dissle

We use Hill Rom however the whole hospital use these. Without weighing facilities. It is hard work as the hoists lift patients off the bed, tubes, lines and wires all at risk of dislodgement. It is not an option to change the beds. I wondered if there was another way of weighing patients.

Hi, thanks so much for your reply. Could i ask who is the manufacturer of these scales? Dissle

Just wondered how you all weigh your patients? We have a hoist but the slings are very expensive so we want to see what else is out there offering better value for money, also that is less dispruptive to the patient with less risk. Thanks.

To be fair, it gives them "permission" to not be there exhausting themselves 24 hours a day. Also, we get quite close to our families, and build up a trusting relationship, they see their relative is bieng cared for with respect and with dignity, then very often feel comfortable leaving thier loved one in our care. We are quite proud of this reputation. Having spent time talking with families, we can kinda work out with them what level of visiting they feel comfortable with. We are a small unit (13 beds) and as long as they are kept well informed and we communicate effectively with them, they dont usually make an issue of visiting. When we have a child in, the parents stay, no questions asked....but then we transfer them ASAP to a specialist centre.

2 til 8pm, visiting, that is it. 2 visitors at a time, and next of kin only. Any other visitors are allowed if the nOK gives permission, again, this is restricted. This is a given and is not questioned in my dept. Relatives are told of this rule and why we have this rule. There are of course exceptions to this as already stated. It works well, it has done for years. We have never had to call security, we have never had an issue..may be somethig to do with the polite English, but we all know what we are doing and we all do it.

AAAAHhhh the positives of the British NHS! We do get this, but people are usually very English and very grateful for everything that we do for them! But then i am sure that an English nurse will come on here shortly to tell me that i am mad and that this IS what they get all of the time!!!!

We are about to start training on Prisma flex by Gambro. These machines do not have a needle free system for sampling blood for APTT, we have to use a needle and syringe. This is a practice that we are desperate to avoid/stop using. We could sample from the A-Line, however there is a marked difference between the results given from a sample taken from an A-Line and that of a circiut sample. We are interested in heparinisation of the circuit and not the patient. How do you do this in your depts? I am a bit stuck with this problem, and i am very interested in how the rest of the world do this. Many thanks, Dissle x

Ok so: you need 3 things to make a BP, pump volume squeeze CO=Pump CVP=volume SVRI=squeeze. 3 types of hypotension: 1)Cardiogenic=pump failure= CO goes down, svri goes up 2) Hypovolaemic=No volume so Co down, Pawp down &svri up 3)Septic=BP down, HR up, & svri down.

thanks for those brilliant links, particularly like the FAQ one, that is speaking my language....simple simple simple!

Some one out there, must know of an easy way of learning and retaining all of the information associated with cardiac performance. I jsut cant get it into my thick skull!! C.O C.I SVRI pre load, afterload, contractility etc etc etc.... How on earth did you learn it? is there an easy little song or poem, i have got to nail this thing once and for all, please help me....(pathetic begging to the PC screen...):banghead:

Blueheaven, what pageresiratory says is fair comment. HME,s ARE contraindicated for use for more than 24 hours and in patients with copious secretions. What about patients with pneumonia's who have thick sticky secretions, how are these mobilised with inadequate heat moisture exchange? If a patient blocked off, and this is common knowledge how do you stand legally? Perhaps you should question the powers that be about this policy. However i do understand what you are saying about being given the equipment and having to use it. This is not an excuse in England, unfortunately i would loose my "licence" as you call it without a shadow of a doubt. My hospital would face litigation also.

I cant do links, sorry, im rubbish at computers. Its by Covidian who were Tyco and they are called "Hygroster" I have got some in my office and have been looking at them on and off for months. Now papers are bieng published about how good they are and other units are buying them. Price wise, they are about £3 each as opposed to £19.99 for one wet circuit. However, wet circuits stay in place for 7 days, these are changed daily or if visibly contaminated. The nurses in my unit change the circuits (we do not have any respiratory technicians in England that you seem to have in the USA) Here, the nurses do all of the ventilator care. Thus, to change a HME every day is SO much easier than changing a whole circuit once a week. Do you see what i mean, it sounds great on the surface...but is it?

How about you guys in America, how do you do this?

