bobnurse

Hi, Needing help. Patients with colonized MDRO's such as MRSA, VRE, ESBL, and etc..... Do you isolate (Contact precautions). We isolate (contact) for all MDRO's, c-diff, acinetobacter, ESBL's and etc....I have seen facilities in other states only provide standard precautions for colonized patients. So....what is the current recommendations and can you provide a link so i can use it for reference. I have looked at CDC and it states contact precautions. also, if you have a sample policy that i could review. We are a semiprivate 31 bed specialty hospital and are bedlocked at a census of 23 d/t colonized MDRO's. So i am looking to see if we are right in our current practice of Contact Precautions for everyone or if Standard is ok for colonization. Thanks for your help.

For those who have graduated from the Platt RN program, what are your BSN options. I know they have a BSN program now, but what are the other options. I know U of Phoenix is an option, but do any in-state colleges accept platt graduates. I know they are not accredited, but what if you were to take or have taken all your pre-req from an accredited college. Thanks for your replies.

Hi, One way is to submit through your board of nursing for CEU's. The AHA does not provide CEU's. Also if you have a good relationship with a ANCC CEU Provider, they can award your classes CEU's. There is some paperwork involved, but not to difficult. You can get this info from the ANCC. Most of your larger hospitals are able to do this. If you have any other questions, let me know. Bobnurse

I have been contacted to place piccs at a couple of smaller facilities. I am curious as to how much you bill the facility to place the line. If those of you out there would feel comfortable giving me a ball park figure i would appreciate it. I dont want to charge to much or to little. You can PM me if you dont want it posted. Thanks

Looping IV tubing is simply bad practice. THe problem with it is most nurses dont swab the port before attaching the end of the tubing into the port. This contaminates the tubing. Now if your changing your tubing every 72 or 96 hours,, you have contaminated tubing sitting there being used over and over, becoming recontaminated after each use. We had a BSI issue a year ago or so, and one of the few changes we implemented was the ban of looping IV tubing. We made readily available sterile syringe caps or the nurses could also take the cap off of the flush syringe and attach it to the end of the tubing. Once this practice was established, we went almost a year without a CRBSI. My opinion and my opinion only....

Sounds like fibrin and possibly biofilm build up. IF you go to the cathflo website, they have a pretty good base of education, powerpoints and so forth that describe this. I also agree with the above poster that the line should have been fixed or removed. Occluded lines lead to infection.

Im just curious reading this as we might look at the possibility of the PICC nurses providing a initial read of the xray and the radiologist will read it at a later time (hours later) to confirm tip placement. Does anyone know if the Infusion Nurses Society addresses this within their practice? Does anyone have a policy that they might like to share that allows this and what do you do for competency for the RN who will be providing the initial read. You can PM me if you'd like. THanks

I personally feel that all infusions should be administered via pump through picc lines. Just think about it. Your administering blood through a picc and the flow is decreased...Patient coughs, tubing kinked or some other external/internal force. There is no alarm to tell you this. So you come to check on the patient and find that the picc is now clotted up. Same thing with drugs, dextrose, lipids, or precipitates will build up in the line and cause occlusions. Just my 2 cents, but i think it will extend the dwell times of your piccs by using pumps.

Hi, Ive been reading about using Ethanol for declotting lines with lipids. Is anyone doing this out there and where do you get the ethanol? Thanks

I personally dont see why we dont train the students. I think it would be a great idea to incorporate CPR into the school system. The AHA has a CPR in Schools program.

Hi, We routinely give bicarb when indicated. I have never heard otherwise. Not sure why there seems to be so much concern about hanging bicarb or magnesium? I guess you might look at the indications for administration. Like in a code or prearrest situation, are you ACLS? Also, you have not indicated your level of licensure. That can make a difference as well in many states/hospitals.

