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sherbearccrn

sherbearccrn

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  1. Sounds like a bad idea to research it???
  2. Hi All I was hoping to get some suggestions on teaching Developmentally Disabled Clients to give themselves Insulin injections. I'm only finding results of studies that have been done in the past. Any suggestions or references to sites I can explore would be much appreciated. Thanks in advance:), Sherbearccrn:nurse:
  3. sherbearccrn

    blowing veins during IV starts

        My Technique: [COLOR=#9b00d3]Anchoring/keeping the skin taut; [COLOR=#9b00d3] Insertion to the forearm ; Say, I have a client with very loose, tissue-like skin. I choose the anterior forearm(where I might do a TB test) Although, this would probably NOT be my first choice, as it is extremely sensitive. I place my tourniquet ABOVE theelbow, prep the site (betadine, alcohol) per your hosp. policy. I always slightly twist the needle/cath to make sure the catheter will advance smoothly. Then I grasp the client's arm(on the opposite side I intend to insert the IV) posteriorly, and gently pull the skin toward the palm of my hand (this is the only way I can think to describe it, for you to get a visual). Obviously, I don't fill my hand with skin...but enough to smooth out the skin on the anterior side. As I smooth out the skin gently/firmly, I'm hopefully immobilizing and straightening out the vein underneath. Insertion to hand (posterior); [COLOR=#9b00d3] [COLOR=#9b00d3] [COLOR=#9b00d3]I hold the hand (as though I am going to kiss it ) and using my thumb gently/firmly pull downward to smooth the skin and straighten the vein. Other methods ; Depending on the site I choose. I will firmly "push" the skin up, above the area I'm intending to insert the IV so I can straighten/anchor the vein and smooth out the skin. Or, using your forefinger and thumb (as though your zooming in on an iphone) above and below the insertion site will help to smooth skin and straighten/immobilize the vein). [COLOR=#9b00d3]**If veins are really torturous you WILL have to keep it anchored until the catheter is completely advanced. Thick, rolling veins ...[COLOR=#9b00d3]**[COLOR=#9b00d3]Imagine cruising[COLOR=#9b00d3] next to another car and suddenly turning the wheel 45 degrees to hit it. (it's kind of a quick jab) you see a flash of blood then advance the needle a mm to insure your catheter is also in the vein before you move the shringe to a more parallel position, then continue to advance the catheter (otherwise, the catheter may bend) DO NOT PULL THE NEEDLE OUT OF THE CATHETER or push the mechanism that causes it to retract) before advancing catheter ....if you do, you may have alot of difficulty advancing the catheter esp.on clients with weathered, tough skin [COLOR=#9b00d3]**I have had the catheter tip wrinkle up as I'm trying to advance it over the needle.   [COLOR=#9b00d3]*** REMEMBER, YOU CAN NEVER RE-INSERT A NEEDLE THROUGH THE INSIDE OF AN IV CATHETER ONCE IT HAS BEEN REMOVED. (shearing of the tip may occur and cause an emboli to the patient) If a lot of blood is escaping I will place my ring finger from my non-dominant hand above the insertion site and over the underlying IV catheter [COLOR=#9b00d3]...**[COLOR=#9b00d3]never on the insertion site (remember, aseptic technique) to decrease the flow, and attach the "pigtail" (AKA; Lock, PRN adapter)
  4. sherbearccrn

    blowing veins during IV starts

    @ queenjulie Yikes!... Sorry for the confusion:confused:...I usually have no problem with insertions but if I do I have no problem having someone else try. There are days it's just not going to happen and other days when I couldn't miss one if I tried. The procedure has become so automatic that after I read your question I had to re- evaluate my steps again:o..... So after I get rid of my 3rd arm...I actually pull the skin taut/anchor it /don't let it move... yada yada. I insert the needle. Once I see blood I advance the catheter without moving the needle..let go of the skin...hold the inserted IV with my non-dominent hand... remove the tourniquet with my dominant hand...then using both hands I attach a "pigtail" (AKA; PRN adapter, Lock). Place a small piece of tape on the pigtail tubing (frees up my hands) below the catheter hub and flush. If everything is okay I finish securing it and put a clear drsg over the site. And that's the truth!
  5. sherbearccrn

