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jbp0529

jbp0529

CVICU, CCU, MICU, SICU, Transplant
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jbp0529 specializes in CVICU, CCU, MICU, SICU, Transplant.

jbp0529's Latest Activity

  1. jbp0529

    drips connecting at y-site

    Here is another thing to keep in mind about y-siting drips: Lets say you have 4 drips all y-sited together (not with a "chicken foot", but one y sited with another, which is y sited with another and so on). By the time you have them all hooked up, the entry point of your 4th drip is a considerable distance away from your patient (increased dead space). And if that drip is going at a slow rate, lets say 10 cc's/hr, it will take a LONG time to actually reach the patient and produce it's desired affect. (Levophed) ============== >>>> {patient} / / (Neo) =========== / / (Dopamine) ============= / / (Versed) =========== So my drawing is crude, but hopefully it will better explain my point. In this case, if you needed to make an adjustment to the versed, the solution will have to travel through all those other y-connected drips before reaching the patient. When ever I see this at work, I get really upset and put on a manifold or chicken foot device, so that all my drips are approximately equal in distance from the patient.
  2. jbp0529

    What Personalioty Does Best in ICU Nursing?

    Wouldn't have it any other way.
  3. jbp0529

    Rude Physician - Tips for Handling

    It's kinda like the sterotypical school bully. If you stand up for yourself, most of the time you will be left alone. It's even possible that you will make a new "friend" once the dust settles. I've seen it several times...the doc and nurse get into it, and then the next day they are both laughing about it and have a new mutual respect for each other. Some days you just have to put on your big boy/big girl undies, do battle, brush it off, and go home to your loved ones.
  4. jbp0529

    what is the best/worst specialty docs to work with...

    I hate to label people or specialties, but I would say surgeons. I work with them every day (cardiothoracic). They will use you for a doormat if they dont chew you out first. Once in a blue moon I run into a nice one and it's like a vacation. Seems like the best way to deal with them is to give them attitude right back. I guess one can compare it to the bully at school...if you stand up for yourself, you are usually left alone afterward.
  5. I work in the same hospital as my significant other, his brother, and his mother. We all work separate units so there isn't an issue, except trying to coordinate times for all of us to meet for lunch :-)
  6. jbp0529

    Any one using Cleviprex in their unit?

    My thoughts/feelings exactly. I'm hoping this falls out of style quickly. I dont know how expensive this stuff is, but I'm sure that being relatively new it isn't cheap. Coupled with discarding the un-used portion q 4 hours + the cost of a set of IV tubing q 4 hours...no doubt it adds up $$$. I agree with you. IMHO, they tried to reinvent the Cardene/Nipride wheel and failed.
  7. jbp0529

    Any one using Cleviprex in their unit?

    Hello all: My unit just started using this new anti HTN drip (well, new to us anyway), called Cleviprex. It's a calcium channel blocker, looks like propofol, is run in mg/hr. Apparently someone has won over the minds of our surgeons on this drug and we were told "expect to see it quite frequently". I used it for the first time last week (first time for our unit too) on a fresh carotid endart. Orders were to first use hydralaizine iv push... if unsuccessful in lowering the bp, then start the Cleviprex. Hydralazine didnt touch her, so i started the drip. Her bp was 190/something, surgeon wanted to keep her less than 150. Let me just say that my first impression is that I HATE this drug. First of all, its fairly labor-intensive in that we were told we have to change the bottle AND tubing every 4 hours, whether the entire volume is infused or not. Second, with the drip running at max rate (16 mg/hr if i recall), her bp was only down to 165. Hate it, hate it, hate it ! Maybe I'm just resistant to change, but I called the surgeon and got her switched to SNP and got her pressure consistently on target within 30 minutes.
  8. jbp0529

    Chest tube came out!