I dont have a link. I am a BLS Instructor and was going to help with providing free Heartsaver CPR for the teachers. I am sure you can do a search on it. I can pm you the city where it happened if you want. On a side note, i can tell you that i dont think its a lack of cpr instructors, but a lack in the budget. They still have to pay the teachers to attend the classes (workshop). I have heard this as to the reason why they arent offering it/or werent offering it at the schools. Its odd that in our state daycares are required to have cpr/first aid but not schools/teachers.

About 5 or 6 years ago in oklahoma a child died in the early morning d/t choking on her breakfast. The teachers were not BLS trained and stood there and waited for EMS/Fire to arrive. The child did not make it. This made the news and was a pretty big thing, but as you can see, it did very little as far as requiring BLS/First Aid training for teachers.

No, you are not suppose to hit their back. You could cause further airway compromise. If they are coughing, then their airway is open and they most likely will be able to clear their own airway. Back blows will do nothing for wheezing.........

Hi, I was told that some states allow trained RN's to place central lines. I am not referring to PICC Lines, but either subclavian or internal jugular placement. I have not heard this, but was wondering if there are RN's placing these out the Thanks for your replies.

what i dislike is those that wear tshirts that hang 3-4 inches outside their scrub shirt. Why not tuck it in.

Hi, Will be taking the TNCC at the end of next month. Was wondering if anyone can give me an idea of what i'll be up against/what to expect. Ive done a search and have read that its not to hard or its hard and intense and a good class and so forth. Im more interested in the course breakdown. The good, the bad, and the ugly. Thanks for your answers and replies.

I wonder what type of training if any this charge nurse has recieved on handling difficult situations such as this. I would think she has a good case for wrongful termination. I think she was tired of nothing being done and did not call security because it has been done time after time with no resolve. I have not read this whole thread but wonder what kind of hospital/facility it was. It seems the nurse took it upon herself to "Show" the family member that she cannot treat them like that. I do believe she acted inappropriately by calling the police before internal security. I also believe the hospital/administrative staff was negligent by placing the staff at risk for violence, whether physical, mental and/or verbal. I hope she fights back and wins.

hi bob, thanks for the info. i have a few more questions. you stated that you are affiliated with a training center. does this mean that you work for a training facililty and also have your own business teaching acls? i am afiliated with a training center. i have my own training site which functions independantly with oversight from the training center. i report my numbers to them who in turn report them to the aha. i do not work for the hospital that is the training center. i have developed a good relationship with them though. does the training center find your clients? no. well occassionally they will refer outside people to me that are looking for a class, but overall, they have very little to do with me. what are the benefits of being associated with a training center opposed to having your own site? i have my own training site. the aha would not allow me to become a training center at the time because of the proximety of my business to this hospital. i have not persued becoming a training center because my site functions pretty similiar to a training center. what are your thoughts about marketing the bls/acls classes yourself and teaching the classes at your own site? i dont do much bls because the profit is not there. i do mostly acls. marketing has done some good, but i have found word of mouth a much better marketing campaign. if you put on a quality class, the word will get around. what are the requirements for bls it. does this mean that you can train people to be aha instructors? i can train bls instructors and have 10 that i oversee. i also do bls instructor courses for the public, in which they have to align themselves with a training site/center. as an acls instructor from aha are you allowed to teach this class in different areas( counties, cities, states?) does this require approval from aha? i teach all around the state. it does not require approval. from my understanding, you are only allowed to teach in the state your training center is located. you can align with a training site/center in another state, but will be teaching under them in that state. bob, how often do you teach the acls classes? do you do this full time? business varies, but in jan-may i was doing a class a week. june i only did 2 and july 1. it slows down a bit during the summer, but picks up in the fall. i have a full time job, so i dont teach full time. i guess i could if i really wanted to, and its a future plan of mine. i dont do much cpr and have had many offers to do so. do you teach other things besides bls/acls, such as ekg interpretation? i teach basic, advanced and 12 lead ekg interpretation. i also teach basic and advanced airway management. occasionally i'll do a iv course, picc line course and so forth. i ocassionally do first aid and aed courses as well. i look to doing phtls, amls, pals, and others in the near future. how long have you been teaching acls? since 1999 do you enjoy what you do? very much so. how profitable is this type of business or what is the potential profit for this type of business? it can be very profitable. probably will depend on your location and population. with the hospitals cutting back on education, there is a demand. i also sell study guides, crash cart cards and so forth. i sell other educational products, like train the trainer and so forth. my goal is for this to be a full time job by the end of 2009. thanks again bob. i appreciate all your help and suggestions. let me know if you have any other questions. kevin

