cdash724

I work in a CVICU and don't see these that often but just had a patient today where it was ordered for q6hr IAPs via their foley catheter. I personally had never done them before and when I was getting report the night RN was explaining how to do it and said they'd been injecting AIR into the bladder. I questioned this and apparently the vascular fellow originally told the previous day RN to do this...and they did it without question. I looked up the proper procedure for this monitoring and air wasn't mentioned in any way. My concern is what consequences does this have on the patient, if any? My thinking is that the air they were injecting (oh, 60ccs by the way rather than the 30cc of NS) could cause bladder spasms and possibly make its way to the kidneys and end up causing an air embolus somehow. With that injected air naturally rising to the top of their bladder and the foley catheter sitting on the bottom, short of tipping the patient on their head how could I ensure that the air is removed? Does anyone have any insight into this? The patient ultimately received three, if not more, injections of 60cc of air through the catheter...His readings were 13 this am, 16 this afternoon and he'd been complaining of 'tightness' through his abdomen the whole day as well as backpain (he'd originally been transferred to us for a leaking turned ruptured aneurysm so he does have blood in his retroperotoneum & chronic back pains which he takes massive amounts of pain meds for). As of shift change, the vasc fellow had ordered for an NGT->LWS to decompress him because the patient felt as though he couldn't even take another sip of water he was so 'full'.

Everyone goes through what you're feeling right now. We've all been there, believe it or not. My advice to you would be never forget that fear. I've been an RN for 4 years in a CVICU, which is where I started fresh out of school, and I was scared, nervous, and anxious on my first day of orientation. Although those feelings will subside some, I felt as though I didn't truly feel 'comfortable' as an RN until after 2 years of working fulltime but the feelings you're having are GOOD-you realize what an immense responsiblity you hold in your (soon to be) profession and that'll help you to not make careless mistakes. Here's a little advice. If you don't know something (a surgical procedure, technique, skill, med, etc), ASK or LOOK IT UP! Coworkers will respect you more when you admit you're not a 'know it all' right out of school. We KNOW you don't know, so don't act. It ruins whatever trust/relationship you're trying to build as a newbie with your coworkers. Another thing is HAVE COMMON SENSE! I know this isn't something you can necessarily learn, but if you're the type to just blurt things out before thinking things through, SLOW DOWN and think about it. I once had a student tell me that we weren't finding pulses on my patient because it was caused by a DVT... BE HELPFUL! In the ICU where I work, we all help each other out immensely and there will ALWAYS be someone you can go to for help whether it be a coworker, charge, resource, etc. Whatever orientation you get, TAKE ADVANTAGE of it, utilize your resources, see what classes/learning opportunities are available to you through your hospital and GO TO THEM. As nurses, we are always learning no matter how long we've been in the profession. Congratulations on your upcoming graduation this summer and you'll be FINE!! I'm sure you'll have some days that'll make you question why you went into nursing in the first place and you'll also have amazing days that leave you feeling on top of the world. Just remember to BREATHE and take it one day at a time. Before you know it you'll be giving advice to new nurses about to graduate...