengths to do both but why is that a bad thing and why do we need to demean what the others do???? I can't stand this us versus them mentality!!! This ridiculous attitude that in my department we work harder and under more stress that anywhere else in the hospital and all the other are working against us to make our life more unbearable!!!! Come off it been up to a ward lately?! The patient acuity is higher than ever, it's not all about simple tasks like making cups of tea and "tucking people in" (did u really say that??). It takes all kinds of nurses!!!! I do believe that you should get a grounding in an area of general nursing first before moving into ED (I may now get lynched) otherwise you can become a jack of all trades and master of none. Sorry to offend. I fully appreciate how stressful and busy ED can be and trust me I try and get patients up ASAP and understand why things get missed or simply not done but it goes both ways how about a bit of understanding for the stressors I am under (we have codes/arrests on the wards too). Believe it or not the goal of my day is NOT to make yours hell!!!! Please don't demean ward nursing and what I love to do. I wouldn't work in ED for quids but don't trash what you do!!! Step out of your emergency world once in a while and come for a walk in mine maybe then you might all cut us some slack!

This is one of the most interesting debates I've read to date. Great thoughts and comments. I work in a major trauma hospital on a busy neuro ward and the battle between us and ED is never ending (almost as bad as our war with ICU!). How about a bit of understanding and patience!!! We are all nurses working in a frantic environment and trying to do the best for our patients under very stressful circumstances? Why do we insist on eating each other?? There is the old walk a mile in someone elses shoes!! I did a week placement in ED as part of a post grad diploma which was an eye opener. I came to appreciate their stresses and hardwork, I don't think they were any busier than I am on a day to day basis but it can go from quiet to out of control in seconds. Hence, I never stall getting patients from ED but when I say I can't take them now I have good reason so cut me some slack!!!!! We don't do faxed handovers but a heads-up for all ED nurses if you stop calling me every five minutes to see if I'm ready for the patient I might get a chance to discharge or transfer my patient to free up the bed. How about all remembering we are on the same team, cut the other departments some slack there are very few lazy nurses!!!!!

Hello, As a Melbournian I feel a bit insulted that we aren't even in the running! It is a great place!! I would probably choose somewhere on the east coast as its much easier and cheaper to travel up and down the country than to travel across it. I'd also recommend taking up short contracts so u can really get to know the place and people and get a feel for what it is like to actually "live" there. Sydney is full to bursting with tons of people on working holidays (millions of nurses) from England, Ireland and all over the world so it's not hard to meet people. Although, when I did a working holiday in the UK I made a real effort NOT to just hang out with other Aussies and Kiwis as I could do that at home! Good luck with your decision and hope u have a ball!!!!

Not sure how you can zero the system to atmospheric pressure if you don't remove the cap?? We zero the system once a shift in a completely sterile procedure and change the cap at the same time.

I LOVE neuro/trauma it's a fascinating and extremely challenging area of nursing!!!! It's busy, stressful, heavy and yes can be quite sad and confronting (esp the young head injured pts). We care for an extremely vulnerable population of patients and I find it endlessly rewarding and as you can tell get a great deal of job satisfaction!!! Good luck!! It's not for everyone but you'll learn a hell of a lot!

Well Done!! You fought hard for the best outcome for your patient and should have been treated with the respect you deserve!!!! Listen to your instincts! Some neurosurgeons don't think TCD's hold much weight but with her clinical signs it would have to be a cert wouldn't it???? Did they do a repeat CTB to check for communicating hydocephalus which may also have contributed to her confusion?? (I assume they didn't have an EVD in if they had to do a LP.) p.s. the third H is for hypervolemia not haemodynamics

I agree that the beeping from IMED pumps is enough to drive someone crazy if they go on incessantly!!! I have shown patients or their families where the silence button is and encouraged them to use it and then press the call bell and wait for me. There are circumstances and certain patients where and when this is appropriate and good for the sanity of all!!!

I tend to tell them as they give you a little more info and less dumbed down! They figure it out pretty quickly by the questions you ask anyway.

You would still need to log roll your patient at some point if you have an experienced team and use the correct techniques the patient should not be in danger.