andiekae2

There is a lot of good advice resulting from this question. Ultimately, only you can decide what is the best way to handle this situation. I speak with 33 years of nursing and found have myself in this situation and wish I had handled it instead of walking away. First and foremost, do not give up a position you love, you will regret it. Second, you'll find this type of behavior everywhere and you have to develop methods to cope. Rise above the behavior and show kindness and positivity that will attract people to you. Be a resource they cannot do without. Finally, work for your patients and get joy from them. Save social activities for those you don't work with and you will not find yourself consumed by medical talk. Physical activity will also help,

I have worked in various radiology/cath lab/IRL departments since the 80's. I guess I've been lucky because radiology administration and techs have always welcomed nurses into their areas of expertise. They have recognized how we can work as a team rather than adversaries or an unnecessary expense. Three years ago, I accepted a position in a cath lab/IR combo department. A little old fashion, but still doable. We are occasionally asked to assist in CT and US, however in my opinion, not often enough. I have been taught that "any patient who gets a needle, gets a nurse". I am looking for advice/resources to present to radiology administrators that support the need for nursing care during all procedures or at a minimum: US guided thoracentesis and paracentesis. Often these patients are left alone with just the US tech as the radiologist leaves as soon as they start to drain. Any help will be greatly appreciated, even if the conclusion is I'm overly cautious.

I've tried to find out exactly what it is that makes it hemostatic. Is it thrombin? Bard is very vague and therefore how can we assess for allergies or potential coagulopathies they may cause? In the good old days, we exposed everyone to heparin (through hep-locks) and now we know the consequences.

Our Infection Control Practitioner has approached us regarding changing the brand of chlorhexidine patch we use on all central lines. We have routinely used the Ethicon BioPatch while keeping a few Bard GuardIVa on hand for those lines that ooze. However, she has found that with our purchasing program the GuardIVa are much cheaper and wants to switch. My concerns with this are: exposing every patient to Bard's "propriatary hemostatic agent" the notable difference in the amout of Chlorhexine (I believe it is 24mg vs 92mg) lastly, the lack of research on Bard's part showing their patch "was not clinically tested for its activity to reduce local infections, CRBSI, or skin colonization of microorganisms commonly related to CRBSI" (on GuardIVa box). Any information would be greatly appreciated, especially published studies (hard to find) before we make a decisions.

Unfortunately, starting IV's is such an emotional and psychological roller coaster for new nurses and even experienced nurses if they don't do it all the time. In my book, pain = problem. The antecubital space and upper arms can hold a lot of fluid from an infiltration before it is addressed. Even if it looked okay, I would encourage you to restart any IV in the AC. Our hospital's policy is within 24 hours. On a positive note, I applaud you for trying to improve your skills. While there is science behind starting IV's, most of it is practice and building up your confidence. Take all the time you need, sit if you can, talk with the patient (it will calm both of your), organize your supplies, build habits that work everytime, and offer to start every IV that comes your way. Soon you will be that nurse that everyone calls on because you're the expert.

I am starting my second year of placing PICCs and have been on a success and emotional rollercoaster (I work by myself with no backup). My question is regarding an extremely anxious post surgical patient (shaking, weeping, "this will never work" kind of patient). She spent an entire day refusing the PICC and finally said yes the next day. Assessing her arms, I visualized great basilics in both arms. However, when I accessed the right I could not advance the wire and the vein appeared to have clamped down. I waited however was never able to advance the wire. On the left, the basilic was basically gone when I was ready to access it and never tried. I have found conflicting literature on venous dilation versus constriction with anxiety. I am curious about the physiology and any suggestions with extremely anxious patients? I can usually talk even the most anxious patient through the procedure but feel there must be more. She had already had pain medication and conscious sedation is not an option in my facility.

I am working in a combined Cath/Angio Lab and cover Radiology & PICCs as needed. My director is not a nurse (respiratory therapist). He has no direct knowledge of what we do and is rarely present to observe us with patients. Our annual reviews are coming up and I am concerned. I have been told by this person that I am overly opinionated because we often clash on nursing decisions and patient care. For example, he has told us where to stand during procedures and has mandated a specific length of time we may spend inserting PICC lines. Can I refuse to accept his evaluation? I love my work but am at a loss and do not want a negative review. Furthermore, I feel like I am being pushed out of a job his unreasonable expectations. Can anyone give me sources to back up the inappropriateness of a non nurse evaluating nurses? I know it is not unusual in radiology to have a non nurse director but we have no direct line to nursing. Thanks!!

It's great to have you interested in Radiology Nursing. I have been in radiology for 20 + years and still love it. I have worked in both types of departments: pure Interventional radiology and IR mixed with radiology. I prefer a mixed practice to keep my skills sharp in all areas and because I enjoy lots of different types of procedures (anything from acute stroke to placing a drainage catheter). In addition, My knowledge of anatomy has never been better than it has been working in radiology. Some IR nurses also start PICC lines. Whichever you choose, you will be working with a staff mix that includes rad techs, scrub techs, and ancillary staff. It is different from the nursecentric world you may be used to and some nurses struggle giving up control. Also, the labs I have worked in fall under the radiology administration and not nursing, but experience has been positive. I have come to appreciate the skills and knowledge of radiology professionals. Some questions you might want to ask include: What sort of orientation/mentoring will you be offered. You will be introduced to many new pieces of equipment and procedures. Who will you report to-nursing or radiology administration (to be sure you are comfortable) How much on-call will you take. Many nurses don't want to give up personal time. Do you have the skills they need...ACLS, PALS, EKG, IV starts, etc. Lastly, see if you can spend a day observing. IR nursing is a very different practice and not for everyone. Good of luck and I hope you love it as much as I have.

As JACHO approaches, we are once again in panic mode. Now administration is questioning our dress code in IRL. For all procedures, we have followed the same protocol that is used to insert a central line. The Radiologist and scrub use sterile gowns, sterile gloves, masks, hats, shoe covers, and eye protection. Radiology techs and monitor RN's wear hospital supplied scrubs and do not routinely wear hats and masks as they are not in the sterile field. Our room has no special air flow and is not off a clean hallway. Many people pass through in street clothes. Our current infection rate is nearly 0. I would greatly appreciate any input as to what others in IRL/angio are doing. I've done many hours of web surfing with very little out there to guide us. Our staff feels OR standards are a bit over the top but all agree we want to do what's right.