sweetsounds

Please help! My pt. is to do PICC infusions q8h at home. His technique is good. My question involves cap changes.PICC is in RAC. He has a 12" extension to allow him to handle his line. I was advised to "change caps daily." Extension tubing remains in place for 3days (whereas IV tubings are changed daily). PICC is capped and extension tubing is capped = 2 caps. It does not make sense to me to change the cap on the actual PICC line because I would then be using the same old extension tubing on it. This situation does not fit "hospital" policies because no extensions are involved. Have tried surfing the web, including Mfr. site, still not sure... Any opinions appreciated!!!

A variation on this theme: the visitor with the pt who expresses their "concern" repeatedly even tho' the pt is quite competent/fluent. A friend of mine coined the term "attack friend" for them. Of course, the majority of the time this was a planned stategy; the friend can be obnoxious as possible while the "helpless" pt is so ill they have no accountability (it's not the pt's fault if their fiend is rude to you, right?). P.S. Nurses have incredibly attuned hearing, may be just on the other side of the curtain, OR may be bilingual.

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????Look up Dilantin and you will find (possible) side effect is "V FIB"!!!! Why would anyone push that??? Also literature is pretty clear about using a large vein... What kind of pharmacist would think it wasteful to dilute it? I have had somewhat similar experiences i.e. pt could not tolerate and I reported it to E.R. MD who then changed order to phosphenytoin.

the pump is "incredibly complex"??? The pump is one of my best buds!!!

Please speak to your doctor. I have read that some people have had relief with beta blockers for that kind of anxiety. Also, speak to anyone who will listen. You need to learn how to vent. You'd be suprised how well it works to go ahead and announce an insecure feeling. It usually results in supportive comments from others, as well as possible pointers you can use. Trying to act experienced and/or "perfect" is just not worth the stress. Plus, if you're already perfect how will you be receptive to new learning experiences? Good luck.

IMHO the title of this post could be "...and can I get you some hot wings with that?"

2 incidents, same person? Would love to hear... For every person who clogs up EMS pointlessly your grandmother or mine my suffer, u know?

Amen to everything you said. It's the call the Charge and he/she will get them a bed part that bit me... The hall bed thing is a non-issue, since it has been going on forever. I don't mind statrting IVs, changing diapers, vomit, or intubating; I can handle one thing at a time as you said. Anyway, just curious what the concensus of prudent nurses think. Thanks

where do i get a mgr like that???

I'm sure that really did hurt, but... When will we finally institute a fraudulent or inappropriate use of EMS statute? Maybe the fine should be proportional to how egregious the offense is. Insurance issues aside, we have laws for filing a false police report and we've all heard(or dreamed) of the idea of penalizing frivolous law suit filers. In your pts case I think the penalty should have been ten times the cost of her nails donated to a local homeless shelter or food bank. Oh, and of course, she could substitute community service hours. Maybe there should be a police blotter-type column in the local paper; no names at all, just the basic facts. Sorry, couldn't resist.

Question is, really I guess- how deep do you(or your mgmt)let it get in Triage/waiting room before you have more than one nurse? We used to have a policy more than five deep,waiting for triage, required the help of the Charge or PRN nurse. The other night I was 15 or more deep plus Waiting Room pts who need to be revitalized/reassessed for most of the shift. Of course, this is not to mention the phone calls, registrars informing me of "chest pains","SOBs", etc,etc,crowd control(Why oh why is the security guard thinking I will let the party of 8 pass thru my ER to get to ICU?) AND pts/friends/family who are free to walk up to me at Triage desk and invade privacy of current pt. to ask "How much longer do we have to wait?" Sign me, Trying so hard to wear the big girl panties

My SAGEST advice to fledgling nurses (of any kind), "It's a love/hate relationship, it just depends what day it is." :bowingpur I LOVED the OP!!! .

Just chant to yourself "job security, job security,job security..." You have hit on the one thing there will NEVER be a shortage of.

I'm sorry, Parkland...where?

VERY INTERESTING! As with everything, there needs to be give and take but, alas, we will never have that because we will have "procedure." Too bad for the pt. that we can't all get along together... I am soooo happy for the Unit nurse to ask me ?'s Because, guess what, I don't know it all and another perspective can be a good thing! Also, I would like the Unit nurse to see that Out Of The ER is where the pt needs to go. I completely understand when no one can cover your other pt, hence the "give and take," wouldn't it be great if we all respected each other a little more? I have been fortunate to work in rather small hospitals most of the time where: as long as things are clicking well, it can be between 2 adult/professional people what works best. Sorry, I digress...

How about rating your own hospital internally? I have said FOR YEARS that the nurses should be able to fill out a survey... Was the patient courteous at all times?..etc. Of course, I don't mean those who are in terrible pain, psych issue, etc. Anyway, it is off topic, deserves a thread I think!

Ha ha ha ha ha!!!

Condolences...

I saw the same behaviors by NURSES in a large hospital I worked for. I have also seen a nurse sit her sandwich directly on the counter where we charted- no plate! Maybe the people who touched the charts and papers had dirty hands. As far as the breakroom, I consider every surface in in the entire building to be absolutely filthy. If I can't use a fork, I ain't eating it @ work. I am not a germaphobe; at home if I dropped my Tylenol I would pick it up and take it anyway. Ha,ha.

It is interesting to read theses posts because of the varying procedures in different hospitals. Some of this must be due to different regions, some due to the almighty dollar(US). My hospital WILL NOT divert except in the case of an actual mass casualty. To avoid holding admitted pts in the ED they are sent to hall beds on the floors. Several hospitals that I personally have worked for have a policy of absolutely NEVER acknowledging the fact that they are out of beds(or lack sufficient #'s of nurses). Therefore the problem just doesn't exist see? I absolutely understand both sides of this conundrum having worked on each. When this devolves into an us vs. them situation we nurses are spiting each other. I have to add my little contentious statement though. No matter how many pts I may already have in the ED I cannot refuse the next one, we pile them up in the halls also, then chairs if possible! This is a huge issue of crisis proportions IMO. I could go on and on... Here in the US even "not for profit" hospitals must compete with other hospitals in their market area for patients. This leads to an environment that abuses the nursing staff. Hopefully enough consumers are becoming aware that the landscape needs changing. Sorry, that kind of veered away from the original ? didn't it? Well, good luck to us all since we're really all in the same boat.

You learn something everyday and this was it for me. That kind of environment would make me soooo angry. I am really outraged. Even so, I have to say nothing is ever black and white is it? I have known and worked with a (precious) few people who really did need to be weeded out. The SHAME of it all is that it's not handled in a more direct manner. Sniping at someone until they give up and leave is certainly not going to help them develop a more effective work ethic. It's underhanded of the sniper too.

OK, so it's the middle of the night and I did not read carefully... When I got to the "positive CPS" I kind of freaked because I didn't know what that was!:chuckle

That's really my whole question, if you're a NURSE you get me...