RoxannMM

ERIC, Thanks fro your response I actually have had to contact anesthesia mutiple times in relation to these nerve blocks and it seems that who ever is on call at night does not know much about the nerve blocks. That's why I was questioning thier use. So it's either that we have anesthesiologist that know alot about them and like to use them and other that know very little. There have been cases where patient have been over blocked to the point of NO SENSATION AND NO MOVEMENT. Which camoflagued the symptoms of compartment snydome, which lead to the losing his leg. I am sure this is the upmost extreme consequence/side effect. BUT that should have LEAD to EVERYONE in the DEPT. becoming Educated on these peripheral nerve blocks. Thanks Roxann

It's neither of those. I know which you are talking about though inreference to the total shoulder. I have seen what we call a "Zimmer" Which is probably very similar to the Painbust Ball your talking about. The Zimmer is Pressure controled and is only in place to the first dressing change. The Zimmer is used only on shoulders, they also use sersorcaine. The pump I am talking about in our total joint cause are either femoral, sciatic, (knee) or paravetrebral in a hip. They are set up on a pump. I will Find out the name exactly on the PUMP itself. it's set like a EPIDURAL PUMP on a continous infusion no PCA though. It had it's own houraly rate that is controled by the pump. This pumps use ropivicaine. I have seen a Clavicular Block with an infusing pump for fractured ribs, and a elbow reconstruction. Will re-post with name of peripheral nerve block infusion pump.

DeeDAWNtee, Thanks AGAIN! I can't wait to shadow/observe next monday. I hope what I am expecting plus more. YAY, starthing to feel like a llittle kid who is waiting for christmas. ESP. After my horrible night of work last night. I HATE COMPUTERS, but I can TRULY say even though I had a conflict with a co-worker last night my patient's got more than adequate care, and I got thanked by a OMF(Oral-Maxilo-Facial) Surgeon this morning for my good nursing care. That made me feel like "WOW, sometimes things just workout" The other thing I forgot to comment on above it that I love to teach patient's and/or families. I think that you can be the smartest Doctor/Nurse/PA in the world and if you can't explain things for a patient and/or family to uderstand it's worthless. MY first Apperciation award was becasue I took the time to explain Hip precations for a family (mother and son) to the point where they could understand. Visually and verbally it made me feel like I would worth a million bucks. PATIENT CARE FIRST... my living moto!

Still Awaiting and feedback... Anyone even if you have jsut seen one Ijust want to know if they are being used in other facilities other than my own. Medication that is being used for the infusion is Ropivicaine. Thanks! Hope to hear from someone!

Thanks Deedawntee! I deff. appericate your feedback. I most admit I myself in nursing school wanted to work in Critical Care unit but wanted to become more acustomed with my skills and assessments before. ALong with the put down from a follow classmate that made me feel inadequate. I think working where I am at now has helped me esp. in post-operative patients. Assessment skills are key esp. when your only ordered monitoring is BP-HR-RESP-SPO2-TEMP. It has helped me link my assessment to my vitals and dig deeper with my assessments when things aren't adding up. This continues on from acute post operative pt.'s to trauma transfer pt's. I have this constant need for more, like I want to be able to ask more question and get more answers just LEARN MORE. I love learning and be able to use my knowlegde as a clinician, to help my patients. I found that I have become very "anal" or so I am called by other nurses. I just like everything followed through and try my hardest to see that done. Sorry I hope this is not sounding like my plee to be in Critical care. Just trying to state where I am coming from. This is in generally why I love being a nurse. I like to ask question and get the "that's a GREAT question" response. Or when things aren't followed through in thier entirety they respond with the "well need to look into that" or "well need to find that out." I just dig hard at the "we're not sure" or "we don't have that answer" responses. I don't like those answers I want TRUE backing answers. I just hope others esp. new nurse like myself find the drive and continue to follow it and let in LED them to sucess. EVERYONE PLEASE KEEP THE FEEDBACK COMING... Thanks ALL!

