maloneys

Hi everyone! I could really use some help here. Pt had a 16 gauge, jugular IV that was heplocked. In for 4 days, never flushed, nor verified if still venous return. Pt was febrile, and I wanted to d/c it (he had other access). Staff told me I cann...

Hi everyone! I could really use some help here. I posted in this on another forum and haven't received any replies so I'll try here, if that's ok. Pt had a 16 gauge, jugular IV that was heplocked. In for 4 days, never flushed, nor verified if stil...

Thank you for the very helpful feedback and information. We know the 16 gauge is not a central line, in this case, but there was no consistent documentation on when it was inserted, nor on its care. Again, thank you for your help!

Hi Sallyrnrrt, thank you for your thoughtful feedback. Do you trendelenburg the pt when d/c'ing the IJ or EJ IV, you mean? How does this prevent air embolus? Thank you for helping me learn!

Thank you for comments, ArmaniX. Yes, you can have EJ or IJ cannulation. Basically, when protocols are not in place, we want to ensure best practice. Because the 16 gauge periph IV was used, and not a tunneled cath or central line, which we someti...

RNs can remove them, but there are no set guidelines in place. Thank you for your reply!

What are you seeing most for bedside procedures, like intubation? We always used to use succ, along with versed, ketamine, etc. Now am seeing a trend towards etomidate. I'm wondering what others are seeing. I like that etomidate doesn't affect ca...

Hello! I wonder if someone might help here. I work in a med/surg ICU and we monitor telemetries in the hospital as there is no CCU. A post-op cholectomy, 84 years old, not on anticoagulants, with a history of HTN, was on telemetry immediately post...

After about 90 minutes, he went 130-180 and continued til the end of my shift, with me documenting like a madwoman. It was certainly stressful because of , as you stated, I was worried about him really going sour. I would have loved to see his labs...

I agree about not anticoagulating someone who is fresh, post-op. We're talking 6+ hours. However, I mentioned that because of the fast afib. The patient is under cardiology which is why the cardiologist was paged, and not the surgeon. My concern ...

I hope so, Ruby, thank you!

This is an old story, I know, but only now am I experiencing it. I work in a small ICU and only at night when the staff is minimal. 4 nurses for 11 patients and telemetry monitoring. No orderly or extra support staff. We must rely on each other. ...

Thank you, detroitdano. I'll call them tomorrow. So intimidating.

I wonder if someone might help shed some light here. Post-op day 4, abdo abcess drainage patient who went from room air to tachypneic 30-40 and 100% FiO2 over a couple of hours. I did a D-dimer as I suspected a possible PE. Came back 6000. Doc sa...

Hesitation to do a scan was lack of docs to read the scan at night, due to absence of docs. Thank you very much for taking the time to do this teaching! I'm very appreciative.

I agree, prep8611, and I wasn't using the d-dimer to try to diagnose PE, but without a doc available, it is typical for us to do labs following the physical assessment. That way, if we do need to call the doc, he/she has all the stats. I wonder if, ...

Thank you, Juan de la Cruz, for taking the time to answer my questions and for citing those sources. I'm afraid my continued learning is going down the tubes working in a small, peripheral hospital where there are no docs on at night. I appreciate ...

Hmm, thanks for all the wonderful feedback. So in these cases, both patients should have been scanned then! How many days post-op would I expect to see an elevated D-dimer in the absence of liver diseases?

Really, prep8611? I didn't know d-dimers weren't' used anymore! Both patients had pneumatic boots on.

Where I work, it's always 3:1, unfortunately

I had a patient last week who spiked a temp, had a 2 week old triple lumen in her SC. Horrible peripheral access so I took one set of blood cultures from her central line. A colleague said it was invalid (even for query line sepsis) and that we sho...

In my case, my only access was the CVC so that's why I used that. No docs at night in the ICU so fem stick would have been out of the question. I appreciate the feedback. Thank you so much! So if anything, the culture from the TLC might have at le...

Where I work, we have 11 ICU beds, plus we monitor telemetry for the hospital. On the night shift, we are 4 nurses, no orderly, no managers, no secretaries, no body! Plus, if there's a code on one of the other units, ICU answers the code, so 2 nurs...

Hi everyone, can I pick your brain? Last weekend had a post cardiac arrest patient, 59 y.o.man , hx of HTN, afib, back pain, ETOH abuse, cocaine abuse, who arrested at home. When ambulance arrrived he was asystole. Arrived to ER, asystole, CPR don...

Esme, you're a star! Thanks for the teaching/learning, yet again ;-)