I have sourced a high quality HME that has withstood vigorous trialling and has many papers written about it. It can be used to replace wet circuits for patients who will be ventilated for longer than 24 hours. Taking up your point about thick bloody secretions, the company do state that in this case heated circuits should be used. At present our policy is to change to heated wire after 24 hours. This is costly in terms of nursing time and circuits. The circuits that we use have MDI ports, and so when administering inhalants, there is no break in the circuit at all, this will not change with the HME. There are many ICU's changing over to these HME's in England. They seem (on paper) to be a great controlled alternative to the wet circuits. With proper protocol and procedure in place, i think that these will save us a fortune and reduce VAP. BUT as always i have reservations and need to know of peoples experiences. Dont forget that these are not your every day ordinary HME's, that is not what i am talking about here. I agree with what people have said about the pitfalls of ordinary HME'S, this is not our policy.

Hi, Any one else?

Soryy, "used" them or heard of them?

Thats basically what we do now, but these Hme's are such good quality that they can be used instead of heated wire circuits. They are at a fraction of the cost of the disposable wet circuits. Any one heard of them or heard of them?

We have come across HME's to replace wet circuits. Has any one changed over to these and if so what is your experiences? Good/bad i would like a bit of info before going looking for the research etc. Should i save myself the bother, its just that they sound fab in the reduction of VAP, rainout and nursing time in the setting up as they are just so simple in comparrison to the wet circuits. Thanks. Dissle

Great suggestions there thanks. I can certainly facilitate training for the senior staff on devices. As there is always at least one of them on a shift there is always one person who will know the kit well. My problem with this is that due to poor staffing levels there is no way that they can be sheduled a whole studyday. My other problem is getting them out during a shift one at a time for the training. This makes the training "bitty" with one or two getting the training. Hmm got me thinking now, if plenty of notice is given, and the day is well organised i may be able to wangle a days training to get 80-90% of the sisters trained up, and i could get them through 4-5 bits of kit......... oooh ive got fire in my belly now! im raring to go!!!!!

Oh Sharrie, your place sounds superb, with a great number of staff dedicated to training. We too have good induction and mentorship, but there are only 2 of us and i am part time. Therein lies my problem, i just feel like i am drowning in it all and do not know where to start, how to streamline the service and how to make the whole thing easier. It is the permanent staff that i worry about. I need a plan but i need advice from those who have been where i am and who have a good system in place. The reason for my questions in my first post is to take others experiences and use them to think lean, and make the whole thing more manageable.

Thanks for your reply, it is very much how our Trust do things, however i am in critical care and so the list of devices that we have to learn is vast, and the staff list to get through this training likewise. We are a seperate entity because of this and we do not tend to use the same equipment as the rest of the Trust. This means that we will have to find our own way with training. I want a big cross section of methods adopted by different people from different areas, different countries and their opinions on this. I think that what i will find is that the way that you describe how your training takes place will be pretty standard to the rest of GB. Thanks again for your reply. Any one else?

I am curious about how every one undertakes training post qualifying. I have several questions if you don't mind and would really appreciate any input. How does your department facilitate training, say on a medical device? During a busy shift, when do you find time to go to training? Does your dept organise whole days dedicated to training or ad hoc hours here and there? What about paperwork, do you have to complete self assessments? How often are you trained on equipment, yearly/2 yearly? How are you assessed in practice on the safe and competent use of a piece of equipment? Who provides your training? Is it someone in post to do this, or is it the company who sell the device? If you could make a wish list for training on equipment to make it easier, more accessible, what would be on it? Again, thank you so much for your time and input into this discussion, i really appreciate it. Dissle.

Our unit policy states that patients can remain proned for up to 24 hours with head and arm position changes every 4 hours IF stable enough to do so. This may seem prolonged but it works, the gasses are miles better a very short time after pronation. We only prone when the pateint gasses are poor on 80%fio2 or above. so established lung injury. Pesonally i think it should be used a bit earlier than this. Its usually the sickest of patients who we dont know what else to do with! Its a last ditch attempt to save them. Interesting that you use pronation as an alternative position, i dont know why we dont use it for this more often, i suspect that it has allot to do with the inconvenience of all the bits ans bobs that have to be rearranged!

Relatively uncommon actually. We are using this manouvre more and more and have a protocol in place which tells us when to prone. Have to say that this is a hot topic and in favour at the moment, where as last year it was nitric oxide therapy, the year before that it was oscillation! Any way, we are trialling the head frame device and i have sourced another company which also manufacture something similar, so we will have 2 products to compare. Im having to put together the "trial package" at the moment, which includes risk assessment which is a mine-field in its self! wish me luck.

Yes, in severe ARDS we prone for 12 hours and assess then leave them for as long as 24 hours. every 4 hours however, we turn the head and alternate the arms as described above. Despite this the pressure sores are a problem. We dont use this as an alternative pressure area relieving position though, we only use it in certain situations for severe respiratory distress. thanks for replies.