Hi, I currently teach acls as a business. I do not know if i can link my website here or not, so i'll err on the side of caution. Problems? Not any i can think of. Equipment/manikins purchase might be your only problem as far as start up cost. I purchased most of mine off of ebay for a significant savings. You do not need any approval from the AHA. I have my own training site and im affiliated with a training center. They have monitored my courses and have allowed me to function on my own. I just report numbers to them as requested. I have no oversight and function independantly. I have many instructors afiliated with my training site/training center. Im also a BLS IT which is now called Training Center Faculty. Im looking to soon become a regional faculty to do ACLS instructor. They are a little more strict with ACLS compared to BLS and First Aid. I think this is why many go the ASHI route for ACLS and PALS. ASHI = American Safety and Health Institute. Let me know if you have any questions.

Any new thoughts?

Our ID docs have asked if a coated PICC Line exists. When we tell them no, they say there should be. I just saw that there are antibacterial injection caps. I am sure with the increased picc usage, coated cathters will soon be widely available. With the medicare you cause it you pay for it changes, they will do anything to decrease CRBSI's.

i asked this question a while back and got this response. it is never a nurse's responsibility to obtain consent. "obtaining consent" implies informed consent. "informed consent" means that the patient has been educated regarding risks/beneifits of the procedure. only a physician can give risks/benefits conseling. this is not something that can be delegated. this is not only a state regulation in most states -- including the one i practice in -- but it is also a cms regulation. where consents are concerned, the nurse's responsibility is to witness the consent, and to check with the patient if there is any other info they need before signing. it doesn't matter that the picc is being placed by a nurse. it it still ordered by the physician, and it is the physician's responsibility to do the risk/benefit education. the facility i worked at got "around" this (since we all know that a doc isn't going to come in and give that risk/benefit education, even if they knew what the risks/benefits of a picc were :) ), by having one of the interventional radiologists create a "risk/benefit" education hand-out. hospital legal decided that this was good enough to stand in for the physician-provided risks/benefits counseling. so, once the patient/family reads this, they are able to sign the consent and the nurse can wittness it. (by the way, we [the picc nurses] were not allowed to wittness the consents; it had to be the bedside nurse). the regulations do not say that only a physician can educate about the procedure, only that the risks/benefits counseling must come from a physician. so it is fine for the nurse to answer additional quesitons. however, there were times that i had to refer some patients that had very specific quesitons they wanted answered prior to picc placement, back to their physician before i placed the picc.

I always thought piccs were indicated versus other cvc's when a patient has a bleeding problem.

EMT-B and paramedic are different, so he would not qualify for the paramedic to RN bridge. I was an army medic as well. I was able to take the CNA test without taking the class. THere was a written and practical. THis was 12 years ago, and i havent heard that its changed, so im sure you can still do this. Personally, if i was you, i would work for a transport or EMSA as an emt-b versus cna. With your experience and training, you'll most certaintly get a job. THe only downfall is the pay with EMSA, but the patient transport companies pay much more. I have heard around the state that both LPN and traditional RN programs have long waits. You could get your paramedic, which will take about the same time as it would to get your LPN, then go the paramedic to RN route (10 months more). You'll have another credential, RN, NREMT-P versus just RN. It will help if you want to stay in Emergency/Critical Care. Good Luck Bro and make it back safe.