LRichardson

We tape our ETT and use a bite block... we tried the holders and had a horrible time doing complete mouth care.. oral secretions were almost impossible to get out.. as well as the slippage that someone mentioned earlier.. We rotate our ETT AT LEAST once every 24 hours.. more often if need be...i agree with the earlier comment.. breakdown seems to occur when we quit paying attention or fail to intervene.. if we have the beginnings of skin breakdown on the upper lip then we tape to the nose for a few days or visa versa.. We normally trach patients between 12 and 15 days..

I'm in Oklahoma City... there is no written policy stating that IABP patients are 1:1... in most cases they are 1:1 but it's not because they are on the balloon pump as much as it is because they are extremely unstable.. however, there are times when another stable patient will be assigned based on the stability of the IABP patient.. in our situation i believe the 1:2 ratio has been fair and safe... I've also seen flexibility in that IF the stable patient or the IABP patient become unstable the assignment will be changed even if it is midshift... to accomodate the accuity of the patient and ensure their safety... i think we get nervous about these types of situations because they're like a slippery slope.. we're used to having 1:1 IABP ... but we recognize there are occassions where we could handle another stable patient.. however.. if we give an inch will they take a mile?? and next week i'll have two unstable IABP?? cuz we all know that when you talk to BUSINESS people about patient acuity they have not a clue.. sigh.. in their minds if you can do it in one case you can do it in ALL cases.. sigh.. hate to beat a dead horse but it still comes down to RESPECTING the PROFESSIONAL opinoin of a qualified, experienced nurse.. trust us to make the best decision for the institution AND the patient.. we CAN do it..

Oh Vindin.. there's always room for LOVE!!! I loved that post.. and whereever Tina is.. I hope he finds her.. GOOD LUCK IVAR!!!!

Mary, wow.. that's a lot of information to give in a report.. seems like a lot of it the newer nurses should know to look up themselves.. like meds.. rather than have someone telling them.. just a thought.. as for organization of report.. there are several in our unit that use forms.. and write everything down.. one RN uses the abc's which she likes.. a airway (vent, O2 delivery method), b breathing- RR, c cardiac - rhythm, heart tones, etc, d diet, e electrolytes, f family concerns, g mmm can't remember, h hydration, i integument, l iv lines, but you get the point.. to me it's hard to receive report in this method but.. hey.. different strokes for different folks.. me? i use the systems to organize my report and add iv lines... normally everything else is covered under system.. cuz if i'm talking about cardiovascular and they have low bp then i tell them about drips hanging at that time... etc.. i'm fairly new myself, but i'm working towards not writing report down when i get it.. basically everything should already be written down either in the nurses notes or chart.. so why write it down again? i'm not there yet.. but i'm getting MUCH closer .. one of the super experienced nurses does it this way..and while i'm giving her report orally she's flipping through the chart reading the H&P, reviewing the last 72 hours of lab, orders and progress notes etc. then she is able to assimilate what i've told her..and what she's read and ask some REALLY good questions.. things I would never think to tell her .. anyway.. that's my goal..

When referring to internal jugular vs subclavian .. you're referring to place of origin, correct?? I think the problem is when the origin is the subclavian and the catheter winds up into the internal jugular.. hence any drugs given through it would be directed toward the head rather than the heart.. and it's been a while.. but if I remember correctly the length of the IJ prior to branching into smaller veins is not that long.. therefore, if you're giving some especially caustic medications (especially if going at a fast rate) there would be a greater opportunity for damage to the vessels.. and those vessels being in the head.. OUCH.. not good.. but hey.. that's just me trying to be logical.. Oh.. and I loved your comment about uhmmm compensating

is no documentation to prove it's harmful. >> Your doctor is out of line on several fronts.. first.. he's going against hospital policy which states you must have xray results (and DUH I bet they came up with that protocol for a REASON!).. second.. just because he writes it.. doesn't remove us as RNs from culpability.. if there is a patient complicaton our license.. uhmm and our butts would be yanked into court right along with his! He needs to get over his "nurse as handmaiden" mentality and come into the 90s As for the proper placement and research showing the danger when not placed as intended.. well.. I havent' seen any. but I haven't looked.. next time I go to the library I WILL look it up.. off the top of my head though I can think of some drugs I sure wouldn't want to give unless the catheter was in proper placement.. PRESS ON!!! Fight his irrational thinking with Facts.. and you'll win everytime.. promise

> Our protocol is to use 25 to 50mg Meperidine IVP prior to sheath removal. The rationale is to promote relaxation for the patient and prevent vagaling down. I'm curious about something else.. at our facility we flush sheaths with NS after drawing ACTs.. a friend at another institution uses heparin to prevent small clots forming on the end of the sheath that could be dislodged with removal.. what do y'all do? and is there research on it? (I know I know.. I'll probably end up going to the library!!