ICUPrincessNurse

Strip them. Often.

I've done it both ways. Depending on how much time I have and if I'm giving a free water bolus as well. Neither is wrong. If I'm giving tube feed boluses which is basically almost never I'll use gravity. I've also taken the whole notebook writing thing both ways...as the "nervous need to remember things" kind of way AND the "I'm super litigious and going to sue the pants off all of you" way. Depends on the family!!

Depends. Through a PICC? Sometimes I'll use the pump if it doesn't flow. Mild hypotension/low UOP through a well flowing PIV or CVC? Gravity. Legit hypotension/code? Pressure bag. Code/trauma/bad GI bleed? Level I transfuser.

I was typing mine out. Then read the above. So yeah. What he said. There's something magical about a pH of 7.2 that seems to magically make meds work.

I'm mostly hoping the vasoactives are going through a CVC and not a PIV!!! I flush my PIVs and any ports on my CVC that I'm not currently using. If I have a drip running through it and my pump isn't beeping because flow is occluded- I let it go (Let it go...can't hold it back anymore...)!

I loathe DNI most of all when it comes to a code situation. We'll do Bi-Pap like whoa to try to avoid intubation but we try to be pretty clear to the patients/families that insist on full code but no intubation that in the event of a true cardiac arrest that it is basically impossible to effectively code someone without intubating them and we encourage them to consider what they really want out of a DNR status and what we can do for comfort instead of intubating. It's just a matter of education and expectation management sometimes.

All of our CVICU patients have them. Our MICU and SICU (mostly MICU) will get them if they are worried about Pulm HTN. I've floated them in organ donors before when the choice is "float a swan or go to cath lab" to look at numbers for lung transplant.

Oh. Hail. Naw.

We get "floated" to tele/pcu sometimes but lately our patients have been so sick and there have been so many of them that we've been overflowing ICU patients into PACU so NOOOO ONE has been floated to tele in years I think. But technically...we float there if we are overstaffed and they are short staffed.

Assess, turn, medicate, turn, chart, assess, turn, medicate, (eat????) turn, bathe, assess, turn, scramble, chart, turn. Somewhere in there are trachs, pegs, level 1 infusers, codes, poop, blood, drama, traction, labs, care rounds, labs, meds, daily wake up, codes, chest tubes, emergent "fill in the blank here". it's my favorite!!

My hospital gives a "shift diff" to ED and ICU. Mostly because we had the worst satisfaction scores in the whole hospital!!

When in doubt- record. Gives you a chance to learn the flow of experienced coders and know what comes next. Plus no one ever wants to record. Also...if the room is totally full- don't go in. They have enough people. It's already enough chaos. Check on the other patients in the area. I've walked in on a room where the patient was hypotensive because their levo ran out because that nurse was helping with a code. Plus...I HATE running a code with 87 bajillion people in the room. I can't hear anyone and the process isn't as smooth.

4 weeks once. Very unstable airway in a patient who needed a specially built trach with an extensive history of pulling out his ETT/trachs. Seriously. 4 weeks. He got his special airway, woke up and got sent out of the unit. I'm assuming there was quite a bit of muscle weakness. But 4 weeks.

What he said. We've done that in the middle of the night when we couldn't get a hold of the bed. Otherwise...we use the RotoProne pretty much exclusively. What about the RotoProne has been unfeasible for you? We've been pretty successful with them.

It's not unreasonable for a computer to be close by if they're on call covering the unit. When we went all computerized we got multiple computers at each alcove, extra COWs and extra desktops all over the place. They should understand that if they're on call for the ICU a computer should be close. Plus, theoretically, if your patient is sick enough to need 3 boluses and a levo gtt- your resident should be close. Like, at the bedside close. That said...We have a few attendings who still dictate their notes on principal and whom I'm certain are physically unable to enter an order. I'm not saying they get TORB'd a lot....but. For the most part though...these guys are rounding with residents who put in the orders and it's basically a non issue.

