2shihtzus

I wonder if the same applies to PICC lines? There are no proximal, medial, or distal ports.....?

What is the rationale behind it? I mean I know that once it is infusing, it is a designated line; nothing else should be placed into it. But if its disconnected and flushed, shouldn't it be ok to switch lumens?

I had a patient with a triple lumen central line who had PPN infusing. Anesthesia wanted it disconnected before the patient went to surgery so we disconnected it and flushed the line. The nurse in PACU wanted to know which port (red, white, or blue) it had been infusing in because she said that once TPN/PPN is initiated, it has to stay in the same port for the duration of therapy. I have never heard of this. Any input?

I have only seen 2-3 ports in an arm.....and they should not hurt when being flushed. When accessing them, it is not much different than accessing a chest port. Hold it securly and use the right guage and length of needle. The only pain the patient should feel is the initial stick. Pain whilst flushing is a sign of a problem.

The PICC lines I put in are cut. They are either double or triple lumen (5FR for double, 6FR for triple). They are also power piccs. The lumen that can take contrast is labled. There are no distal or proximal ports. Most of the PICCs I place are between 38-45cm, depending on the size of the patient.

They "should" be taken before abx are given. However, there is always a chance that the culture may grow something that is resistant to the abx that the pt is currently on. Also, it takes a while before the abx get rid of the current infection.

Hmmm.....sounds like you have a reputatation that you are going to have a hard time getting rid of. Statements like: ...In that role I could do 95% of the things that RN could do but was paid less ...I did not like this hospital. It was basically a shell of a hospital (no OR, OB/PEDS..) ...patient care was not organized at all (a nurse would pick up a chart carry out the orders, iv, meds, etc. and not write anything on the chart). ... had a personality conflict with the charge nurse ...Neither had worked in a trauma center to the best of my knowledge but you couldn't have guessed it by the way they acted ...I was once scolded by the PACU charge nurse for "talking to the doctors too much." Also, I was the only male in the PACU ...I bust my butt everywhere and am always the one to take on extra responsibility ...I have 2.5 yrs. in as RN ... I do not want Med/Surg, ICU is a possibility but prefer the ER truly make me wonder. It seems to me that you thought you were too good for the "shell" of the hospital you were at. Criticizing other nurses and how they chart (or do not chart) isnt something you should be doing. You need to watch YOURSELF, not others. A personality conflict with the charge nurse shows that maybe you have a problem with authority. The fact that the charge nurse and his "pet" nurse hadnt worked in a trauma center really seemed to bother you...just because you were a paramedic doesnt make you more qualified than them. You "always" take on extra responsibility makes it sound like you have a persecution complex. 2.5 years as an RN is not that much experience when you take into account that you have only worked a short time in the ER, was let go from PACU, then acted as a "substitute physician" at a blood donor clinic (never heard of a substitute physician). Also, if you are really wanting to get back into patient care, med/surg is a good place to start. Granted, this is just what I am gleaning by your post. Im not trying to be mean or harsh, but this is the impression I got. I would apply on a different unit and use the opportunity to start off on a new foot.

Out of curiousity, what were you supposed to call the doctor about? I would have been annoyed at the unit manager as well. Its always nice to be told to your face what you did wrong instead of hearing it 2nd or 3rd hand. It rarely happens though.

Update: I went and talked to the manger of day surgery and she said that yes, it had all been set up and that I had a position! I am SO relieved!! :)

I feel so stupid because before I even gave any thought to the possibility that there wasnt a position in day surgery, I emailed the director asking her what my start date would be! (Talk about presumptuous on my part) I honestly thought that it was something directors talked to eachother about before a transfer was approved. What I ended up doing was emailing both of them: to day surgery, I apoligized for the confusion and asked if there was a position available, and that I would be delighted to come and work with them. To my manager: I told her that my intent was only to start the process and that a position had not been offered to me...and of course I asked for clarification that if there was NOT a position, would I stilll have a job on my current unit? Thanks again for the input.....I seriously do not need this stress right now...thank goodness for fellow nurses that understand. **hugs**

Im a charge nurse on a med/surg unit. I have been wanting to get out of med/surg for a long time (ive been doing it for 5 years and wanted a change.) I worked on Day Surgery the other day for PICC line training and loved it! So much that I enquired about a full time position there. I was told that a position was opening the next week as one of the full time staff was leaving. I did not get a chance to talk to the director that day to enquire more about the position. I tried calling my director several times to tell her that I was interested in transferring, but did not get an answer. So I filled out a request for transfer form and attached a letter asking if I could transfer to day surgery, that I had learned alot on my unit, etc etc....and turned it in. I did not hear anything from her. I then found out from my coworker that my charge nurse position was offered to her, which of course, my coworker accepted. In fact, my coworker found out before ME that the transfer was approved. I did not receive one word from my director. What I did was a very abrupt email from my director the next day, stating that she signed off on my transfer request and took me off the schedule effective October 10th. I have never requested a transfer to another unit. Im freaking out now because I have not heard anything from day surgery ... A position was never offered to me! I was just "told" that there was one coming up.....my intent when I filled out the paperwork to request a transfer was to let my director know that it was something I was starting to pursue. I had no idea that she would approve it without talking to me or take me off the schedule so quickly. So now Im freaking out....she is OBVIOUSLY ****** at me. The tone of her email was very abrupt. Can she take me off the schedule if there is not another position secured for me? What if there isnt...is my original position gone??? I tried calling her to talk to her....and of course, there was no answer. I had assumed that when she signed off on the transfer that she had spoken to the other director. I mean, would she just approve a transfer and take me off the schedule and leave me in limbo?? Gentle input requested please....like I say....I more than a little concerned about this. (BTW...hindsight being 20/20, I now realize that I should have secured a position in day surg before requesting a transfer)

Yep...we see it all the time. But it goes both ways. Ive had to give report to ICU nurses who take out their stress on the wrong person and are just plain RUDE about it.....for the massive GI bleed that we had to transfer to ICU I got, "This pt should have had vassopressin!" Me: "I agree, but we cant give vasopressin on the floor." "Well they should have given it in the ER!!" What the hell am I supposed to do about that??? Thats why we are transferring the pt to ICU!!! Or for the pt that had massive CP, HR in the 180s, BP 210/120's. He needs to go to ICU for a nitro drip. I get flack because the doctor ordered a nitro drip, when we should have just "kept him on the floor and dealt with it." It goes both ways though: Ive seen some of the floor nurses ask ridiculous questions to the ED nurses...."When was his last BM?" or "What color is his urine?" Please! Oh well...for every jerk nurse I have to deal with, there are usually some pretty cool ones I can give report to as well. Its all in the tone of how we speak to eachother....one would hope that this everlasting power struggle between floors would end some day. I mean we ARE on the same team right?

I think that speaking quietly in the med room with a few peers is a far cry from "trashing" your employer. If someone overheard, what were they doing? Standing as close to the door (that was open a crack) eavesdropping? It would have been nice if "they" had said they heard about your concerns and wanted to address it proactively.

Hmmm......your on their "list" now. Watch your back.

We got a muffin, a cup of fruit, a cranberry juice, and a breakfast taco for breakfast. ( I heard that last year it was made to order omlettes) For a gift we got a fanny pack thing you can use for workouts...I kept the pen and post-it note pad that was inside. :) Nothing makes people complain more than getting something for free!!