sister s

We currently use a syringe driver when we infuse noradrenaline/levophed, but have had some incidents when we swap syringes with significant drops in BP, even when we have a second infusion ready to go. On some occasions nurses have said that they have left the safety clamp on the new syringe and not realized this, and the syringe driver has failed to alarm due to the low infusion rate. Then, not only do you get a low BP, when you discover the clamp is on and you un-clamp, you get a sudden purge of inotrope. We tested clamping a syringe driver that was 'infusing' at 2ml/hr, and it took the Alaris syringe driver 40 minutes before it alarmed! Then, when I un-clamped it 6 or 7 drops purged out! My question is, if you run your inotrope through a bag and pump, rather than a syringe driver, how many of you out there have actually experienced problems with the VTBI running out or air in the line? Obviously these are factors that are avoided by using the syringe driver method, but at least with the bag and pump method you never have to stop the infusion, even momentarily while you change infusions.

Australia

Thank you. It's interesting to see how the truth gets stretched.

One of the nurses on our unit (in Australia) is from Canada. She claims that "about 14 Canadian ICU nurses died during the SARS epidemic". Can anyone clarify this for me?

G'day all. Can anyone tell me why so many ICU patients need potassium infusions going? Is the missing potassium being used, or stored in the cells? Thanks for any help :paw:

Yep - I work in ER too. On night shifts everyone brings a plate and we have snacks through the night. Sanitary? You should see our tea room. What difference does it make if you eat a chip on the floor or in the tea room? You still wash your hands don't you? I take breaks and eat on the floor at times. Sometimes I even have a coffee on the desk too - ooooh!

Yeah, I'm lost on this one too. I get that there's way more sugar in the blood in HHNS, but why doesn't the body use insulin to store that excess sugar, and if the reason is that the body is resistant to insulin, then why doesn't the body feel low on energy because it is resistant to insulin and can't store/use glucose? And as a consequence, because it is resistent and can't store /use glucose, why doesn't it then go down the same pathway as DKA and break down fat and make ketones? I don't get it either.

Absolutely. I know exactly what you mean!

Unreal! Must be the same the whole world over. In a way I'm glad it's not just here in Australia

Yes, I hear you! I've just left ICU to work in ED for some extra experience - to see the other shoe type of thing. I've been here a month now and I'm finding it very hard to appreciate. There's a definite clique, almost verging on outright rudeness to anyone new or unfamiliar. Looking at blood results or EKGs is almost frowned upon "just give it to the big boys (meaning the doctors) and get on with your job" was one remark I got from a senior nurse last week when I was looking at a patient's EKG. One nurse in triage admitted a patient under category 2, declaring that he had "EKG changes". "What sort of changes?" I asked. "Inverted T waves" she said. Turns out the leads were on the wrong way! Yesterday I got into trouble for not keeping the patients moving in and out fast enough. I'm finding it very depressing. I'm going to give it until Christmas, then reapply for a job back in ICU if things don't get better. It's true about the different kind of busy. In ICU I was often stressed and busy, but my focus was on the patient, not on their bed, and I felt like I had a lot more responsiblity and respect.

I'm trying to come to grips with understanding the difference between ALI and ARDS. All of my resources state that the difference is: ALI has a specific definition: a PaO2/FiO2 ratio of less than 300 (i.e. if the patient is on 30% O2, the PaO2 is less than 90mmHg) ARDS - acute respiratory distress syndrome, has the same definition as ALI except that the PaO2/FiO2 ratio is less than 200 (i.e. on 60% O2, the patient's PaO2 is less than 120mmHg). I just can't understand the ratio formular. I know I must be dim, but can anyone highlight the obvious for me? Eternally grateful - Sister S x

Our ward protocol says that IDC bags should be emptied at the end of each shift. One of my colleagues says that she was taught at uni' only to empty the bags when necessary because opening a bag to empty it is creating an unnecessary portal of entry for possible infectious bugs. Our ward manager said that if she can provide evidence of this theory then the ward protocol would be reviewed. However, she can't find any literature to support her arguement. It sounds plausible to me. What does anyone else out there think, and is there anyone who can direct me to a study or some literature to support her arguement?

Yep - so if the patient is ventilated they have 1:1 nurse. It's a 5 bed ICU ward (we don't separate surgical/medical etc, and there's a nursing float for the ward to fetch and help with stuff and answer met calls. Other than the Intensivist, physios visit once a day and the dietician visits once a day, but that's it. It seems to work. Other ICU patients can be 2:1 if they're not invasively ventilated.

Yep - so if the patient is ventilated they have 1:1 nurse. It's a 5 bed ICU ward (we don't separate surgical/medical etc, and there's a nursing float for the ward to fetch and help with stuff and answer met calls. Other than the Intensivist, physios visit once a day and the dietician visits once a day, but that's it. It seems to work. Other ICU patients can be 2:1 if they're not invasively ventilated.

In Australia if a patient is on invasive ventilation then they have 1:1 - like the UK I think.