JohnW

Thanks for the replies. I've always used Alaris pumps (and I know they are approved for blood). The hospital where my wife (she is also an RN) works uses Baxter pumps, they have blood tubing, but their policy is that blood can only be run through a pump if it's going through a PICC, otherwise it must run by gravity. I think it might be an outdated policy, enforced for no good reason.

Does anyone know of a resource that lists which major brands of IV pumps are OK to run blood products through? I searched on the Baxter site for a while and could not find anything. Thanks!

It really depends, most institutions have a Sliding Scale heparin order sets that tell you how much to go up or down the gtt based on the ptt. As the nurse, there is no set calculation that you need memorize.

RRTs by familes? I think that's absurd. If you don't trust the floor nurses/MS on the floor where your loved one is staying TRANSFER to another hosptial. If the family thinks the floor nurse (and supporting team) are so weak that they can't recognize and emergency so blatant that the family can see it, that family and the patient should go elsewhere.

We used this drug in my SICU the other day (per cardiology) for a paitent who had ended up in Afib/Afluuter. The paient, who was in his 20s, was given concentrated IVP neo (by mistake) in the OR. He dropped his HR down to 30 and was given atropine. He came out to Us (direct admit) in RAF. We gave him the Ibutilide and had a ton of ectopy while the med was infusion. He then flipped into sinus and all the ectopy stopped. We kept him for 10hrs or so checking his QTc (we were doing 1 hr EKGs for a while) and then dc'd him to home. Anyone very familiar with the drug? I'd love some feedback, tips, what to expect type information? Thanks!!

Of course, sitting someone straight up will help prevent apiration, but it's certainly not a cure all. Many people with MS changes are not safe to eat (or eat everything) and deserve a S&S consult. Don't forget lots of people are silent aspirators, use extreme caution feeding someone with a change in MS.

Wow, that is a big difference. You guys do a lot, but it seems weird to me that you guys pull pleurals, but they don't let you draw ABGs? Our NPs or PA pulll epicardial wires as well.

We don't insert A-lines, although I wish we did, as sometimes it's painful to watch Interns struggles to get one. RNs and RTs can draw AGBs. We dc Swans, but do not advance them. We maintain CVVH, but do start it. We do not place central lines, IV nurses places PICCs and the MDs place other CLs. Some of the nurses I work with pull Medialstinal CTs, but I don't and don't really have an desire since I'm not good at reading CXRs.

Not sure what you mean here? Are we talking about non-vented people? It's comon sense and comon knowledge that for any patient with trouble swallowing that you sit them straight up when you feed them. Or are we talking about people getting TFs? Or are we talking about vented patients and "micro" aspiration around the cuff (VAP bundle stuff)?

In my view, this is a very sick patient. As others have posted, you would need to check her code status ASAP, she is a hair away from being tubed and on pressors. It's a big problem that she is not on a monitor and probably a liability. It's not OK for someone to be hanging out with a BP in the 80s and a HR in the 120s, espically an elderly person with a bad heart with an unclear MS. Also, this poor person has PNA - this is bad stuff here. It's not accpetable to just let her hang out with those vitals. With that said, here's the other info we need: 1.) Some BL stuff: does she have a recent echo (i.e. how bad is her heart), do we know her baseline creat (i.e. does she have baseline renal insuff or has being deydrated in the NH beat up her kidneys). 1.6 isn't that bad, but it's signifcant. Home meds: she's probably in A-fib (also probably having PVC with that K), what does she take? 2.) Is she septic? What's her temp, what's her WBC, how bad are the infiltrates on her CXR . She was just admmitted so her sputum is probably not back, most hospitals have a criteria for a dx of PNA. She needs ABX, and she needs a central line. 3.) Does she have COPD, does she wear home ? If the answer is no, we need to fix that Sat ASAP - we are beating up her heart. Time for an ABG right away. Brace yourself for a very ugly gas. Send it wil lytes to, those labs could be "high dries" - look for her K to even lower. 4.) Do we want to consider cardiac enzymes? Probably not going to do much, but you can be sure with that BP and that HR, her heart is really being workedver. 5.) What is her fluid status? Given the Hx, we assume she is dry, but she could also be in failure as well(time for an echo or time to atleast draw a BNP). Maybe blood with lasix (espically if she takes it at home). 6.) We need to fix her HR. It could be just that she is dry, but it is more likely she is now in A-fib. We need a 12lead to see what's going on. She doesn't have the pressure to give BBs or CCBs. But, she is not tolerating the fast rate, she needs that atrial kick and she needs a slow rate to perfuse her coronary arteries. We need need to consider cardioverting her. Bottom line, it's unlikely that there will be a simple fix here (such as giving her a few liters of NS). What are going to do if here BP drops to 70 and her rate goes to 150? 7.) Don't forget saftey. This woman is a fall risk at baseline and now if she's hypoxic, things are going to get worse.

All of our hearts come out with Swans. We do not wedge, we use PADs. We seldom Swan our non-CT patients, surgical patients. When we do it's most often a septic paitient whose heart is failing. We are just starting to see the "Presept" triple lumens CLs that measure continouse SVO2 and can give CO/CIs, with these I expect to see even less swans.

Don't you guys do a re-back on verbals? That would have been time to clarify. In this case, you can be pretty sure the Doc meant 10ml/hr. Depending on the concentraion you guys are using, 10ml/hr often works about to about 30mcg/min, a nice place to start your ngt at. Personally, I think is a big mistake for places to go by mls an hr, but lots of hospitals do it.

We use PO cardene as part of our vasospasm protocol for strokes/coils etc, but I have not used it IV. Personally, I don't like using Calcium channel blockers as first line drugs to control hypertension, but that just might be my comfort level.

We were inserviced the other day on the "presep" triple lumen CLs that allow for cont. SVo2 monitoring. One hope is that if these lines are placed in the ED, the Docs will be more willing to really pour in the fluid, even with an "ok" BP, in light of a less than optimal mixed venous.

Perfect, thanks! I'm assuming the wedge is used as a differential versus CHF?