    blowing veins during IV starts

    The posterior forearm is my favorite site. 1) Offers a large vein 2) It's out of the way 3) gives a lot of arm and hand mobility to the patient 4) rarely infiltrates 5) doesn't bend the IV catheter or the IV tubing
  6. sherbearccrn

    blowing veins during IV starts

    Thanks to all for sharing excellent tips. So....my 2 cents. When prepping the area with the alcohol pad I use some pressure (remember the friction not the alcohol is what cleans the area), thus increasing the circulation and hopefully plumping up the veins. I hold the skin and veins taut with my non-dominant hand (enough that I won't get movement of either) Once I get the flash of blood I immediately remove the tourniquet and IDO NOT MOVE the position of the needle because the flash tells me I'm IN the vein. I DO NOT REMOVE the needle before I've advanced catheter. Think of the needle as the stylus(guide wire) they use when they insert a central line (the needle is maintaining the introduction into the vein). Then while holding the needle in place with my thumb, middle and ring fingers, I use my pointer finger to gently push off the plastic catheter. Once the plastic catheter is in place I remove the needle (if I remove the needle too soon I have nothing to guide the catheter into the vein, therefore I may be unable to advance the catheter and/or it will bend). I'm hesitant to blame "valves" as the reason I can't advance a catheter (unless they are "sclerosed" shut) because they open towards the heart which is the same direction my catheter and IVF are headed. Also, just an FYI....if you see Two veins merge into One you have found the strongest insertion site for an IV (at the top of the triangle where all three come together)
  7. hmmmm......i wonder where/what research your instructor used to come up with the 85%. can you ask her where she obtained the info. from? as an instructor, i usually ask my students what made them want to become a nurse....a high percentage have said they decided after they observed nurses taking care of their sick loved ones. they either truly admired and respected them or they thought they could be a better one (nurse) :heartbeat. but, no one said it was because they had an abusive/addictive family background.
  8. sherbearccrn

    Fun Questionnaire for Nurses

    this questionnaire is about your job as a nurse. please feel free to answer the questions and respond. thank you for your time! 1.) what type of nursing licensure do you have? please check or type your title. ____lpn[color=#ee82ee]__x___rn______other 2.) how long have you been a nurse? a. less than one year b. 1-3 years c. 4-6 years d. 7-10 years [color=#ee82ee]e. 10 years or more 3.) what annual salary do you expect as a nurse with your amount of experience? a. $35,000 - $45,000 b. $45,000 - $55,000 c. $55,000 - $65,000 [color=#ee82ee] d. $65,000 - $75,000 e. $75,000 or more 4.) what type of nursing education have you received? a.) diploma [color=#ee82ee]b.) adn c.) bsn d.) msn e.) ph.d f.) other___________ 5.) what type of facility do you work for? [color=#ee82ee] a.) hospital b.) long-term care facility c.) home care d.) other _________________ 6.) have you ever worked on a medical/surgical floor? [color=#ee82ee] a. yes b. no 7.) what shift do you work? a.) 7:00 a.m.- 7:00 p.m. b.) 7:00 p.m. - 7:00 a.m. c.) 7:00 a.m. - 3:00 p.m. [color=#ee82ee]d.) 3:00 p.m. - 11:00 p.m. e.) 11:00 p.m. - 7:00 a.m. f.) other___________ 8.) do you like being a nurse? very often_[color=#ee82ee]x___often_______sometimes________rarely___ _____not at all______ 9.) what kind of nurse are you? (ob, critical care, er, etc.) [color=#ee82ee]critical care[color=#ee82ee]/instructor
  9. sherbearccrn

    Fun Questionnaire for Nurses

    I agree Dueydew....Jeez
  10. sherbearccrn

    missed NCLEX date anythign I can do?

    according to the ncsbn website (ncsbn.org): it looks as though your letters are switched ... sbn not bsn[color=#333333]
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