iluvivt BSN, RN

iluvivt has 32 years experience as a BSN, RN and specializes in Infusion Nursing, Home Health Infusion.

iluvivt's Latest Activity

1. 

   Blunt Fill Needles for IM injections?

   iluvivt replied to cb57's topic in General Nursing

   Look at standard IM needle...look how thin it is...it's thin for a reason, to minimize tissue trauma while meeting the objective of delivering the medication.It also has a really nice smooth, sharp bevel. Now look at a blunt fill...that thing is huge and the bevel is shorter and blunt.
2. 

   Blunt Fill Needles for IM injections?

   iluvivt replied to cb57's topic in General Nursing

   There are two types made.A blunt fill is for drawing up from a vial and the blunt filter is for drawing up from an ampule. They should not be used to administer IM injections. If you were to use the filter blunt you could theoretically inject the small glass particles that collected in the filter section of the needle.
3. 

   PICC NURSE

   iluvivt replied to MforMs's topic in General Nursing

   Yes, you can place a PICC without the use of Ultrasound because you essentially use the Ultrasound to access the vein above the ACF. Once in awhile now I do not need the Ultrasound because I can easily access the Basilic ven well above the ACF.This is usually on a thin male with good muscle tone and where the desired vein(s) can be easily palpated and/or seen.I have been placing PICC since the lates 80's and we used to access mainly at or near the ACF, along the Cephalic vein (which is easy to access all the way up the arm on a lot of individuals) and the occasional Basilic vein above the ACF. I only use the Cephalic now if there is no other option. It's so true it looks easy but it's not.I am training a nurse now and she said you make it look easy and it's so not! To access a vein now by palpation, visualization or with use of US seems so natural to me.It's like writing with a pen,you don't even need to think about it.I have spent almost my entire career in vascular access and home infusion and have always had a passion for it and also love to study all aspects of it.
4. 

   Incident

   iluvivt replied to Lovely's topic in General Nursing

   Often the elderly fail to accept they need help. A 95 year old is likely to have osteoarthritis and other diseases of the aged so I just assume they are apt to get in trouble.While I make certain they understand my instructions I still don't trust and plan accordingly. You can't always prevent a fall or injury because many situations can't be made ideal..but you can lessen the chances.Learn what you need to learn from it and move on because you have more people to help.It could have always been worse.
5. 

   PICC line dressing changes difficulty

   iluvivt replied to Gyh's topic in General Nursing

   Ok...It is coming out because nurses are pulling it out 1 to 2 cm with each dressing change.The average SVC is 7 cm long so if the original tip placemat was at cavoatrial junction or low SVC a loss of 7 cm or more is significant. So you can clearly surmise that if there is a change of more than 7 cm the odds are it's tip is now at the top of the SVC or at the brachiocephalic/SVC junction. This is considered suboptimal and now the patient is at increased risk for every complication including thrombosis and infection. Even with a stat loc or other adhesive type securenent device it can still be pulled out if done incorrectly or if someone did not line up the radial slit in the CHG patch with the PICC. We use SecurAcaths on most of our PICCs which is a device that anchors the PICC to the skin with wires.They are the best invention! If you don't have those try removing the old dressing by peeling from the side and not from the top down or bottom up.If you peel from the side you can peel off the TSM dressing and steri strips easily.If the PICC is getting stuck in a CHG patch..just moisten it with some sterile NS from a prefill... it will puff right up and come off .Take your stat lock off last and put a temporary strip of tape on the tails only and tell pt to hold still if they can.Have everything ready before you even take the old dressing off.I did not give you each step but if you want more detail about the dressing and needleless connector change procedure ..let me know.
6. 

   How to Best Handle A Patient When They Jerk During an Injection?

   iluvivt replied to MagicalGirl's topic in Safety

   Al you can do is prepare them snd assess them before the injection.Ask them if they are good at at holding still because you need them to focus on doing just that.If they say they are a jumper.give them something to do just before you poke them...such as take a deep bresth... or have them hold a squishy ball or one of those squishy blood drawing items or ask them to tell you their favorite place to go on vacation.You want to distract them.
7. 

   Immunocompromised Loved One

   iluvivt replied to lillianbenders's topic in General Nursing

   No it's not a realistic expectation. You may find your coworkers will begin to resent you you as well if you happen to find an unusual employer who will even grant this kind of request.Learn and use standard precautions and faithfully use excellent hand hygiene. The one thing that is hard to control is patients who just cough right in your face.I tell alert capable patients who do this to please cover their mouths then offer them a hand wipe. I agree with others, his greatest risk is just in every day living ,using shopping carts, opening doors,sitting in the doctors office, going to the movies. I have been working in bedside nursing for 38 years and not once have I got anything horrible from a patient. I am at risk for bloodborne pathogen transmission due to my constant exposure to blood and worked many years before engineered safety needles were invented. I have developed a routine I never deviate from that decreases my level of risk.
8. 

   Mistake after mistake after mistake

   iluvivt replied to AMRN445's topic in General Nursing

   You need to change your narrative right away.Instead of "mistakes" you need to call these learning opportunities for professional growth.New nurses do not come out of nursing school ready to hit the ground running with all the knowledge and skills they need to succeed! In fact you are just "safe to practice".Safe ,among other things means you know where to look for the answers.if you do not know something.The situation you describe is not necessarily a mistake,it's more of a missed opportunity.In fact, when too many respond to an emergency it can get chaotic and crowded.If they need more help they can call for it.As long as enough help is present all is good!
9. 