    Julie, funny story: I had a similar thing happen to me several weeks ago. I work in ICU and its still a big headache and kinda stressful for a few minutes. My pt (who truly was AOx3 and appropriate), intentionally pulled all 3 of his chest tubes out!! Yes, he knew what he was doing!! He didnt want them anymore, said they were bothering him, and "oh...well i was told they were coming out in the morning." I knew he was kind of a butt and self centered before it happened, but never imagined he would do THAT. LOL. Guess he had no idea that he could have made himself worse. Maybe he didnt care. idk The worst part was...I was at lunch when this went down. A fellow nurse saw it happen after-the-fact, came into the breakroom holding my "presents" for me, and smiled :wink2: I knew right away what happened. I ran out to my pt's room, assessed him (he was fine and the sites were already covered w/ an occlusive drsng). I then proceeded to scold the heck out of him (actually got him to apologize)! But what are you gonna do? What's done is done. Wasn't like he had an indication to be in restraints and wasnt. And the tubes really were gonna be d/c'd in the AM. But I still had to notify the doc at 2 AM and have some humble pie for dessert ...uh, I could have slapped that patient. So angry.
  9. Just wanted to vent a little, I apologize ahead of time... I recently moved to a smaller, private hospital in one of their ICU's, from a larger teaching hospital. I am appalled how a handful of the docs at this new place treat the nurses. They frequently throw tantrums, curse, whine, expect us to clean up their messes, and/or simply dont want to be bothered with anything. Sound familiar? I know, its a tale as old as time, and the subject of many rants on many posts here, and a problem in many places. However, I'm just having one of those days where I need to vent about it & share some info. When someone at my facility tries to stand up for themself, the issue is either quietly swept under the rug by management, or the nurse is thrown under the bus and blamed. And this is supposed to be a Magnet facility! To make things worse, instead of nursing having a united front against such behaviors, there are a few influential nurses who have worked there for 15-30 some odd years (my hospital being the only place they have ever worked, in some cases), who are buddy-buddy with these docs, kiss their butts, and take their side in these matters. It's such a disgrace. Whenever I hear one of these nurses say, "well, yea, he/she hung up on you and swore at you, but if it wasnt for Dr So-and-So, we'd have less patients, the hospital would have less $$," and blah blah blah... ...Well that may or may not be true, but nevertheless, it's a cop-out. Nobody should be a doormat to someone else. That certainly can be said of any relationship in life, be it professional or personal. Anyway, sorry for the long and slightly poisonous post, but my ultimate (and hopefully positive) point is: from one professional nurse to another...thank you to all who take wonderful care of your patients, despite sometimes difficult odds. Thank you for your hard work, on sometimes little rest. Thank you to those who take a stand, who are an advocate to your patients, as well as fellow nurses, and are not always assimilated into the collective.
  10. jbp0529

    ICU Interviews do's and oh no she did not's!!

    Ditto that. If one of our prospective nurses mentions CRNA during the process, its automatically a big red "X". I'm not personally saying that having CRNA as a goal is good, bad, or indifferent...its just my unit's written/unwritten stance on the matter.
  11. jbp0529

    "Is this patient abandonment?"

    That's extremely unfair to you, the rest of the unit, the pts, and the student. The involved nurse and charge nurse should be questioned by management.
  12. jbp0529

    "Is this patient abandonment?"

    Aside from the obvious pt abadonment issue, leaving a CNA in charge of an ICU pt, etc... I would also think (putting myself in the role of the hospital's legal dept), that if something happened to these nurses while they were clocked in and off hospital property, performing non hospital/patient care duties, that the hospital could be held accountable financially (in the event that the nurses were in a car crash, or something). Mind you, I'm no expert on this. I just know from my current place of employment that if we leave the hospital campus, we must be clocked out and have some sort of a paper trail giving approval to be gone. In any case, 2 hours is an extremely long time to be gone on break. Some type of disciplinary action should take place. Can you imagine if the pts coded? Heads would roll left and right.
  13. So here's my situation: a few months ago, I changed jobs from a teaching hospital CVICU (for personal reasons), and thought I'd try out another CVICU in a private hospital. Interview process went well, staff are friendly, facility is nice looking, etc. Well, it wasn't till after I started working that I noticed how strange things are at this place (I guess that's true with many jobs - you dont really see how things truly are till after you start). Alot of the surgeons at this new place are very old and set in their ways. Here are examples of what I mean: - surgeons routinely use glass bottle chest tubes - only labs done on arrival to ICU are: potassium and hct - vent settings ordered with no peep and/or no pressure support - no ABG prior to extubation...you are just expected to pull the tube - once extubated, many of the surgeons here dont want incentive spirometry. no one has given me a good rationale for this. maybe post op pneumonia/atelectasis is a good thing? - insulin gtt's are rare; no clear indication when to start. I've had many a pt at this place with sugars in the 200-300 range and been told to just continue with subcutaneous insulin. - chance of the pt having a swan is bout 50/50; when they do have one, surgeons dont care about critical #'s when called. - rarely does the pt come back with pacing wires. - one surgeon (who is especially old) uses a transthoracic swan. its tunneled thru the sternal incision into the PA. its essentially useless except for PA #'s. Cant infuse thru it or shoot outputs since its directly in the PA. - no propofol and/or any other type of gtt for sedation. they dont even come out of the OR with anything on board but what anesthesia pushed. if we can't get them extubated, or are told to keep intubated, we have to use morphine and valium iv push around the clock (seldom use versed). - if a pt is crashing,... start up an "Epi-Cal" gtt (we have to mix this ourself, I dont think pharmacy this is in pharmacy's formulary. its basically 4 mg of Epi and 2 gm of calcium chloride) - If a patient has a IABP...OMG the whole place just about shuts down! The pt is kept 1:1, which is fine, although I've had many an IABP paired with another pt in the past. Cath lab and OR do not run their own balloons at this place, only the CVICU nurses. If an MI is in cath lab and needs a balloon...cath lab doesnt know how to set it up, our nurses have to go. If a pt has a balloon pre-cabg, our nurses have to go to OR and sit thru the entire surgery and run the pump. It's truly ridiculous, but as I'm frequently reminded, "this is how its done here." I really hate to be the type of nurse that comes into a new place with exerience, complains about the status quo, and says things like "well at my last place this is how we did it"... so I dont. I just keep my mouth shut and go with it for now. Occasionally I do regret leaving my former, more "progressive" CVICU, bc IMHO this new place needs an injection of fresh ideas and practices.
  14. jbp0529

