IABP4U

Been a while since anyone posted, but I'm passionate about this topic (partly bc excess "stuff" causes clutter, which drives me nuts). One time I took it upon myself to keep an informal tally of all the excess supplies that are not used after a pt is discharged from my ICU. I then got with my manager to determine the "cost" of one J-loop, lopez valve, suture removal kit, etc. The rest was simple math. When the dust settled, I was shocked at the total dollar amount. My unit used this information as a teaching point for everyone: bring in only what you truly need, return what you don't use (unless the pt is isolation).

Agree with the previous responses. ~ 0.5 degree/hour is ideal. Only 1 degree in 8 hrs...something isn't right. Are you using a topical vest, or endovascular cooling catheter? My facility uses the vest (unfortunately). If we have difficulty achieving our goal of 0.5 deg/hr, then our protocol allows for adding forced warm air (bair hugger), heat to the ventilator circuit, etc. In one case, a patient's temperature actually continued to decrease (mind you, this man was basically dead and probably wasn't the best hypothermia candidate to begin with). In that case, we had to run heated IV fluids.

Excellent article about enteral nutrition, gastric residuals, tube placement, etc. I was surprised to learn from the article that bowel sounds do not necessarily correlate with GI motility. Development of Evidence-Based Guidelines and Critical Care Nurses ' Knowledge of Enteral Feeding

I've worked with Epic for a total of 6 years (at several different facilities). Each hospital tweaked it a little differently according to their needs. Some were more user-friendly than others. My current hospital has the best version, in my opinion. "Best" being the most streamlined, easy to use, most forgiving.

I'd say, yes, swans have gone out of style. However, you'd probably find the majority of them used in management of patients after cardiac surgery. What always amuses me is the number of times I have called a surgeon about bad hemodynamics only to get a response like, "I don't care. Why are you calling me about that?" Alot of research has shown questionable patient outcomes with having a swan vs not having a swan. In my personal experience, I'm convinced that there are many doctors/nurses who misinterpret the numbers obtained from a swan. So is the issue the actual piece of plastic sitting in the pulmonary artery or the provider making poor decisions based off the numbers? Food for thought....