SLP12

MD pulls the balloon and sheath and applies pressure and the nurse takes over and holds in for at least 30 minutes. At our facility we need an MD order to use the femstop or anything aside from manual pressure.

So I just began working in the CVICU about a month ago. One of the cardiologists newer to the facility came to remove the IABP of one of my pts. Me and my preceptor attempted to stop him d/t the Heparin gtt that was still going. HOWEVER, he went ahead to try and do it because he says he pulls the balloon THROUGH the sheath and leaves the sheath in for a couple hours. Now from my understanding, that increases the risk for a clot to dislodge by forcing the balloon (that could have small clots attached) through the sheath. My preceptor tried explaining this and even got a clinical leader to come speak with him AND had him speak on the phone to one of our cardiothoracic surgeons. All of the consulted people said that it was not the way it should be done. The cardiologist said he had done it that way several times and went ahead and pulled it leaving the sheath in!!! Later, we called the Datascope company and they gave us the same info that the balloon should be pulled with the sheath and for the same reason in which we had said. Do any of you know of any other cardiologists that pull IABPs with this technique? Also, how long do you all leave the heparin off before pulling the sheath normally?

From my experience, the new grad residencies accept very limited number into the ICUs and yes, most ICUs PREFER 1-2 years ICU experience when looking for new hires. However, it can be hard for units to find nurses applying with critical care experience, so it may just take right timing and finding the right place in need that would be willing to orient you to critical care. I have worked on a medical/oncology floor for 2 years and just now started a new job in a CVICU. When interviewing, they had said that obviously if someone was interviewing that had ICU experience they would be obligated to give them the position. BUT they also said that those are sometimes hard to come by. Many people in CVICUs end up leaving to go to CRNA school and use CVICU experience as a bridge to get there. So there is a constant change in employment needs in these areas. Honestly, I would 100% reccommend getting your med/surg experience first before jumping into critical care. It will get you familiar and comfortable with your basic skills, intuitions, and nursing care. I'm overwhelmed going into the ICU and have been working as an RN for two years. I cannot imagine going straight in after school. Plus, the management that you will learn working med/surg is necessary! Just because you work in critical care, does not mean you will not get pulled to other floors when there is need!! Some nurses that were pulled from ICU that have never worked anywhere BUT ICU, DROWNED with the change in pt load. Think about it....going from 1-2 pts to 5-7 pts?! Less critical, but a lot to handle especially without the management skills that you acquire working med/surg. I hope this helps a little! Good luck!