    Help Please!!

    Very interesting (and heated) thread. I, too, work in an ICU, but would like to weigh in just the same. I can truly understand both sides of this discussion. The ER needs to move ppl out for other sick patients, and the ICU needs to keep close monitoring and continue treatment of the sick patients. So where does that leave us? Perhaps there is a middle ground of some sort? I guess, at the end of the day, its all about the patient, and patient safety. Perhaps, there are several keys to making such a policy work. 1) there has to be a clear policy set forth by the hospital, laying out the details of pt transport from the ER to the ICU. 2) it has to be uniformly supported by all of the ICU's in that particular hospital (if there are more than one ICU). 3) everyone from the bedside nurse all the way up to hospital administration has to be supportive of such a policy. 4) there has to be a little "give and take" between the ICU and the ER, without either side abusing the system. If the ER has multiple criticals waiting on beds, or lots of traumas rolling in, then the ICU should be understanding of this and make arrangements as quick as possible to help transport up pts waiting on unit beds. Likewise, if the ICU is consumed with a critical patient or a code, or whatever, and isnt able to come bring a patient up, then a reasonable time frame should be set. I am all in favor of change and for making the system work faster and better. I guess the bottom line comes down to making our patients the priority (whether in the ICU or ER), making sure everyone is on board with whatever transport policy is in place, and keeping the relationship between the ICU and ER a professional and understanding one. We both do hard work, we both have sick patients, we both deal with crap from unruly patients, families, and doctors, and we are all great nurses. Just need to work together and communicate. If nurses are constantly in-fighting and bickering, then its no wonder certain doctors/patients/families dont give us the respect/credit we deserve. Ok, I'm off my soap box now :wink2:
  15. jbp0529

    Lowest Blood pH

    pH 6.7, mixed metabolic and respiratory nightmare. Came from ER intubated, advanced sepsis. Bicarb drip at 250 ml/hr, maxed on multiple pressors. Chest xray a total white-out. Vent changed to an osscilator on arrival, quinton placed for CVVHD. Family called in to say their good-byes, and the pt passed within about 5 hrs after being made DNR.
  16. We usually single fresh open heart patients for at least a few hours (another RN babysits your other patient, if you have one), but longer if they come out unstable or on a balloon pump. Otherwise, if its an uncomplicated surgery, or relatively stable pt, then the nurse may have the fresh heart plus another patient that is less busy. At my facility (a 25 bed CVICU), that averages 6-8 heart surgeries a day, it can be quite challenging, as far as staffing goes, to completely single each and every fresh heart surgery...there just isnt the staff to do it without tripling or quadrupling the assignments of the other nurses. Not to mention, the budget would be out of control. However, balloon pumps are always kept 1:1, as well as CVVHD's. Our daily assignment sheet does keep track of the 1:1's, though.