NtannRN

I also agree with MunoRN.

We don't have the wipes, but we have it in a pump style bottle. We use a few squirts in with the bath water. We're supposed to be getting the wipes. I wonder if putting it in warm bath water reduces it's effectiveness since some posters are not allowed to warm the wipes. Anyone else use the pump bottles?

Grey gull, it's not laziness, I think ambulating an intubated pt has fallen out of favor, esp.when you dont even have the time to get yourself to the bathroom. From my stand point, we barely have the staff to get through the day, our cna's get pulled according to the# of pt's, not by the acuity. So when our pt population drops regardless if they're on something like hypothermic protocol, we have to reduce our staff, I cannot walk an intubated pt when theres only 2 of us for the floor.

I haven't gotten an intubated pt. Oob since I was an aide 18 yrs ago.i think if I suggested that now the other nurses would want me to get a psych consult! Lol. We have a10-14 day limit, then it's a trach and peg. Honestly,i don't think we have enough staff anyway to walk them. Lately, with all the different documentation we have to do, the unwillingness to pay overtime and working short staffed,i am thank full for my continual rotation bed that does crappy cpt.

My pt the other day coded and passed away. The family waited while we did a "quick" clean up so they could come in asap. When they left, we did the complete post mortem. We have a specific gurney that has a cover. We place the pt on that place the cover and then cover with sheets. As we were about to place him on the gurney, more family came and I could not in my heart deny them to see him. I stressed to them that my pt. Was about to leave, I unzipped the bag (think goodness he had a jonny on) covered him with a sheet and placed a pillow under his head. I worked hard to save this man and failed, the least I could do was help his family and make sure he looked as they would want to remember him.

I don't care who you are, if I cannot care for MY patient appropriately with you there You will leave. Because if something goes wrong it will be MY license there going after. And who's to say the pt wants them there. Maybe they don't know how to tell their family to get out

My answer: They're in critical condition, you'll have to get any and all info from the family d/t FEDERAL HIPPA LAWS. Sorry..............

We use "vamp" set ups. On central/a-lines, I came across an issue I wasn't told about. We have s 10 cc chamber in the set up for our "discard" that we reinfuse after we draw blood. Well there is a stopcock there so you don't draw from the discard. Don't forget to reopen the stopcock before reinfusing. I forgot ONCE, the blood backed up into my transducer and I had to get a whole new set up. What a PIA that was. :smackingf:smackingf:smackingf

I agree Getoverit. We dont use it very often, I have yet to see the effects as advertised. Lol:yeah:

Question......if I'm dumping blood in as fast ask can, they're on pressure bags etc. Do I need to flush with saline before I hang the next unit? Or can I just keep going. We do have a 2unit or 4hr tubing limit.

Can I just say OMG, OMG, OMG. Propofol has never been legal here to push even prior to MJ. Not even during rapid sequence intubation. MD only! This whole conversation has me wondering about where I work. Thank You. I am now going to look more carefully and really take s look at our policies. We use Baxter pumps. They're not the best for calculating total volume ,but the work. We have to scan bar codes on all our meds. How do you do that if you're bolusing from the bag? How about trying some seroquel or other antipsycotic ? Haldol anyone? Our docs haven't started entering their own orders yet, but we do have already printed order sets. Thanks again for the food for thought.

Icudavis, I would love to hear about the non-invasive glucose monitoring. I didn't know there was such a thing. At my facility, it does not matter if It's peripheral or not. Central line is preferred when our pt is fluid overloaded. After while, their finger tips look absolutely horrible.

DeLana, I guess there was s study done somewhere, that showed (don't quote me) better absorption, efficacy. We used to give over 1hr. Now its s pain, your holding up an iv line for 4 hrs.

We go by Gerhart's IV Infusion book for all iv meds. Kcl 10 meq 1 hour peripherally Kcl 20 meq 1 hr central line only. Mag 2 gms 1 hr centrally CA+cl (per our intensiveist) 2 amps (diluted in 50cc ns) over 10min on monitor Sodium phos 15 milimol over 4 hrs, 30 milimols over 4-6hrs **we now give zosyn (ABx) over 4 hrs. ANYONE ELSE?

OMG You're not kidding, we special order "SizeWize" beds that are supposed to automatically turn your patient. They also have a button for "big turn" to use when you're rolling them over to assess their bottom, but the part of the bed that blows up to turn them also gets in the way. Can we say 400lbders, whose legs must weigh 40lbs each, which are now full of fluid, intubated, sedated and have no necks. Then they pull the nurses aide, I wash as much as I can by myself, then call in the troops-----if we have any! LOL

Oh no, I don't think so. Fem lines are considered "diry" lines and are to be removed asap anyway. Just thinking of ambulating anyone with any kind of fem line gives me the heebeejeebees.:smackingf

I was a new grad 2 yrs ago. Scared to death. I had a great preceptor and great classes/orientation. I still get a bit anxious at times when I get a very sick patient. I have the pleasure of working with some exceptional nurses that are always willing to let me bounce ideas off them. We have resident coverage at night so there is always a Doc around. I'm not shy about telling the Doc, Hey, I'm not too experienced in that, could you please explain your rationale, what's the plan for this patient. Stay open to learning. We go to all the rapid responses, I haven't gone in a long time so the other day I asked another nurse to go with me. I want to be the best nurse I can be. I'm at a community hospital and my goal is to get to one of the big city hosp. but I still need to learn more. Good Luck in ICU, it was the best decision I ever made, it makes me proud to be a nurse.

Are you a Union hospital? It doesn't sound like you are. Everyone's right, your license is on the line, not to mention lives.

I'm laughing because whom ever wrote about changing your sheets made me smile.I never had to change the sheets yet but had to change the whole aline (we use a "vamp set up) that has a small stopcock that I forgot to uncock when reinfusing the blood and it went backwards into my transducer. I had to change the whole thing. Live and learn!

We don't have a protocol. We don't even have fancy stickers for the tubing. But, it's good practice for all involved to label the lines. Protocol is all our lines have to be dated. When I get a patient with a ton of iv's labeled or not i check where everything is going, esp. to the right pump. We just use good 'ol regular medical tape and label at the distal end. All our pumps have the guardian but it's not very big so sometimes we tape the top handle with the drug name. Labeling is very important but not as important as tracing your lines back at the beginning of every shift.You can't be too careful.

South of Boston here, I work in a 16 bed unit, we've been about 1/2 full lateley althought the rest of the hospital has been pretty full to the point we have med/surg patients because we can't move them out. That's a long night. Last summer I think I spent more days off than on. I hope it's a little better this year.

I guess I apparently CAN read since there is more than 1 person to stand by the fact that yes you do indeed infuse levo and neo peripherally if need be. There was no need for the rudness, I was at first on the side of central line only, which changed when bending the ears of my senior more seasoned nurses.

I stand corrected. I went back to work and asked my senior nurses. Yes we do give it peripherally but we try to never do that. We also try to give bicarb alone without anything running with it. I don't know why the Gerhart iv book we use has compatibilities. No one at work is able to tell me why we give it alone either.

Only RN's or Resp. for A-lines, Only RN's for Central lines and only RN's from our IV team for Picc lines. And in extreme cases where there is absolutely no access other than a Vas Cath, The resident (MD) will draw off that. We have fantastic techs, and we have one that if she can't get blood from the stone than no one can but please don't touch my lines.

I was always taught in school, hold tf if the residual was 2x the rate. Now our facility has changed its policy to hold if residual is =/> 200 cc. My patient the other night had tf @ 45 cc/hr, his residual, 110, I held it for an hour. He was sedated and had been previously paralyzed.