   Do you think I can get my job back?

   iluvivt replied to allyyyjustine's topic in General Nursing

   I agree that she is retaliating and the minute she got some power she could not wait to find any reason to get rid of you! When you mess with someones livelihood that does not deserve to be messed with you are playing with fire. All good advice and especially about would getting an attorney...you can sue for wrongful termination but you have to get moving on it and will need all your employment documents.If I were in your shoes I would be looking for a new job and making an appointment with an attorney....You need to start writing down dates and times including the date you got the call .You will need a copy of your personal file.employmemt agreement or contract..an employee handbook.any applicable HR or workplace policies...job evaluations...Pay stubs..any communication about and incident s with this employee. I would be furious at this person's childlike behavior and honestly she needs to learn a lesson!
10. 

    IV infiltration

    iluvivt replied to AllyRN's topic in General Nursing

    Yes! I am totally aware that time should not be used as an indicator of risk for peripheral IV Therapy related complications and site change should be based on assessment.That INS white paper came out awhile ago but the evidence was mounting long before it was was published as the importance of vein preservation was finally being recognized.My point is when you are assesing an IV site it is prudent to know its dwell time or in other words how long it has been in place.It is of course, is not the only parameter I look for but a site is more likely to become symptomatic the longer it dwells.I actually got the average dwell time of 44 hours from an article I read that summarized multiple studies I may be able to locate it..I do notice though our sites started by IV nurses and other highly skilled nurses do last longer owing to the skill of the insertor.
11. 

    Working with a vindictive coworker

    iluvivt replied to nurseontheway's topic in General Nursing

    Why should they leave when they are not the one causing the problem. I would be watching this person like a hawk though and would not trust them! How do you know it was not handled? Any corrective action or counseling must be kept private so you may not be privy to that information.Any reason for this person to be jealous of you or have a reason to get back at you or even the score?
12. 

    IV infiltration

    iluvivt replied to AllyRN's topic in General Nursing

    While you may not feel a palpable cord or any erythema, inflammation or warmth along the vein pathway, pain and discomfort can be an early sign of phlebitis or even a very early infiltration. One thing you left out is how long had the line been in place and what had been infusing through it.Those pieces of information are useful in making the best decision for your patient.With only the information you provided me if I chose to leave the PIV in I would up my assessment frequency.If it is indeed "going bad" it will only get worse with time and that will soon be apparent. If ,however, it is a fairly new line,the medications and/or fluids are not irritating and the patient tends to be hypersensitive it may still be good.Keep in mind the average PIV has a dwell time of 44 hours before it becomes symptomatic...I said average now and have seen many PIVs last longer, but it's helpful to know that.The odds are it's on the way out.11 venipunctures in 3 days is not as bad as it may seem because it is all relative to the benefit the patient is going to receive by getting his IV antibiotics or other IV therapies. But you are correct in assessing the availability of the peripheral veins and then determining if they can sustain the currently prescribed IV therapies and if not some other type of access needs to be obtained...Midline,PICC or other type of CVAD...perhaps an EJ if there is a short term need
13. 

    Called Down to HR

    iluvivt replied to Davey Do's topic in General Nursing

    Ok...so wow there are cameras everywhere.Are they there to have evidence should someone file a lawsuit or are they there to protect patients and staff members? What action is administration recommending when you are physically attacked? In California we now have mandatory self defense classes where they teach is how to escape physically violent patients or visitors. That is what we have come to in this culture of entitlement! These types of classes are good but the moves must be repeatedly practiced to make them second nature especially during a moment of extreme stress.In your situation you should be able to immediately summon help by initiating a panic button or alert you carry.Is any technology used? I would have left the door open too!
14. 

    staffing policies

    iluvivt replied to painmeds's topic in General Nursing

    Confused...what is the problem? If you like the job perhaps you can make attempts with management to change it.No place is perfect and you may find worse problems at other places.I would never leave a job I liked over a minor issue but it's all relative to how the issue impacts you and it may not be minor to you.
15. 

    The Abuse of Nurses By Patients

    iluvivt replied to Melano's topic in Relations

    You are going to need to work on this skill set.Right now you do not have psychological armour or verbal skills and tactics to handle these situations.It does take studying various techniques and then practicing them as the situations occur.If you Google , "dealing with difficult or abusive patients" or strategies to deal with difficult patients of verbally abusive patients you will get all kinds of resources.Read through them until you find some good techniques.Write then down and study them then start implementing them.You will be surprised how effective they are.Many times a patient will make a complete turnaround. You also have to make a quick assessment on what is causing so much anger---it's often loss of control ..so acknowledge their upset, show concern and empathy and really listen to their concerns.Sometimes patients are so out of control your priority is just keep them and yourself safe.Keep in mind too that abuse should never be tolerated as just part of your job.Also see if you can actually find a class that teaches deescalation techniques.
16. 

    Medication Error?

    iluvivt replied to jeane1090's topic in General Nursing

    It's not the gravity of the error but the fact that you made an error that is bothering you.In situations such as these try to figure out why you made the error and what steps you can take to prevent a similar occurrence and this may decrease your anxiety level. I am not necessarily talking about the 5,6 or 7 rights but what is about your system that failed.No one knows you better than you and what you need to do so it does not happen again.