TLCinCICU

It's policy where I work that you must aspirate from a sheath before pulling it. The theory is that any clot at the tip could be stripped loose as the sheath is pulled. It (in theory) could then embolize to the lower leg. If we cannot aspirate, we...

Our facility runs Levophed at mcg/min, where many run at mcg/kg/min. The highest I have ever titrated Levophed was beyond our formulary max of 300 mcg/min. (My Kathi White reference notebook says 30 mcg/min.) This particular patient was a "heroic ...

I attended a small gathering hosted by a physician that had the sole purpose of contrasting the healthcare plans of each of the two candidates. A healthcare economist spoke. His materials came from http://www.health08.com . The speaker did a fine ...

1. how long (years) have you been a nurse? 8 years 2. what is your annual gross income? less than 30k, 30-40k, 40-50k, 50-60k, 60-70k, greater than 70k 60-60k 3. do you have an associate or bachelors degree? associate 4. how long have you worked for ...

The reason is simply anatomic. Arteries flow outward from the heart. Vein flow toward it. You get systemic distribution of the drug using a vein. Using an a-line will send the medication away from the heart. There would be quite a significant de...

Between my prior position as a lab tech and my first few years as a nurse, I worked night shift for 12 years. I thought I had always handled the night hours well both physically and emotionally. I did, however, spend much of the first day off aslee...

It's wrong to accept any kind of monetary gift/tip for our care from patients or families. Just think of how it could be if tips were allowed. Those who could afford to tip generously would receive the most devoted attention and "service" while the...

Codes do give me a bit of an adrenaline rush, but I am much more pleased with myself after a day where I've felt like I've spent the shift about 15 minutes away from a code at any given point. I prefer being proactive - somewhat aggressive - and tak...

Nursemike - you and I think a lot alike. I would enjoy working by your side. I've had those same warm-fuzzies when a patient & his/her family asks "Are you back tomorrow?". You're also right about teamwork being such huge part of it - includin...

Running IV lines across a patient isn't a safe thing to do. I've seen patients get disoriented and pull on the lines, resulting in the IV pole falling into the bed with them - and sometimes hitting them. The "vent side" just happens to be wherever ...

I half-expect that anyone who provides direct patient contact will be cultured for MRSA at least yearly. They could even choose to treat us "for prophylaxis" periodically in the pursuit of keeping the costs of nosocomial infections down. Our ICUs ha...

We have just recently purchased PrismaFlex (made by Gambro) CRRT machines to replace our prior - outdated - Prisma machines. My only experience in caring for CRRT patients has been using the M60 or M100 hemofilters. Gambro has an HF series hemofilt...

Whenever pronation is ordered in either of our ICUs, we rent a specialty bed from KCI called the "Rotoprone". Before that, we used a brace called the "Vollman Pronator". It required multiple staff in order to use the straps and "flip" the patient f...

I would chafe just as much with that preceptor. And as a preceptor, part of our duty is to allow/encourage you to chart and point out areas where you might not address required charting (like "comfort goal", which Joint Commission seems to want to m...

Thanks for sharing the story. Out of curiosity, what was the brand/maker of pump?

I'm with you. I've found the NIBP cuff set for Q60mins on vasoactive patients, and VS documented on CRRT patients Q60mins - when those patients are "hemodynamically unstable" by definition. I document at least Q15mins with a NIBP and more frequentl...

Our standard is to begin with propofol as sedation for intubated patients, even in the ER. It almost follows an algorithm. Propofol first, then it will get combined with fentanyl if it appears that pain is an issue. If mechanical ventilation is an...

I was an MLT for nearly 15 years by the time I got my RN license. I debated going back to school to become a nurse for close to 5 years. Each time I had nearly decided to go for it, I would go onto a floor for a blood draw and someone would have fi...

Our assignments are all based on acuity. The only patients we have that are 1:1 by policy are CRRT (CVVH) patients. IABP patients are paired with the more stable ones - like the standard "turn/water/feed" vents. It doesn't mean that it's an easy a...

That part alone says you should go for it! I also felt something like a "calling" to make the career change - and I've never looked back. It's been one of the best decisions I've ever made in my life! I agree in that there's really no other field w...

This scenario reminds me a bit of what a nursing school instructor said "Treat your patient, not the numbers!" Some of our little cardiomyopathy patients are on such high doses of beta blockers, ace inhibitors/ARBs, and diuretics that their BASELINE...

Ugh....clinical pathways...the least favorite part of my workday. To me, they aren't anything even approaching a valid "care plan". They are a checklist to make sure we do the things that a) get us the maximum reimbursement for the patient's LOS a...

I worked 40 hours/week on night shift for the duration of my ADN program. However, I only had to take nursing classes during that time. My previous degree (for the lab job I worked) had many of the same prerequisites and I had a school workload tha...

You can chalk me right up there with the crowd. I've had several patients make a comment about dying soon and then have it happen within hours. I've also developed something of a "sense" or strong "gut feeling" (or perhaps an overactive imagination)...

There's a little rehearsed tirade I've had in my mind for years that I've never had the guts to actually say: "You are NOT on public property. You do NOT have the right to act however you want. You are here as a COURTESY to your loved one that is...