brent_25

LOL - that is probably the funniest reply I've seen yet.

Sent you an email

Hey there - send me a PM - I can help you with this - I moved from Canada (Vancouver) to NYC 3 years ago and I am familiar with the process. I can't promise I will have all the answers but I'm sure I still help. A lot to write - easier to pm. Brent.

As previously mentioned - a midline catheter is a peripheral IV (ie not a central line). The tip (or end - where the medication infuses) - is in the mid basilic/cephalic vein - it does not extend past the axilla. They usually are about 20cm long - and are intended for long term peripheral access (up to ~6 months)..because they are not a central line - they should be used for non-vesicant infusions and are not suitable for blood draws - if they require either of these, they should have a PICC or other CVC placed. Midlines aren't used much anymore as PICC's are becoming more abundant - PICC's usually are a better choice - longer life, more functionality etc... Brent.

1. RN - staff nurse 2. BSN 3. 9 years exp 4. Peds ER 5. NY NY 6. 79K base + 5K nights. (120K last year with OT)

I have seen patients 'play' with their IV's too many times..it is so easy for a roller clamp to get opened (or closed)..I think what everyone is saying is that infusing KCL without a pump just isn't safe. If your confused patient opened the roller clamp and ran that bag of KCL through in 20 minutes - you're responsible - and your actions would be deemed unprudent. KCL needs to go on a pump THAT IS LOCKED OUT. Your job is to do everything in your power to ensure that first - we do no harm to our patients. That is what will be asked of your actions - did you did everything in your power to ensure the safety of your patient? - and if you say you ran it to gravity for whatever reason - then the answer would be no.

I work in a peds ER and a co-worker of mine has the stethescope you want to get - the 'blazing sun' one..she LOVES it, and I have used it a few times and I can really hear well with it - they really work well..and cute too! We see newborn - 21 year olds and she uses it for everything, and find it works well even for the newborns. I'm sure if you decide to get it - you will love it too.

Just interested as to the reason a CVC 'didn't happen'? I'm assuming it was attempted multiple times without success? That is really the solution here - obviously this type of fluid resus patient needs large bore central access - or if that wasn't available in your ER - at least a peripheral IV inserted into the EJ? That can easily be placed by most ER docs, and it gives you a large vein to infuse into until proper CVC access can be gained... Otherwise - if that isn't an option either, then yes, you would have to stop one infusion to run the blood in...not ideal, but better than the chance of a transfusion reaction...

I should have added to my last post that I work in a 60 bed ED in NYC. Trust me when I say we're busy - and in the last year I've only gave a written report ONCE! Every other time has been verbal handoff. It is the safest way to endorse patients. Patient safety always has to be #1 no matter how busy you are - sending a patient to a floor without anyone knowing is asking for trouble...

A phone report is ALWAYS the best way to endorse a patient - but occasionally our ED will have to give a written report - if the receiving nurse is unable to come to the phone. Of course, we have 'guidelines' on which type of patient we can send a written report on - they have to be (obviously) stable, not requiring cardiac monitoring (no telemetry floors), no infusions that would require increased monitoring (heparin, cardiac meds..), no isolation, and only to regular med/surg floors (no ICU etc)..and only after at least 2 attempts to give a verbal hand-off. If we decide to send a patient up with written report - the receiving nurse must be made aware of this - we would never send a patient up without letting them know first. Patients should never just 'show up' on your floor. Also - on the written report sheet there needs to be the name of the nurse in the ED, and a local so you can call them if you need something clarified regarding the patient once you receive them. Hope that helps.. Brent.

Flushing with anything less than a 10cc is syringe is a big no-no. It has to do with the pressure exerted from the syringe - and the smaller diameter syringe you use - the more pressure it exerts. Most PICC's are 4Fr or 5Fr (in adults) - smaller in peds. I have seen PICC's fracture from someone using a 3cc syringe to flush with - so it can, and will happen! So ALWAYS use a 10cc syringe when dealing with PICC's. As for the use of heparin or not - really depends on the types of PICC's being inserted in your facility - try to find out if the are open ended catheters or closed ended (Groshong style). If they are Groshong style - no heparin is needed. If you use an open ended PICC line - you should flush capped lumens with Heparin (usually 3cc of 1:100 strength) when not in use (check with your facility policy regarding flushing protocols). Brent.

We run CVC's to gravity all the time (mainly because we simply don't have enough pumps in the hospital for all the CVC's we have!)..but when we do - it is our policy to hang micro-drip tubing instead of macro, to decrease the chance of the pt inadvertently receiving a bolus (for all those fidgety pts that may have a tendency to play...). The only time we insist on a pump is for infusions that require exact (heparin obviously) or someone on multiple meds where we want to ensure infusions are given on time... Brent.

Is this really true? All I can say is that I am a "foreign nurse" (educated in Canada - BSN) who is now licensed in multiple states - and of course I had to write the NCLEX (as well as undergoing extensive and lengthy credential evaluation) before obtaining my licenses. As far as I am aware - every foreign nurse must undergo this prior to obtaining licensure.

I have drawn blood from PICC's for years on an IV team - and we always use vacutainers - and have no problems. A syringe actually creates more pressure than the vacutainer we find - we will use a syringe when the blood will not come vacutainer method. For these times we have a syringe transfer vacutainer so we don't have to add a needle to the syringe to perform the transfer.

My 2 cents again..at my hospital (every institution has different policy of course) I work on the IV team and we do all the blood draws from lines - we draw from all lines - groshong ended or open ended (we use Bard lines) - and Bard states that it is ok to draw blood from all lines (groshong included) - this includes percutaneous, PICC's, Hickmans, IVAD's etc..and we have had no problems using vactainers on our PICC's. It is recommended that with groshong style lines, or lines that have a valved cap (positive pressure cap) that you flush with at least 20-30cc NS post blood draw to clear the valve of blood. Brent.