We use vigileos often. It's part of our sepsis protocol to insert a presept catheter and monitor ScVO2 on them. Usually they end up with an a-line and we flo-trac that right on into our vigileo. We also use them on a lot of our sick traumas, sick patients in general and any trauma in the elderly who end up with an a-line (no a-line elderly traumas get the Bio-Z for non-invasive CO monitoring). It is my understanding that the SVV is the only parameter affected by arrhythmias. For what it's worth...your SVV is also really most reliable if your patient is passive on the vent and on a high tidal volume positive pressure ventilation. One of our attendings will have us give a patient some one time doses of fentanyl, versed and vex (vented patients only, obvi) and then come to the bedside with the whole MICU team and do teaching on fluid responsiveness as far as passive leg raise (watch your CO and SV there) as well as SVV and it's uses. Super interesting to watch. So your buddy that is a POD#1 exutbated CABG that you're about to go walk....don't put all of your fluid responsiveness eggs in your SVV basket. Look at the other parameters as well. I've seen physicians give orders to bolus until the SVV is With a good waveform and within the parameters of a passive on the vent, high Vt PPV, sinus rhythm...it can be VERY useful. But they're fairly restrictive guidelines.

This. This is exactly what we do. We have the order to cover us but really...we do what we want. They're coding? Levo doubles. Triples maybe. Maybe gets maxed out. If it's that bad...we honey badger it.

It is what it is...sometimes you have to leave your patient. I always try to make sure that I leave my patient as low maintenance as possible. Bags full, calm, comfortable, clean. If the nurse nearest to me isn't my most trusted neighbor I'll ask another nurse or two to keep a "fuzzy ear" out for alarms and make sure they know DNR status. I always make sure my hall leads (36 beds, 2 18 bed halls means we get a team leader and two resource nurses- one for each hall) and team leads know I'm going as well (unless they're going with me). Usually it's okay. I'm super lucky that my unit has AMAZING team work. I've left the unit for 5 hours before (worst. TIPS. ever.) and my patient was charted on, my I&Os were done, my meds were up to date. It also helps if you're helpful. Lesson I've learned the hard way.

I use it on both all the time.

I usually do mine first thing in the morning, as do most nurses I work with. There are a few patients that I'll wait for clarification from the docs because for whatever reason I feel like a sedation vacation might not be the best thing for the patient (ARDS, vent dysynchrony, just last week it was a possible traumatic diaphragm rupture, bad head injuries, status). But for the most part...Off with my morning assessment. Usually our patients on drips usually have some PRN available for breakthrough so a lot of times what I'll do is grab a PRN and keep it with me so that I have it available if the patient ends up going crazy.

One of our trauma surgeons holds that belief and is VERY vocal about it. On my very first day in the unit (straight out of nursing school, BTDubs) he told me I didn't belong there and should go work med-surg to learn assessment skills and that I'd need to do a lot of reading. He was so rude his intern came and apologized to me later. I asked him what he thought I needed to read (Marino by the way...ICU Book) and now I'm one of his favorite nurses and we're pretty good friends AND he told his residents I was smart once - I almost fell down from standing. Then reminded him of the day he told me I shouldn't be there.

Your I-stat must be different than mine because my immediate thought is "in your hands". Ours is not terribly much larger than our blood sugar machines, which is to say- not large at all.

I'll use mine as a timer for heparin gtt timed titrations (like, turn it off for 30 minutes and then restart at 2 units/kg/hr less than previous dose). I also use mine alllllll the time for CRRT calculations- easier to use for me than the computer calculator. I also use mine to text our CV surgeons. It is their preferred method of being reached and super easy. Otherwise, on silent, in my pocket. Except for bathtime tunes. Everyone needs a dance party during bath time.

Our policy is nothing over the phone aside from a "yes they're here, yes they're stable" (or yes they're here and you need to come NOW). I tell families from the get go that they're really only going to get information in person or if I call them and that the family needs to pick a point person then that all information filters through. If the patient is awake and talking (and then likely waiting for a tele bed) I transfer that call right on into the patient room!!!!

We have a two day class for CRRT. It covers set up, modes, charting, I/Os and flow setting- the whole shebang. Then at least 4 hours with a CRRT provider to make sure we understand what we're doing in a practical setting. In our unit there are only a specific set of CRRT providers. We've all been on the unit at least two years and have shown critical thinking skills and the ability to manage the sickest of the sick patients well. Same with IABP.