HyperRNRachel

I am needing a policy, procedure and competency to be able to suture picc lines in place. Currently we use a stat lock but all chemo lines going to MD Anderson have to be sutured in place or they will remove to line and start another. Anyone willing to share? You can email me at [email protected] I work for a small hospital and am willing to help the doctors with suturing in PICC lines but getting a policy, procedure and competency form from our education dept is taking FOREVER! Its as if i am asking them to kick puppies or small children. I need help. Rachel

Anyone using Bard site rite vision with Sapiens? Hospital recieved the vision ultrasound machine today- super exicted but wanting some feedback. The good , the bad :uhoh3:and the ugly . We get formal BARD training in August- over the top excited about this. I want to be able to ask all questions and avoid any "wish i would have known that ahead of time" moments. Thanks Rachel

First a little background information. I work for a small hospital in the cath lab, we currently have two nurses who cover PICC placements not done by the interventional radiologist in Special Procedures and also help start PIV's and ultrasound guided IV's for the entire hospital except the ER. The PICC team is available during our scheduled work hours of 0630 to 1700 Monday-Friday. We take on-call until 1900 every day of the week with guidelines in place for minimal call outs (although they seem to be ignored by EVERYONE). We do not get on-call pay during the week or on weekends. We only get our regular salary plus any shift diff. when we do come out -two hour max per PICC. Ive only been placing PICC lines since Feb and am learning as I go. I don't know it all and don't ever plan on knowing it all - and now i need help from you. So here is my situation.......Tuesday at 1830 I get called from the ICU, nurse states she got an order from the primary MD for PICC placement for antibiotics. On further assessment I find the patient has a newly placed ( in the OR by GI surgeon), functioning, non infected double lumen right sided IJ and is getting amiodarone and cardizem in one lumen and TPN with lipids in the other. The problem is she needed to give Zosyn (not antibiotics as she originally stated but one antibiotic and needs an additional port. Instead of starting a PIV she called the attending MD to get an order and then called me for PICC placement. I told her I would not come out because this did not fit our on-call guidelines and if the line was still needed it would be done in the am. The next morning I go to check on the patient- cardizem stopped per MD order. Nurses started PIV the previous night. I go to nurses station and tell the charge nurse that we will not be placing a PICC- they had enough access. She states "well we still need a PICC- we struggled to get the PIV". I told her I would do some checking and be back. After talking with my picc partner he states we could remove the IJ and place a PICC. I was blown away!!!! WHY?WHY?WHY? 1.Am i missing the logic in removing a functioning central catheter to place a PICC??? After talking with the admitting MD she stated to hold the PICC order until after the surgeon saw the patient. No new orders since his last assessment. 2.Ive tried to find information on what the standards of care would be in this situation. I feel like the ICU nurse thought that two central lines would give her enough access. What are the standards? 3.Is there a such thing as having two central lines in place? Ive never heard of such a thing. 4.How cost effective is it to replace a central line with a PICC? 5. How would you have handled this? 6. How does this benefit the patient? HELP! I am one confused PICC nurse!

I've won the nursing lottery! After being burned to a crisp as a 7p-7a ER nurse for the last 4 years, I was offered an incredible day position in the cath lab working 8 hour shifts 5 days a week. The position is awesome! The hospital is awesome! It's a small hosital with a one room cath lab. Since there can be "down time" I am also being trained on PICC line insertion and LOVE IT. The set up is time consuming, but I'm comfortable in that area but I'm having one small problem- (haha only the most important part). I'm having a difficult time keeping my vein centered while attempting to access. Any advice, pointers, suggestions, thoughts or help is much needed. Are there any training aids, books, or classes that I should be looking into? Thanks Rachel

Danskos-love them. I can also wear my Muzuno running shoes but only every once in a while.

You know you are truly an ER nurse if: You have ever told a patient that Geodon is a pain med that can only be given IM.

How do you cope with a med error? Learn from it and move on to being a better nurse.

