iluvivt

I'm a a long time IV specialist . The reason you have off days is because there are so many variables that effect whether you. easily succeed at gaining IV access. When I was still learning a few decades ago every single time I failed I evaluated why I failed . Did I not look enough? Was I rushed ? Did I select a cannula that was too large ? Did I not use the proper skin traction ? Was the vein too sclerotic? After I determined what if was it added to my skill level and I just got better and better. Several main reasons for failure are improper angle of entry causing a through and through puncture or just nicking the vein and it's blown ,failure to drop your angle after achieving a flashback or other confirmation that you have entered the vein then advancing a few more mms before pulling your needle back and threading the remainder of the cannula , failure to stabilize the vein by appropriate upward or downward traction or both and not taking the time to look for a good vein with the appropriate characteristics that will lead to success. I actually use Transpore tape to stabilize and straighten out the selected vein . I usually just use it for upward traction because I can easily hold downward traction . This one little trick I created a long time ago as increased my success rate and honestly I rarely use US unless I'm placing a PICC or Midline. I got good because I had to do so and didn't have all the tools we have now. I hope I was of some help.

I can ,but I need to know what brand/device it is,It is an introcan,insyte autoguard,insyte autoguard BC or jelcoprotectiv ? There are some idiosyncrasies that may make be getting you hung up !

I see your point Muno but the process you are suggesting is never going to happen where I work.

As an IV nurse I can tell you that many times,depending upon how the IV is being used' and what kind it is, this is pertinent information and I'll tell you why! There are several types of peripherals now,such as the standard short PIV,extended dwell,midlines and extended dwells that can function as a midline depending upon where the tip is.You need to know the type and length so you can properly assess it.and so you can make certain you are not infusing a vesicant or irritant through it (applies to midlines).You also need to know WHEN it was placed or inserted and how.(traditional or ultrasound guided) .The average short peripheral has an average dwell of about 44 to 48 hours before it becomes symptomatic. If it's been in place for that length of time you know you will need to assess it more frequently .Many of the deeper USGPIVs tend to leak then infiltrate within 24 hours unless a longer PIV was used.The anatomical location of the IV is also very important. If you are administering a vesicant or irritant or a vasopressor,areas of flexion should be avoided and areas with a small amount of tissue.( such as the hand) should also be avoided. If I got report that Dopamine was being infused in a hand vein I know I would be starting a new site.There are many procedures too that require a specific site and gauge, such as a CT scan. As you can see it really is vital information that can very easily be relayed in report. The patient has a 15 cm SL Arrow Midline in the right Cephalic placed on the 25th with the tip just below the axilla and it has a brisk blood return and is asymptomatic. and for a short PIV: The patient has a short 20 gauge PIV in the right mid FA placed yesterday and its asymptomatic.I have more if you need it

I would suggest to you that you increase your knowledge base regarding acid base balance and fluid and electrolytes.I am fully aware of the tough subject matter here but it will serve you and your patients well to have this knowledge.The absolute best book I have ever read and actually enjoyed is by Metheny Fluid and Electrolyte Considerations.They go through the many common disease states that cause these disorders and explain all the treatments and nursing considerations. You will thoroughly understand why this combination of medications was ordered if you.read this book. I would also get to the root cause of your insulin error and correct it. Why did you not have your dosage checked by another RN? Something seemed off to you and you did not question it further or get more information and why was that? I agree it's good to get emotional support but it's much more important to learn from this error,make some changes to prevent similar ones from occurring and correcting your knowledge deficits. That all takes effort on your part but I suspect you do want suggestions and not just cheerleaders.

I would personally never chart anything like that. It sounds like you are trying to cover for less than stellar care and if anything did happen,especially with a lawsuit, you are giving someone a reason on a silver platter. It's best to chart what you did do for the patient.

Honestly, this is easy to correct.If you have authorized PRN visits you can just send a nurse out to change it or change it with next nursing visit. I have missed a few labs over the years usually because the order was not clear. They wrote the order to draw labs with each infusion, not thinking he had 2 infusions of different medications on different days. In another, the order to draw lab before every infusion got changed to every other. Recently,they failed to put the lab order in the nursing tasks section but I was scrolling through the orders and caught the mistake and drew the lab. I don't ever get too stressed about it because I just correct it, learn my lesson and move on.

I can just tell you what I have experienced.In all the cases I have seen they have first collected some evidence.Several times they secretly monitored the nurse and pulled them right off the floor once they had seen they had checked out narcotics.They basically caught them in the act.

Throw up in the car and a little on the squad too!

I just had this done too and had Versed and Fentanyl ( moderate sedation) .The only thing I remember is they had this oxygen bar resting on the bridge of my nose and it was hurting me so I remember telling them it was hurting me. It was very heavy to be resting on the bridge of someone's nose.I have never seen any Oxygen delivery system like that before.My nose hurt for 10 days post-op!

Absolutely unacceptable to restart the pump without assessing the alarm type and troubleshooting the problem.That is the responsibility of the person with the nursing license! Not every alarm is a downstream occlusion either. There are many alarm types.Keep doing what you do now, it's perfect!

It's always best to consult with the PICC team. As a PICC nurse I would have been preferred to be called so I could assess the situation. You do not necessarily have to switch arms just because an existing PICC was pulled out.You can go above the hematoma, assuming the vein is collapsible and it's asymptomatic.If it's not then the left side,in this case, would need to be assessed. We do ask our nurses not to use the PICC veins for USGPIVs.Yes, I do understand that you can take it out but then you would have to start another peripheral (I like to have an access in place for the procedure,just in case and the patient gets poked again).The other factor is that that if you use a PICC vein ( Basilic, Brachial or Cephalic) the vein has now had trauma/injury. Remember Virchows triad? One aspect of the triad is vessel trauma and that will theoretically increase the risk for thrombosis.I would prefer a virgin vein! I would have asked you to try to establish a PIV below the ACF in either arm and call back for help if you could not get it.Then I would have helped if needed. That is the ideal situation!

That's correct,You should not dilute anything unless a credible source states it is acceptable.My favorite IV medication course will always be: Intravenous Medications: A Handbook for Nurses and Allied Health Professionals Book by Adrienne R. Nazareno and Betty L. Gahart. Check it out....The best! Also some think that if you dilute an IV medication that it is less irritating to the tunica intima of the vein but this is not always true.Many medications are inherently irritating and it makes no difference whatsoever.

I would want a bowl of baked macaroni.It must be home tomatoe sauce too.

I totally. understand.I have been in hospital nursing for 40 years and about 30 years in home infusion. What makes it even more difficult now in some systems is the ability of your employer to track the timeliness of care provided on the computer. For example, if you give your IV Vancomycin dose 3 hours late they have documentation of it. This can put a tremendous amount of stress on a nurse but you still must work with the system. I bring this up because it's critical for you on days with total care patients, a ton of blood sugar monitoring, ambulation and turning schedules and other orders to prioritize medication administration and other critical orders and tasks ( eg: Once you work those into your schedule a lot of the other tasks can be done when you get to them) Do not give them the same priority level and allow them to stress you out! I know we live in this world where everyone wants everything done right away and this is even more true in healthcare but really think about each task.Once you realize that many tasks can wait it will ease your stress..Even feeders can wait! Put a note on the tray so no one takes it and you can heat it up. Broken equipment is unacceptable and you must report it immediately.You must have the tools to do your job! Try and group your tasks for each patient. Or in other words do everthing for patient due at that time. Also cut yourself some slack.Also get a buddy so you can help each other during the shift. The reality is that on some days it's way too much work to get done comfortably and you just do your best! Get the important work done and then do your best with what is left to do.