I don't know if this topic has been brought up before. I am just looking for some feedback if anyone has had any experience with nerve block infusions. It's like a regional block except a catheter is used. Patient's get a loading bolus for the surgery and then post-op the infusion is start after patient exhibits adequate movement. These nerve blocks are being used a lot on patient with total joint replacements. I work as an Ortho Rn. I have seen these pumps being used more and more. Which I think is great for acute post-op pain management. Only things is that these pumps are either work good, or they over work or don't work at all. Each is different. I have never seen the same therapeutic management. Most of my knee patients seem to be affected the most. Losing total sensation and movement of their foot. Which clinical makes is hard to assess that patient for complication of the surgery etc. compartment syndrome. I do understand that the purpose to eliminate the pain stimulus and that it's none by using a medication that subjectively effect sensation and alter movement. Anyone have any other feedback??

I like this Thread Quite intresting, I did know all of this about Toradol which is more than frequwntly used on our unit with both joints, and backs. I didn't know that is deceases that chance of fusion with spines. Which is intresting to me. We use Toradol with coumadin on our joints. IF anything it's helping them reach there therapeutic PT/INR faster. To prevent clots. We have one surgeon who on his knees will only use ASA, no toradol, nothing other than TEDS and compression device for DTV propho. Yeah, deff. seen the differnce his pt have had PE's. I just have some questions does any one have any idea on how many does of toradol to signifigantly prolong bleeding times??? I have never seen any documentation of how much toradol is take to prolong bleeding times. Out trauma patients are forbid from using any toradol. I think it's a great non-narcotic pain mainment.

Congrats Welcome to Nursing! Like tweety said, Circulation, Sensation, Movement. Priority everytime. DTV prevent also very important in these patient's. So Keep an close eye on your Saturation level. Antibiotic therapy is very important with the high risks on infection. Watch your bllod counts in these patient's too. H&H's, PT/INR's very important. Know your protocol for how Hips and spines should be ambulation what is allowed and not allowed. Common Meds: IRON VITAMIN C Stool Softners Antibiotics: Ancef, Cleomycin, Gentamycin Narcotics: Morphine, Hydromorphone, Oxycodone, Percocet Our ortho Surgeons that do joint replacements have been using infusing nerve blocks, and around the clock tyelnol and toradol.

Looking for some feedback. I am currently an RN on a Med-Surg specially floor. I work with primarily Trauma/Ortho patients, and now I am considering a move to the ICU. Shock Truma we are a level 1 trauma center and I am truly loving my time with the stable trauma patient and looking for an up-grade to something more critical. Always been drawn to Critical Care, just wanted some experience first. Just looking for some helpful advice to the move from the big move from pulse ox’s to vents, single blood pressure cuff to a-lines. Going to shadow a day first to make sure it’s what I want, before I drive in head first. Thanks

I Work in Orthopeadic with alot of acute post operative Total knee replacements. I totally agree with you, about the pressure cuff what I refer to as SCD's (sequential compression devices) which help to prevent DVT. We use them in conjunction with Compression stockings. Post discharge patient's are expected to wear the stockings for 6 weeks depending of risk of DTV. They are allowed to remove them for 20mins. 4x per day. I have seen a few DTV to PE. So continue to use your skills when assessing patients.

I loved hearing all these stories unfortantely I don't have any of mine own yet but I can't wait till I do. Keep up all the good work and great care.

I just wanted to say Thank You All for the POSITIVE feedback. It's been great and reassuring. I am glad that other nurses see questions as a good thing. I have always asked question thoughout school they were ones that needed serious thought and most nurses where stumped by them as well. Two + Brains are better than this Lonely Novice One. Thank you for all the tips as well I just have one my question do you think a Goniometer will be a good clinical tool for me to have. It is used to measure like degree of flexion and extensions. If you think it is TOTALLY unnessecary please don't be affarid to tell me. Here is a picture of what it is. http://www.allheart.com/pm47.html

I have to agree with this statement. I understand that it is our job to take care of patients. Though at home I feel like we need to take care of ourselves so that we can continue doing our job. Exposure to germs is what keeps us strong. Just like while at home you should not use ANTIBACTERIAL/ANTIMICROBIAL soaps. Because it is weaken our immune system thus leading to the spead of infections and more importantly nosocomial infections. Something to keep inmind. Stay strong and continue On.

Thank You Very Much. Great little helper!

CMS?? or CNS?? Sorry. I have been through 10 ortho surgeries myself (as a child13-15yrs). I hoping that will help me.