nightshift82

Thanks you are correct. I was also upset about the intervention of deflating the balloon and inserting it higher and then re-inflating. Is this a practice that others are doing? Any thoughts?

The catheter has been in place for a few days...they are deflating the balloon, not taking it out but advancing it higher...thinking that it may be in the neck or urethra...still not sterile. Anyone heard og this practice?

Many years ago some nurses who cared for patients complaining of pain or urge to urinate post foley insertion would deflate the balloon,re-adjust the catheter and re-inflate the balloon. I would never do this because this because it was not sterile. I recently heard of it again and was wondering if others practice the same? If there is a concern that the balloon became dislodged into the urethra it should be removed and a new catheter placed?

Thanks for your response...I thought I was crazy. One of the patients died and the other for possible LVAD at the transfer hospital. I did speak with the Datascope RN for our region and confirmed the same 1:1 for frequency. I have not been able to catch up with the interventionist. As for some of the strange issues with the pump console I was told to video it and send the clip to the hotline.... had not thought of that b/c with the other console your would it up with the phone cable to the hotline.

Sorry I forgot to add that I do not know the LVEDP and both were SR-ST not AF and were large AWMI. I did not take care of them but was posed the question. Also with this same console I did care for a patient who had a great ECG and R wave...no arrhythmias and the new Cardiosave Hybrid would stop pumping and alarm trigger loss and go to pressure mode. I would have to force it back to ECG trigger by pulling the pressure cable...augmentation was better in ECG trigger. I had already changed all te electrodes before I resorted to pulling the pressure cable in and out. I was close to replacing the ECG cable from our other IABP and calling the hotline when it finally stopped?? I was told this happened again with our last patient. Anyone having this issue?

I work at a small community hospital which used the Arrow/Teleflex IABP for years and we have recently switched from Arrow AutoCAT II to Datascope Cardiosave Hybrid. There was very little support from the company compared to Arrow which is very frustrating. I have read the manual over 200 pages. I was told that these two consoles use very different technologies and that there is not a bellows system with Datascope/Maquet? Does anyone use this console and my second question is that we have had the interventionist order 1:2 instead of 1:1 for the frequency in two of the most recent post-PCI patients with DHF/cardiogenic shock on levophed which makes no sense to me and he could not explain the rational. Timing was good with regards to inflation and deflation points with augmentation 80 and MAP 60. These patients did not get worse but they did not get any better and both were flown out. Both were on intubated and HR were between 90-120. I was not sure if the reason was because of the HR but I thought that 1:2 was for HR >150?

1:1 until rewarmed

I have a question about getting all the air out of the bag before you prime the line and then > to the 300mm of pressure. For years I have always taken great pains to remove the air before I prime the pressure bag. I read ? an article some whre that stated it was a old sacred cow but I can't remember where I read it or maybe it was a seminar. Anyway it kinda made sense in that it was most important to have the line free of air and that the small amt of air in the bag would be pushed to the top when the bag was>to 300mm and would not enter the system. It was stressed the importance of never lying the bag on the bed during transfer or transport in that the the air in the chamber could enter the tubing. The question was raised about if the fluid got low in your system wouldn't air get pushed in the tubing and the answer was that the pressure in the body would be greater if the fluid ran out and you would see blood in the tubing then. So I have looked on several sites regrding this and it's about 60-40 in favor of getting the air out before you prime the the tubing. We don't have a policy that states this and I am currently a preceptor. Any hard facts and or opinions? Any thing evidence based?

Thanks for the information. Will be interesting to hear your results.

Thanks so much. Great information! I have the same concerns. Some of the articles were vague and did not give full disclosure of the study design but I have since gotten more information. We did have 3 over the past 6mos. 0 for the previous 3yrs. Our bathing practice had change in the past 12 mos. We were using the packaged bag baths and due to $ went back to basins and soap. I feel there is a correlation but no one is listening. The knee jerk reaction is to use CHD baths for all. I understand but wish we looked at our whole practice. Thanks again.

Thanks for the spelling correction. I have found the internet is very forgiving in regards to my spelling.

Thanks for the article. I found some others and one that discussed that perhaps it is a good prevention but each hospital should look at the infection rate prior to instituting a policy. They all seem very positive in regards to risk vs benefit.

Of course I did not mean to openly give the email without permission and then it could be shared privately. I have no problems with a lit search as previously stated but it is always helpful not to have to re-do the search if someone has that information available and is able to share it. I will just do a goggle search for companies and the chlorohexidene. I was just trying to get an idea of how common it is. Thanks all those who replied.

