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  1. iluvivt

    IV Fluids Infiltrated w/o pain?

    No, not necessarily and if the patient does have discomfort or pain it may not be the FIRST sign as you stated. If there is discomfort it may only be at the beginning of the infiltration or extravastion and as more fluid enters the tissue the discomfort subsides.I always look for swelling first then I always palate the site and feel for for coolness and feel of the tissue feels taut or tight.Also lift the arm up off of the bed because depending upon the cause of the infiltrate the swelling does not always present as this classic lump proximal to the site. It can be a very diffuse swelling. Then always compare to the opposite. side.A good way to remember this is TLC for touch, look and compare. Also there are no pump alarms for infiltrations. I can explain more if needed
  2. iluvivt

    HIPAA breach

    It's kind of odd you had to come up with all the things you have posted.It seems like of they are making an accusation and/or investigating than the burden should be on them to prove it! If you did nothing there is no need to be concerned and you are just dealing with a mean and vindictive person.What is your and your coworkers history with this person and whyis she so intent on "getting you".Thinking back is there anything you could have done differently ? One thing is to identify those people you can not trust and keep your business private.Yes ....this person is trying to cause you grief and there should be some kind of consequence if she is filing false claims.I too would be livid and honestly I would be entertaining some thoughts of payback.I probably would never act on those thoughts because people like this create their own misery and tend to be miserable small people anyway.So rest assured she will get hers!
  3. iluvivt

    Phlebitis management. Was this handled correctly?

    The PIV should have been taken out immediately.If the catheter is still in the vein, yes, it may flush but the vein was clearly inflamed and red and that will not improve until you get the mechanical irritant out (the cannula) and most importantly stop infusing the chemical irritant,in this case the antibiotic.Unfortunatly, this nurse used bad judgment.The PIV needs to be taken out...treated with heat and a new PIV placed.Then you need to look at the big picture=how long is the patient going to be on IV antibiotics=how irritating are those agents=what are the quality of the patient's veins=are they adequate enough to sustain the prescribed course of therapy.As a general guideline if a patient will be needing IV Therapy for more than 6 to 7 days a PICC or other type of CVAD is prudent. Although,with all the worry about Catheter Related Bloodstream Infection I have begun to see many more patients going much longer using peripheral veins than in the last 10 years or so and their peripheral veins are taking a beating. Our IV team is available for consult at any time and we will will evaluate the case,assess the quality of the peripheral veins (even assess with Ultrasound) then advocate for the best type of line for the patient. This is a very helpful service we provide and our nurse colleagues appreciate it.Many hospitals have algorithms that guide you in the type of line that is most appropriate but honestly you sometimes have to push the providers to order it.If we tell them we can no longer place any more PIVs or will not place anymore and they must come in to place a central line...we get our PICC order or tunneled CVAD...Yep they don't want to come and do it...
  4. I am great at getting any tube or catheter in that a patient may need and thus I gravitated toward IV Therapy.While IV Therapy encompasses much more than getting catheters in you must be so much better at than the average nurse and you must be able to get impossible sticks. Yes that is me...I have so many tricks up my sleeve that some nurses just must tell me...I have never seen anyone do that before.I have worked at it but did have this natural tendency to be a good aim. I also am good at documentation and can word facts in a succint and cohesive manner.I can list the facts in policies easily because once I have read them they come easily to me.
  5. iluvivt

    The Sad Nurse Speaks

    I love your writing..it is so vivid and your loss palpable. So sorry for your loss. I mourned for weeks after the loss of my cat. They become your little buddies and companions and are part of your family. It comforted me when my sister told me "You gave her a good life and a good home and you did the same and your patient was lucky to have such a wonderful group of nurses caring for her. We should all be so lucky.
  6. iluvivt

    .....and Other Days, You're The Statue

    The concept of "patient as customer" is an odd one to me and by using that model they are expecting nurses to provide high quality care with one hand tied behind our backs and with blindfolds on. The so called rules and scripts often go against what therapeutic communication entails and what one needs to do when dealing with abusive patients and family members. I just keep thinking about the concept of appeasment and basic human nature. Often When you appease bad behaviour (and this applies in war as well) the bad behaviour continues and often escalates..not ceases. So it is drawing the line clearly in the sand and being firm in your conviction that this behaviour will no longer be tolerated that the behaviour actually STOPS. I have seen it time and time again happen this way.
  7. iluvivt

    changing a IJ central line for a PICC

    I will answer all your questions once I get home just leaving work now.
  8. iluvivt

    Always be nice to your coworkers...