We have one girl who comes in every 2 months in DKA. NO viens anymore, so now we are restricted to central lines! I honsestly think she does not given herself insulin in order to maintain a VERY low weight- she looks anorexic. And, although, she comes in with n/v (i have never seen her vomit) she always has a negative ct and ultrasound but asks for pain meds! How often do you see the same DKA patients? Does anyone know the name of the condition for DM patients who do not administer insulin in order to control weight? Rachel

$972.00 on an overdose patient who came in due to ETOH and taking his mothers klonipin. He was not even sober when he started asking for his pants and low and behold he had a bunch of money!!!

guilty too. one pink pad. it was the patient's birthday and she asked.

Can you say restraining order and battery charges???? The man needs to be out of the hospital setting if he cannot handle people or stress. OUT of a job, out of a license and off the streets. DO NOT PASS GO DO NOT COLLECT $200.00!

I have a crazy obsession w. lung sounds so I listen to everyones. You come in with a possible broken baby toe and I will listen to your lungs. I have only been a nurse for 2.5 years so I am still perfecting that skill. But I do not recall his right lobes being decreased. No tracheal deviations. Since his only complaint was the right shoulder- he was very specific- I did not place him on any monitor. He was speaking- almost nonstop- in complete sentences. I do my own vitals on discharge and there was not drop in pressure, increase in resp, or decrease in pulse ox. This whole thing has me feeling a little insecure. NOT alot insecure just enough to make me smarter- hopefully. How did the pneumo get missed by the MD? I do not know. He is an excellent MD. This really has me perplexed. Its not like it started small and grew large. IT WAS LARGE to start with.

You are smart! A large pneumo!!!!!!!!!! Not small or medium but LARGE. It was picked up by the radiologist who read the xray in the am, but by that time the patient was back in the er complaining of dyspnea and needing a chest tube. Since a chest xray was done, what else do you think I could have done? I had one of those "feelings" when he told me he felt hoorifice- but I knew the chest xray had been done and I chalked it up the the helmet strap. Rachel

I was wondering about the iv K as well. If she was alert and talking why not give PO KCL. Potassium in a thumb- no way, especially since she was such a hard stick needing pain meds. I never risk blowing an IV. If she was to be an admission I would have asked for an EJ, PICC (our hospital does not do PICC insertion in the ER), or Central line. As far as diludid, I have given and also refused to give 4 mg dilaudid ivp every 2 hours- my drug book states that amount is above the recommended dose range. Every patient is different though. I know in the ER you cannot start a PCA pump, but it sounds like that is what this patient needed and or a combination of drugs. Sounds like a hard day and I feel bad for the OP.

Patient ambulates in s/p motorcycle crash with no loc complaining of right shoulder pain and mult. lacerations and abrasions to right hands and bilateral knees. Right shoulder and chest xray done. Right shoulder sling applied and iced. Patient keeps telling me, "thank God Im left handed". He also keeps talking about how stupid he feels and how he feels scarred (sp) since crashing his motorcycle. Full, packed ER, and the MD is taking a while reading xrays and discharging patients. Motorcycle patient, who has his mother, baby, and two girlfriends (dont ask), is telling me that "the pain meds are working" and he really wants to go home. He is standing in the doorway taking w. the patient in the room across the hall or pacing from his room to the hall - giving me that stare- you know the one that says "hurry the F*&^ up and let me go". I had security tell him to stay in his room due to HIPAA- and to give me a break from the stares and glares. After about an hour, I go in to discharge patient and he tells me he feels like his voice is hoorifice. But he is speaking in complete sentences with no problems and he is insisting that he is ready to go home. He was dignosed with a sprained shoulder- and tells me he can feel it popping when he moves his arm. I dont feel or see any deformity. Patient discharged home w. pain meds and instructions. Do you know why he was back in the ER the next morning????? :confuse Rachel - still learning!!!!!!!!!!!!!!!!!!!!

Parents of a 3 month old infant "he goes cross-eyed sometimes" Parents of a breast fed infant " mustard colored poop"

My husband and i are both nurses and I think he has an excellent response on raising patient satisfation scores in the ER. First, during the triage process explain what the ER is for, give realistic wait times, and set clear expectations regarding the care they can expect to recieve. Inform patients that the ER is not the place to get a clear diagnosis but rather to rule out the possibility of a life threatening condition. (i.e. - they are not going to find out WHY they have had a headache for the past two weeks, just that it is NOT a tumor, bleed, etc), and that chronic conditions (i.e. "i need a RX refill for back pain due to a car wreck three years ago")will not be given any priority unless it can be determined that it directly relates to an EMERGENT condition. Once expectetions are set, only then can they be met.