Thanks! Is this is a daily bath? And is there a way you could inform me of the nurse educators email in order to save same time regarding the research? Is there a company that supplies these for you?

I work in a community hospital, Cardiac Intensive Care (mix of MICU/occ SICU and Cardiac(PCI)) rare if any trauma and no open heart. Our nurse manager who took away our packaged bag baths over a year ago due to ?cost (using basins and washcloths again). Now she would like to try the 2% chlohexidene bath packs because we have had recent >>> in our central line infections..hmmmm:confused:. She read a study that showed a significant

You are correct. We are about 60% electronic. Our MAR's and all drug rec forms for transfer are electronic for printing only. The original Med rec for home meds is not and neither are the MD orders and progress notes. We will be all electronic in about 2 yrs or less. Would be great to see and cross reference all current against dc meds. I was thinking about putting the Home rec list in a plastic sleeve so it could be found quickly. We currently do this red sleeve for blood permit and blue fro DNR. Thanks. I guess there is no real answer to this problem.

We also have the Med Rec form (in use for 3 yrs) and it is put into the order section fro the MD but it is a joke because the person who signs is the nurse. We don't fax it to Pharmacy but some told me we may be doing that soon. Does the MD sign it before you fax it to Pharmacy? How did you get the MD's compliance? Any suggestions about dc'd meds in-hospital that might need to be restarted? Maybe there should be a list of in-hospital DC med list that is generated 3day and the MD needs to review and sign off?

The same happens for us. The "hold" becomes a automatic dc but the problem is just that...sometimes it needs to be re-ordered and when that does not happen it can cause the problems I described. I was wondering if others had the same problem and how they handle it. We have so many hospitalists it can cause problems and even more so when the staff don't have the same patients to provide a HX.

Our hospital years ago would send a message after 3 days of a "held" medication to make sure it was to continue to be held or did it need to be restarted. About 7 yrs ago this was stopped and if a med was ordered to be "held" then it was automatically dc'd. Here are a few problems that I have encountered and it is probably more of a problem due to the staff not having the HX of the patient. More of us are 12hr now and the Attendings are no longer in house we have hospitalists. Patient1 comes in with Patient 2 comes in resp arrest from the floor. Intubated. Tx'd for pneumonia. Had been on BB. Initially hypotensive. All floor meds held. Does well and is weaning VS WNL and no pressors day 4. Remind Chrg. AM that will need to be retarted on BB. Off for 3 days and find pt w/HTN and SVT needed esmolol gtt...... Patient 3 elderly woman comes RR team due to pulm edema. Post op day 4 with NS @ 150/hr. Pt had been also taking po fluids. Lasix was initially held due to OR but never restated plus IV NS @150/hr. Is there some type or prompt or documentation of dc'd med list or home meds that were nver started that your hospital uses to prevent things like the above from happening? Is the MD required to review this? The problem is the patients move about the hospital so often you just don't know them that well anymore. All the Med Rec forms in the world won't stop this from happening. Sad for the patients and $ with longer hospital stays. Need to be a CSI and somedays there is just not enough time. Any suggestions on how you prevent this from happening @ you hospital would be greatly appeciated.

Wow you must secretly be working at my hospital! The exact same thing happens here. The only good or bad is that they are on for a week at a time. We have 4, 2 of which are not like that but the other 2 have the same stupid behaviors. It is very frustrating for staff and families. Even if spoken with about these behaviors they are good for awhile but then revert back. Hmmm last time I checked it is supposed to be about the patient not beating on one's chest!

Thanks for the information. I guess there is really nothing about this that makes it easy. Would be good if we knew it was all worth while and perhaps you are correct in that it does not occur soon enough?

I work in a small community hospital and the manager of the CCU and ICU is considering purchasing a bed for proning. We don't have that many maybe 10 patients or less per that have been proned. The past month the Pulmonary Doc decided 3 needed to be proned but did not seem to change out comes by much. One did well but was only ever on 60%FIO2 and the other two did not make it. Research I have read is +/_ with regards to proning. They seem to indiciate it does not change the mortality rates. Are others still proning or are you using other forms of tx's. Thanks

Thanks for the input. Too bad this thread is not connected w/ the students so they know they don't have to sign such contracts and they are not the "Norm". I know this has been discussed in my daughter's "Leadership in Nursing Class" and all of her professors were very concerned about such contracts.

I am, what can I say:redbeathe Am always willing to learn.

Only drugs we have running as piggyback or secondary are antibiotics. If a drug was compatible w/ heparin, dopamine, levo,etc that is to be attached at the Y site below the pump and then that drug would be running on it's on designated pump. It has been a policy for at least 15 years because of the above mentioned incidents.