SWAT_RN

Someone help me understand this please! We are to follow the "new" maximal barrier precautions when inserting PICCs, full sterile head to toe drape for the pt., sterile gown, gloves, head cover and mask for the person placing the line. And we thought and were told we were wrong, that the second person (our circulator, per se) was fine with a head cover and mask since they often need to assist with pt. positioning, comfort and "gofering" prn. No, the ptb say that second person also must wear a sterile gown and gloves. And if they need to move the pt., touch the pt. or gofer stuff, then they must change out gloves. Now, in OR, in the cath lab this isn't happening. We still have a scrub (sterile) and a circulator (clean). Why the double standard? Add to this that most of these placements are done at bedside with the typical beside traffice and clutter to contend with. Thanks in advance!

I have a son with ASD. Please demand that your congressperson support insurance parity bills which are pending in many states. Currently many of we working parents with insurance cannot afford to pay for the therapies that our children need. For example, my medical insurance company classifies autism as a mental illness...idiots! And as such, they will not pay for ABA, OT and so on, because "the need of service is not a result of an illness or injury". Sometimes I wonder why I work. There is no help in my area for a working family with an autistic child, he would get help if we were on welfare, Medicaid pays for therapy. Something is very wrong here...

I was taught to find the vein with US and mark the skin, then measure from the mark to the shoulder, then to MCL, then to the 3rd ICS. I've had the opportunity to assist with PICCs placed under fluro and I lust after that kind of accuracy!:bowingpur

Yeah I have that sign too, but still have problems with people coming in. I think I need a shotgun, or a loaded saline syringe...maybe I could shoot all tresspassers on sight...LOL!

We no longer change caps after draws, have studies to support this practice. We use positive displacement caps and flush with 20ml non preserved saline after blood draws.

I understand the push toward maximum barrier use when inserting PICC lines (and other CVADs). Our IC nurse insists that I use a drape that will cover the pt. from head to toe, exposing only the small area needed to insert the PICC. I have been using the Maximum Barrier Kit from Bard, but she doesn't think that's good enough. The gown, gloves, mask (for pt. and me) and cap were being done already. Also, do you place PICCs at the bedside? If so, how do you deal with traffic in and out of the room? I find it odd that we fixate on draping the entire pt. but allow the procedure to take place in a semi private room and/or have the usual hospital traffic in and out (Oh, sorry I'll only be a minute..etc.). If you don't place at bedside, where do you place them? In my perfect world, I have a procedure room with all my supplies and equipment, no interuptions and an extra set of hands...LOL!

Hi everyone, I wanted to ask for any pointers in measuring a pt. for a PICC. We use Bard caths which are trimmed at the distal end, so once it's in, it's in. It seems that my insertions are like the 3 bears...first one is too long, second is too short and third is just right....LOL. I want to be more consistant with my tip placement. Help all you old pros! Thanks!

Where I work both bullies and whiners succeed. Closely following that are the brown nosers. It amazes me that those kinds of behaviors are rewarded.

I absolutely know that the alcohol gel ate the skin under my wedding band. I had blisters and actually denuded the area under my ring. When I approached my manager at the time about any alternate sanitizers, etc. she said, "maybe you shouldn't wear the ring". Plain gold band, my wedding ring and to me not wearing it is not an option. So I refuse to use that evil gel, back to soap and water. Joint Commission can kiss my...uh..blistered, peeling hands.:angryfire

Hi all, I've been under tons of stress the past 6 months. Problems with hubby, kids, ex...and more. Been seeing a counselor who is gently prodding me to consider meds, specifically sleepers. I don't sleep well at all, maybe an hour or two, then I'm up and tossing and turning, might sleep another hour or two. I can't remember the last time I slept all night. Anyway, I'm reluctant to ask my doc for anything, don't know how it would affect me the following day. Anyone with any experience or suggestions?

I personally have very thin nails, they split and peel and curl up on the edges. They look and feel awful. I've tried all kinds of "treatments" without much sucess. And I work in a "no fake nails" policy place, therefore my split, peeling and bloody mess is what I have. Once upon a time I had falsies (LOL) and kept them up weekly, they were short and smooth and always clean. Even with the dirty nail horror stories, I know they were cleaner with washing and glove wearing than those people who don't wash, now that's gross! Ah well.

In all honesty, knowing then what I know now...probably not. What would I do instead? Maybe information technology, or business. Something that would have allowed me to make and keep a decent living and a family life. I wish I had back all the missed school events and kid's milestones. On the other hand they say the devil you know is better than the devil you don't. I make a decent wage, have no say in my life at work, and am at the mercy of a mangament team who imho in woefully out of touch. As long as I'm a Stepford Nurse, I should be safe. Maybe I'm really tired today and need a vacation. Unfortunately, I can't afford to take one.

Some of the smaller hosp. have loan repayment options, you sign on, they pay off your loans. It's a good deal unless you need to be in a big pond.

I've found that sometimes when the wire gets snagged up, the problem is the wire itself and not the needle or anything you are doing. Try a good quality floppy tipped wire, like a Nitinol and see if that doesn't solve your snagging issues. I was a doubting Thomas myself until I used a few, now I hate not to use a Nitinol, no more getting the wire snarled and having to pull out the wire and needle too, that always fried my fanny. Good luck!

Several year ago while working in our ED, call came in from one of the local EMS. One of the audience at a very large, outdoor country music festival was in full arrest. OK, we got ready and were standing at the squad doors when they unloaded the pt. Watching the medics roll the pt. in, we decided they must be doing excellent CPR cause the guy's color was great. He was hustled into the trauma room, EMS doing CPR, and we began to assess the pt. Anyone arriving in that condition gets stripped immediately, so we relieved the gentleman of his only clothing item, his shorts...as two of us deftly yanked them off, ice flung forth from his uh...southern hemisphere and all over the trauma room floor. Since noone at this point was physically able to do CPR the doc checked the pt's. ABCs and lo and behold our full arrest pt. was mearly dead drunk. His pals found him passed out, emptied their cooler down his shorts and when that didn't revive him, they summond the EMS. The rest is history. The squad got a lesson in assessment once the doc regained his composure. We learned how to hold ice capades in the trauma room. Gotta love ETOH!