    Yes this is always my policy.i used to work with this evil ward secretary that was spreading rumors about me.she knew I had heard about her lies.i just continued to be kind to her.about two weeks after I heard her evil lies.she comes to my floor as a pt.i was charge that noc and she was miserable with a small bowel obstruction.i made sure she ea Got great care that noc.she knew what she had done to me...but I tell you I never had a speck of a problem out of her ever again.
  9. iluvivt

    On call with no experience. Help!

    How are things going?
  10. iluvivt

    IV pump falls onto patient's head and seriously injures him

    If that was my dad in that bed....... YES.!.......I would hold the nurse responsible. Every day that I am at work I am on high alert...always cautious and careful and never take anything for granted in my environment. Yes, medication errors are often multifactorial...BUT the last line of defense..the last chance to catch an error is the NURSE administering the medication or treatment. Yes...... the nurse in part will always be blamed and held accountable..it is just the nature of the beast...stressful?...sometimes unfair?..YES...but so true... Yes accidents happen..but that is a simplistic view there are degrees and ones that cause grave bodily injury and death should always be examined and a cause(s) determined.
  11. iluvivt

    Heparin Flush for CVC

    I work in a big Ca hospital and I finally found the reference used by INS and I stashed the INS flushing cards somewhere in my office . I will look for them tomorrow and will just post word for word what they say
  12. iluvivt

    On call with no experience. Help!

    Well they better have some P and Ps. I can not imagine they would not. I agree with everything IVRUS has said. I have worked for a home infusion company since 1994. I used to work for Apria in Ca..but there infusion component was bought out and I was hired by that company. I also worked for a short time for a nationwide company. They all had very extensive policies and training manuals. My current Co has now switched everything to a company website. I can tell you the things we get the most common calls on 1. Flushing and how to do it. It used to be how to draw up NS but now everyone uses pre-fills. 2. The next is spiking and priming and getting the air out of tubing 3. PICC with blood at the site (almost always a newly placed PICC) 4. Pump issues. Yes you need to know the pumps backwards and forwards..especially the terminology used by the pump company. One of the ones we use if you say resume when you hang a new bag of medication instead of repeat the infusion will complete long before the medication is infused. You will be working with ambulatory pumps and syringe pumps for mostly antibiotics and steroids. Will you be infusing IVIG? 5. A TPN (3 in1 ) can be a bit complicated if you have not done it before. You have to know it really well to teach another. 6 GOOD TEACHING is the key to success in home care. Find out immediately if the company sends out a drug profile for each and every drug they send ,including the flushes. So say for example your pt is on 2 antibiotics that have a known complication of ototoxicity and nephrotoxicity . You need to direct them to the pt drug profile and review that with them so they know what to report. You also then need to document that you instructed them on this and the pt and caregiver know what actions to take. I think you need to get their master teaching list and you need to be signed OFF on every pump they use and every therapy they use. This may take a few weeks but it is not fair to send you out after only a few visits. The company also should be concerned and what to document your competency. You also need an entire day in the office reading through the policy and procedure manual. Yes its boring but I always insist everyone I train do this. I think you need to go back and advocate for more orientation. You do not want to shortchange yourself or your patients because they need to fix a staffing problem. Did you ask in the interview how long an orientation you would get? You want to succeed here
  13. iluvivt

    IV pump falls onto patient's head and seriously injures him

    I have seen a lot of near misses in my almost 30 yrs of nursing with IV poles. We still have many that mount into the frame on the top near the headboard. If you are not very careful when elevating the bed..it can easily hit the light and crash onto the patient. The other day I was elevating a bed to provide some IV care..I always make a quick sweep of the area to make sure it is all clear...so I am elevating a bed that has a trapeze frame and notice the frame is catching onto the IV pole that is on the slider..had I continued it would have been unhooked and fell off..perhaps onto my patient. Yes I saw it b/c I know when you have moving parts in tight areas you have to make certain all is clear ans keep watching. Yes this was the fault of the person elevating the bed and not making sure all was clear.
  14. iluvivt

    Central Lines and EZ IO needs

    You can pm me about some CVC samples. Also there is so much to vascular access.infusion and infusion therapies..if you could narrow it down a bit I can give you a lot of ideas. Are your main concerns in obtaining access,monitoring and care of all types of CVCs,port access and care,troubleshooting all complications. Do you want to talk about prevention of CRBSI,maximal barrier precautions,SHEA/IDSA guidelines,CDC guidelines, per INS standards.prevention of CRT. What is your main goal or concern? Personally ,I do not agree with not showing pictures of devasting results that can occur from poor nursing care or showing pictures of a simple or complex infiltration/extravastion. It helps RNs realize that complications can have horrible life long effects and most are preventable.
  15. iluvivt

    Bard Access education manual

    BARD changes it code every 90 days......could you pm me and I can tell you more?