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Infusion specialtist

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  1. iluvivt

    Vaccination for clinical

    Why would a healthcare provider take the risk of having unvaccinated workers.No easy way to get out of it if ever....not in this litigious society.It's not fair to expose others and patients necessarily to any infectious disease process you may have.
  2. I agree. All this nurse had to do to prevent this egregious error was to be able to read. If she did not know the drug, it's action, it's dosage, or its administration parameters she could have looked them up or called for assistance. I can't get over the fact that she did not even read the box, the vial, the computer screen... NOTHING stopped her, so that tells me she is either very stupid or unbelievably reckless. I believe she was totally reckless and practicing nursing fast and loose I can't even believe she is able to practice right now.
  3. iluvivt

    Is management breaking the law

    Well maybe the staff is wearing them because they are too busy doing unnessary crap like begging for briefs.
  4. iluvivt

    My First Enema, PANICKING?

    There are several positions that work but what probably happened is that you did not have enough of the tip in and you probably did not get enough of the solution up into rectum and bowel. I like the left sided position and with the patient in bed. If the patient is in bed you can have them change positions if needed for larger volume enemas. Fleets enemas have such a small volume you can get them in easily. For larger volumes you can start instilling slowly and if the patient is feeling pressure they can rotate them to their stomach a bit or even have get up on their knees with buttocks up. This way you can disperse the enema. Also if in bed it leaks on the bed and not on you and the floor.
  5. iluvivt

    Question of legality

    I would not be getting my infusions there ever! What do they have available should you have a hypersensitivity reaction including a severe one requiring IV Diphenhydramine and some Epinephrine or is the plan to call 911? What you were getting before was some premedication to limit the adverse effects and decrease the likelihood of a hypersensitivity reaction and you had to ask for it at this place... Not good practice! Then the MA did not know what to monitor you for so how could she catch the signs and symptoms of an adverse reaction or a hypersensitivity reaction? Lastly, is it even legal in that state for her to perform these functions under direct supervision of the provider?
  6. Does the resource need to be for the patients and also does it need to be teaching material? I ask because most teaching material provided to patients may need to run through the nursing policy committees and sometimes the legal department. Usually women in labor are in no mood or state to absorb any more teaching.After the birth there are many subjects to cover. If you stick with a teaching tool make sure it's written at a 6th grade level and you read about how to make medical teaching literature that is effective and accurate. I agree the poster board in each room will not be effective. What I needed to know right away was how much to feed my baby... when to feed my baby.... types of formula and how to prepare them since I was not breast feeding. Another important issue is sleeping.. How to position your baby...etc.I know the basics...boring but so essential. This is what first time mothers need!
  7. 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
  8. 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!
  9. 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...
  10. A fresh post op priest with a newly placed penile implant.(unfortunately this did happen to me)
  11. 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.
  12. iluvivt

    How is this cheat sheet?

    I made a cheat cheat for Oasis when I used it at first too. I just put down what I seemed to forget. Things like glasses for near sighted or far sighted ..use of assistive devices..things like that. Then I added the things I forgot to ask such as name of pharmacy and their phone number and name of their caregiver. I got so used to it that I no longer needed it, Use whatever make your work day easier...nice job!
  13. iluvivt

    IV starts in arm with a DVT

    It also depends upon the type of clot..occlusive versus non-occlusive. We do not perform dopplers or other tests on every patient with a central line. Many have clots that we are never made aware of and they remain clinically silent.
  14. iluvivt

    IV starts in arm with a DVT

    Contrary to what many think using the ACF for routine IV therapy is not a good plan. They should be considered blood drawing veins and may be used for very short periods of time such as a need for a power injection and urgent IV access. They have a very high rate of thrombosis if left in place for days and especially if used for medication and solution with high osmolalities. We added to our policy that PIVS in the ACF must be re-sited as soon as possible. If this can not be done it is a great time to assess the veins, the prescribed therapy and determine the most appropriate VAD to use. My hope is that IV teams will be utilized more. Hospitals that have reduced their IV teams have seen an increase in their PICC and CVAD placements so the right line in the right patient at the right time is not going to happen unless the resources are available! Thank you Muno, many think if you have a superficial vein thrombosis or DVT if in the Basilic vein you pull the line...not true. It also depends on the type too, occlusive versus non-occlusive and whether the patient has symptoms or not. If you were to order a doppler on every patient with a CVAD I think we wold be surprised to find more thrombosis than expected.
  15. iluvivt

    IV starts in arm with a DVT

    No it is not OK...once you have a venous thrombosis you should not place any VADS in that arm until it is completely resolved. It is,however, NOT a deep vein thrombosis if it is in the lower part of the arm or in the Cephalic or Basilic vein of the upper part of the arm. These are superficial veins.The Brachial vein is a deep vein because it is paired with an artery! I see MDs and other LIPS get this wrong and it annoys the heck out of me! Please stop this practice as it violates the standard of care.