MaryMc/RN/CM

In regard to bevel up, or bevel down...I was taught that you use bevel up for venous access and bevel down for arterial access...the rational as I recall had to do with the direction of blood flow and how it effects the flap created by the catheter bevel. The goal being to use the direction of blood flow to close the flap and reseal the vessel.

The 60-day summary info is spelled out fairly concisely in the book by Marilyn Harris titled "Handbook of Home Health Care Administration", 2004 edition, on page 40...... you can find a preview of the book, including pg 40 under a google search "home health 60-day summary information", and possibly under an amazon book search. Be aware/advised.....I've discovered over the years that this 60-day summary form and its contents varies widely from home health agency to home health agency......some want just the patient info...generally adverse facts from the last 60 days, other's have you add each and every physician contact, including the physician reply and/or any new physician orders, (even though the physician himself wrote the order, you have to tell him what he did over again, including telling him you found a new drug in the home, even if the script has his name on it)...smile....anyway it should include the pertinent facts from things like...lab work, the "H's" & "L's" rather than each lab value, etc., did the patient fall, get injured, how many times, is the patient compliant with his medication regime, is he allowing PT to come for each scheduled visit, is the nurse able to contact and visit the patient when scheduled, ie., is the patient still homebound, or is he/she to weak/fatigued/HOH to answer the door..., was the patient seen in the ER, was he/she hospitalized longer than 24 hours, has the patient benefited from PT, OT, or a home health aide the past 60 days, has any diagnosis worsened, any exacerbations of existing problems, timely healing of wounds, new infections, has the patient been seen by a different doctor and received new meds, or had new problems identified by that physician, for instance...was seen by a cardiologist and is now on coumadin, seen by a pulmonary doc and had a nebulizer ordered/delivered and needs instructions, was put on O2, etc..... What are your new nursing goals based on the identified problems/changes, what changes were made, or added to the plan of care...sometimes you'll just be continuing an ongoing plan of care/treatment...are your patient discharge plans still the same....., if more than one nurse made visits, you'll have to go through the patient's chart to see what occured, including other dicipline notes/reports from PT, etc..... Some of the criteria will depend on your state and your agencies specific policies....the 60-day summary form your agency uses should help guide you..... Hope this helps...please let me know.........