Gail-Anne

Are there any nurse advice phone lines where you are? Our province started one a couple of years ago. It's a job where you actually give advice (eg. get to emerg! or suggestions for what they can do themselves) not paper shuffle. How about your state registration board? I assume nurses evaluate whether or not someone can be registered, answer questions, evaluate compliants about nurses. Of course, there's always the good old Dr office or admin. Good luck with those knees.

Yes, you can draw labs from a "port-a-cath", same as any central line. It's also fine to leave a port with an Infusor cap between meds, it doesn't have to be left running (if that was your question). Your facility should have policies for all that stuff. Not sure what are you asking about Vanco?

yes, there are safety hubers, my facility is just looking into them so can't give any hints. Just google and you should get company sites up. What I've taught people to do is think "reverse karate"! Hold site firmly and pull up firmly with other hand ( this is where the karate...Ah-yah sound and follow-thru motion comes in!) I expect the needle to be about a foot above the pt where it won't hit nurse or pt, easy to assess that it came out intact. No *****-footing around! Hope that helps until your facility gets safety hubers....push for them, occupational health should get involved if the powers that be are stalling.

Have you looked into what will be required to work in Ireland, if that's your goal? I guess I don't see any sense in doing a course if it's not going to give you employment. (or the Irish equivalent of a green cerd)

HOLY *&%$#@* BATMAN! I would never have reinserted this PICC, regardless of what the Dr said. This is totally against any and all that I've ever read. Even doing a change of PICC (wire-reintroducer over-then reinsert new PICC) is an iffy thing to do. I've always pulled the PICC and started from scratch,one time was on someone with breast cancer, so only one arm to use and only one good vein. I'd say there is cause for a lawer making $$$ here. However, an infection from line insertion usually shows in 2 days, after that it's a usage of the line issue. This makes the time-line interesting. I'd be interested to hear the results of this.

We require consents and I can't see that ever changing. Basic consent to be treated in hospital is fine for the basics (like a peripheral IV) not for invasive proceedures. What do the risk management folks at your institution have to say about this?

I'd probably be querying more if pt had heparin in one and platelets in the other! Remember, the 1/2 life of Heparin is about 5-6 hrs. (I used to know the time for sure...memory isn't what it used to be). I'm wondering if your question had more to do with compatibility? If so, general rule of thumb is anything is compatible once mixed with blood, that's why you can have 2 IVs along same vein tracks if necessary. One note of caution re: 2 IVs though.... If running a couple of units of blood (not talking about an actively bleeding person here) and person is on regular IV of, say, 1000ml/hr, turn the IV down. I've been to cardiac arrests on elderly people who were put into CHF getting their hgb topped up after surgery. We didn't have to think of this before pca pumps, as IV fld was stopped and blood hung, now we need that 2nd IV and it's an easy thing to not think of on a busy day.

Totally acceptable to have your questions written down so you remember them and to write BRIEF notes. Just make sure you spend your time making contact with the interviewer not with your paper! If possible, I'd try to do most of my note taking after leaving the interview and only jot down one or two things while with the person. You can also say that you prepared a few questions (after they have finished questioning you), then refer to your paper. Good luck.

Having called codes (2 as a student nurse), going to many codes and spending many years as a volunteer CPR instructor, I thought I'd put my $.02 in. Do we sometimes flog the perverbial dead horse? Oh Yeah. Do we sometimes revive someone who goes on to live a great life? Oh yeah. Do we sometimes just give a bit of time, allowing family to say goodbye? Oh yeah. Many years ago I was at a CPR conference where one of the talks was on the miracle of CPR. A little bit later I had a great example of that. My exhubby and I were teaching CPR for a highschool teacher ( phys-ed class Grade 11/12) every semester. I got a call from her "Know what some of my students did on the weekend?" I said no, drugs? (okay, I have a perverted sense of humor) "They did CPR!" 3, 16-17 yr old boys are out somewhere when the Grandma, in the family in front of them, collapses. One ran for the phone to call 911, one started CPR, the other looked after the family. Grandma stayed dead. By Monday, the family had contacted the boys school, and the newspaper and written all 3 boys letters of thanks (the police had attended the scene and they got the info from them). The boy who ran for the phone hadn't been in her class yet but was going around the school saying everyone should try to get her as a teacher so they could learn CPR! So 3 teenagers made a decision that they would be good citizens in society and help others. That's the miracle of bystander CPR.

There are loads and loads of tips on threads, just do a search. Take home a stretch of IV tubing and a few IV needles and start kits. (Get your boss to okay this, as you don't want to be accused of stealing needles!) Tape the tubing to the counter or table at home (tape lengthwise, 8 inches or so of tubing), set up your supplies and insert IVs in it, even lay out a tournique across the top and pretend to put it on and take it off. I know it sounds hokey but I've taught many people to start IV's. Getting the movements (by the way---you're not bracing the vein well enough!) down pat without anyone around really helps. Actually brace like you really would, figure out how to get your thumb out of the way and still put a tug on the vein. Practice putting a tournique on people and pick out a vein and brace it. Then get a calm person to go with you to insert on people. Sometimes you need to take a break and not even try for awhile. Good luck.

Lots of years since I worked psych... what kind of people in the group? We always had a variety of groups. Something as simple as "activities of daily living" for example. It's amazing how many people don't know how to read clothing labels and do laundry, teens may not understand finances and how to keep track of their money. Manners and how to behave applying for a job (can get role playing going---get a teen to be the "suit" and you be the gum chewing, foul-mouthed kid and see if they'd hire you!) Not all groups have to be about dealing with your mental state. Sometimes these other groups get people talking.

Are you inserting on babies only, or did you get a chance to do quite a few adults first? And how many insertions did you do with a mentor? Any particular point of insertion that seems to be the failure point? That would help for giving you advice. What proceedure are you using ( I assume Modified Seldinger), are you using ultrasound? Using straight needle or an IV catheter to get the vein? If you can give more info, please do. Maybe I or one of the other PICC people can give some specific advice then.

Now that I'm old it doesn't happen... not to say people take me seriously now, but at least it's not because I look young. Used to happen all the time! I had pts think I was a first year student, loved to scare them, telling them I was in charge! You need to learn to be assertive, if you aren't already. I had a situation where I was discussing with a Dr, another nurse came up and put in her 2 cents worth, the Dr turned and started taking with her (ignoring me)...she wasn't even there when the incident we were discussing happened/ wasn't the pts nurse. Actually she wasn't even an older nurse-just looked like it! I had to excuse her and get the Dr attention back. That's just one example. Most of the time I could take it with a sense of humour, when not being listened to though, it is irksome. Only advice is to make sure you aren't dressing like a 15 yr old and practice professional opening lines. Good luck

I agree with the last posts. Whats so wrong with feeling stupid anyway? You are new at this. I'm concerned that you are creating a self-fullfilling-prophecy, you think you'll screw-up, so you do. Try getting someone to help you with a standard daily worksheet. A place for timed procedures, priority stuff etc. Keep it simple enough that it's a quick referance through the day. Are you taking your breaks? Often nurses who feel slow or disorganized don't feel they can take a break, yet they are the ones who need it the most. Even a quick second in the bathroom, taking a deep breath, can get your brain back on track. Good luck.

I think that flushing with the syringe sanwich method is best, as was just said. Saline-med-saline, even though you saline flushed from a bag. The syringe flush gives a more turbulant flush as well as cleaning out the port. Sometimes, if meds are very incompatible (eg Dilantin ) we'll suggest a seperate IV line, then you can unhook and hook-up again at the extension site close to the pt. I think you did well to realize you had a problem right away.