cleverusername

My facility has recently started lung transplantation. Post-op pain management consists of an epidural 24 hours out to lower the incidence of epidural hematoma post on pump heparinization. I have read articles (granted small sample size) regarding pre-bipass epidural placement with no increased incidence of hematoma in CABG patients. Do any of you have experience with pre-op epidural placement in patients going on pump? If so, were there any incidents with hematoma? I realize that epidural hematoma is catastophic and reason enough to not "test the waters", but placing an epidural 24 hours after a clam-shell incision is ridiculously painful. It is also a logistical nightmare. I don't know if time on pump is considered in the decision making process. The point is really moot since a process change in a brand new program is not going to happen, I was just wondering for curiousity sake. I already printed the articles and mischieviously left them outside the rooms for the anesthesia providers to peruse. Thanks in advance.

I am currently a Hospice nurse, part time and have been for a little over a year. I work on-call mostly, but fill in with scheduled visits periodically. A nurse certainly needs at least one year of experience before embarking on this important work because you are an island. You need to know your meds, what meds and services are covered, how to qualify patients for hospice care, etc. You need to have great critical thinking skills, which goes without saying for any field of nursing. Many of the rules are state specific. You need to be 100% confident in your assessment skills and know major disease processes and progressions inside and out because you are the sole source of information for many of these families. Physicians fix things and by the time they qualify patients for hospice care are generally at their wits end and put the patient through many treatments that have weakened these patients to shells of their former selves. Families are generally just tired by this point. The flip side is that by the time of terminal diagnosis it is too late to attempt these aggressive treatments, so the physician qualifies the patient, but doesn't explain what to expect. Granted this is a sweeping generality and I am not anti-physician at all. In fact, in my area oncologists are qualifying patients for hospice care, specifically my hospice, for pain control, then disqualifying them after 60-days for aggressive treatment when pain is managed. This actually makes me happy because we are good at what we do and are being recognized for providing pain management services. Sorry for such a long winded answer, I am actually a full time ICU nurse who moonlights for hospice, so shifting gears is often difficult for me. Good luck in your hospice endeavor.

I recently had a patient who got necrotizing fasciitis from popping a zit on her butt.