altusjg

I work cvicu and micu and have place picc lines for about 2yrs now. I have never recieved extra pay for a picc line placement. I became interested in picc line certification and placement because i wanted to advance my own skills and beef up my resume. However, I do not think it is fare that we are not payed anything extra as i am requested to place picc lines on the floor while i am in the unit with a pt load and i must rely on the charge nurse to cover my pts while i go to the floor for the hour or more that it takes to place the line and do all the paper work, wait on cxr verification, ect. associated with it. I have only recently started talking to my unit manager about compensation for picc line placement but doubt it will happen due to one or two nurses who are willing to come in on there days off or dont mind handing over there pt load for a couple hours to go to the floor to complete the insertion for no extra pay. I respect there diligence but believe that Picc line placement is an advAnced skill for an RN and therefore should be compensated as such. Until my facility agrees to start compensating me for PICC line placement, i have decided not to place them anymore and will refer the request to the nurses who dont mind practicing the advanced tech and accepting the responsibility that comes with it for NO extra pay..... Ok i guess i'll get off my soapbox now. Sorry for the rant.

Nurses Rock!!

I'm not sure about Florida but im in Texas and we definately do all those things. I would imagine that you would hear the same from nurses in Florida or just about anywhere else for that matter. As much as we may all wish otherwise it's simply part of the job.

Although I appreciate a response to my question, I have to admit that I am rather offened by your tone and implications of my ER nursing background I was seeking some supportive advice about a patients situation, not an assesment of my nursing skills. I'll start by saying I'm truely sorry that you took my comment about your ER background out of context. You said that you had recently transfered from ER to CCU and gave no indication that you had a proper orientation/preceptorship. I've been in facilities that have put nurses in situations that they were not ready to handle and put the nurse and the pt at risk in doing so. Seeing as how this was not the case in your circumstance, you could have disregarded the comment as it did not pertain to you. I'm sure your ER experience has proven invaluable in your transition to becoming a CCU nurse and will continue to be. In reading your post i wrongly jumped to the conclusion that you were yet another unfortunate nurse who had been thrown into something they were not ready for. Again, i apologize. Also you did not say that you had already tanked up the pt with volume and did not give a CVP in the initial post to indicate that you may have done so. I was going off of the limited information that i did have and did not mean to sound judgemental but was in my own way offering the supportive advice you were looking for. Sorry if i offended you. As far as the questions asking why volume would increase SVR, I would refer you to aCRNAhopeful's post as his explanation is dead on. I have personally seen this work time and time again. Great post on vasoplegic syndrome!! I definately intend to do some reading up on it.

Hello Melissa, I've been a CVICU/MICU nurse for 5 years now and have recovered my share of post cabg pts. I've had the same problem from time to time but must admit i've never had an svr in the 200's. I like to keep mine between 800-1400. In reference to SVR, I generaly stick with the old saying High is Tight and Low is Loose. Two ways to increase your SVR are: 1. increase volume and/or 2. increase vascular squeeze. Since you were low it would appear that you were loose. Seeing as how you had the pt on a substantial amount of pressors and inotropes I'm willing to bet that what you needed was volume. What was your CVP as it is used as an indicator of the pts vascular volume? I generally like to keep my post cabg pt's CVP around 10-12. Now i'll move on to why your blood pressure dropped as your SVR came up. When you squeeze down on your vasculature, your heart has to pump against that squeeze/pressure in the vasculature. My guess is your pts already sick heart could not pump sufficiently against the pressure in the vessels and therefore could not maintain an adequate bp. I'm sure that if you would have opened up a liter or 2 of NS and slowly titrated down the pressors and inatropes as tolerated, you would have seen your SVR and BP come up as well as seen your CO and CI come down a bit to within normal range. You have to think about the whole picture and consider the intire cardiovascular system not just the heart or just the vessels. If you have not yet studied up on preload and afterload, i would recomend doing so. As a side note, I dont mind saying that 3 yrs of ER experience does not qualify you to recover an open heart and your facility should not have put you in that position without having a proper CCU preceptorship and orientation to recovering post CABG pt's. I hope thats not what happened. I wish you luck in your future endeavors and hope this post helped you wrap your mind around the problem a bit. -Altus