helix

I was wondering...I had an 87 yr old female pt who ended up with a perforated gastric ulcer that leaked over time into the gut. They took her to surgery, and when she came back to me she was dry. She received large amounts of fluid, but the surgeon refused my suggestion for plasmanate stating that it is a myth that it would help keep the fluid in the intravascular space. He ended up ordering it in the morning because low and behold the patient remained anuric and started to blow up like a balloon. Any comments on this? He is a new surgeon to our hospital, and I was surprised by his opinion on this. Helix

Okay, Having read everyone's posts, I would like to add my two cents, whether I am right or wrong. We hang TPN thru the central line that has lipids already in it. We are NEVER allowed to piggyback anything into it. I was surprised to read that other hospitals allow it. Secondly, we draw blood from our central lines, and have a very low incidence of infection. For a while, we had a high rate of infection, but the infection control team found that it was the type of dressings we were using, and this was changed. We keep close records on infections and the events surrounding them. We have dead-ender valves that have a blue membrane that wipes clean and is needleless. We are by policy to change them with every blood draw, but I know for a fact that I am one of the only nurses to do this. We wear gloves and clean the membrane and hub with alcohol, draw out the blood, hand it to the lab person with the alcohol wipe between our gloved hand and the hub, then draw another, and flush the line. I prefer to clamp the tubing, use the alcohol to take off the old dead-ender and attach the new one that has a syringe with my flush solution on it, then unclamp and flush. I would like to know from those that do ivpb into the tpn...do you use a separate pump or interrupt the tpn? I wonder about the drop in blood sugar as well. Also, we have a policy that allows hyperal thru a peripheral iv dependent on the osmolality of the solution. We always protest, but there are a couple of doctors that do it anyway.

Okay, I give...what is a HT test? And much congratulations on your achievments, sounds like you are very smart and determined!!! :)

Hello, Our hospital offers conscious sedation classes, and once you have passed the class, then you are able to do conscious sedation anywhere in the hospital. The only problem with this, is do the nurses really have time out on the floors to monitor the patient afterwards? The answer, is no, unless they get another nurse to watch their patients. We do cardioversions in the room on our step-down units, and the nurses recover the patients themselves. We don't have to do the special paperwork on our CCU/ICU if we document everything in our notes, as it is usually an emergent need. Hope this helps...