I know this goes without saying but always document your *ss off when patients are unwilling to follow instructions or are noncompliant with written orders. I had an elderly lady come into the ER with her daughter. Patient was too weak to get into the ER bed without assistance from several people. When she stated she wanted to get out of bed to use the restroom I said no. After I left the room the daughter puts one of the big square emesis basins on a chair and then helps her mother onto the pan to have a bowel movement. Yep, smasked to basin like a pancake. When I walked in I find this I was furious. I immediately get the lady back in bed, turn on the computer in the room, and tell the patient and the daughter that I am documenting the entire event. I further instructed them that if she did have a fall in the hospital from not following directions that she would have nobody to blame but herself. I also told them I would pass the information when giving report to the floor nurse. If you have someone unwilling to follow basic instructions, document, document, document. It may save your butt or your fellow nurse.

I saw this movie the other day, made in 1931, with Clark Gable and Barbara Stanwyck. Besides being a pretty good oldie, it was enjoyable seeng the big screen portrayal of nursing as it was back then. One particularly funny thing was as punishment for acting up in the dorm, the new nurses were "punished" by being assigned to 2 weeks in the ER on the night shift! Also, one funny quote was by Barbara Stanwyck, referring to the difficulty of getting a job as a nurse..."I used to think this place would burn down before I got in, now you've got to watch me around matches". I also found it funny that apparently the treatment for malnutrition back then was to put a child in a double boiler "milk bath" on a stove. Overall, it's a good movie and worth a watch if you can find it.

YES! I work in the ER and we get many, many, many people who come in wanting antibiotics for EVERYTHING! I cannot tell you how many times I have had a patient tell me " well I started running a fever an hour ago so I took some antibiotics that I had left over". YOU SHOULD NEVER HAVE ANTIBIOTICS LEFT OVER! Parents also need better education, 90% of ear infections are viral and yet parents demand antibiotics. We live in an instant gradification society and people do not want to be sick or treat symptoms for longer than a day. PURE CRAZINESS.

0400, male patient- "itching to groin area x1 week" and was leaving to go out of the country and did not "have time" to go to his PCP. Patient told it was not a medical emergency and to follow up w.his PCP or we could tx his "jock itch" for 150.00. Patient decided to go to his PCP!

This is all a bunch of crap! We are basically suppose to follow a script in or ER which consist of selling yourself to the patient, tellling them how long you have been a nurse, tell them all the great qualities of your co-workers, ask them if they need blankets or drinks while they wait and the list goes on and on. All of these things before the patient ever sees a MD. And when the "gallop" survery sites patients think we lack a sense of "urgency" management can't figure out why? Let see, I just spent 10 minutes of doing nothing but talking about myself! The whole "gallop" survey is a joke, because we are to "de-gallop" any and all patients that we think may not score our ER a perfect 4. Our lamea** director even had buttons made that say "ask me about 4"! Does management have open bar at the narcotics cabinet? Cause someone is stoned out of their ever lovin minds!

Do you dilute it with 10mls of NS before pushing it?

Thank you so much to everyone who took time to reply, I am kicking myself for not posting this sooner. UPDATE: Called HR (as suggested here) and left two messages, after being told (with the third phone call) that the HR person was "just leaving for a meeting" I then called our CEO. Although the CEO was not in (will be out until Tues.) I was assured someone would call me back in 10 minutes. Guess who calledme back? Yep, the HR person who, just minutes earlier, was "just leaving for a meeting". I voiced my frustration, told him I did not want an apology I wanted answers, and stated that I want to receive a check within 48 hours. I now plan on writing a detailed letter to the CEO thanking the woman who was able to get HR to return my call in less than 10 minutes, and in detail decribe the apathic and unprofessional manner in how this payroll decrepency was handled. Again thanks to everyone.

I transferred from one HCA facility to another in Feb. I had a negative TB result with my hire on exam, but I have gotten an email from employee health stating that they require two TB test? Is this safe? Has anyone else heard of this?