questions about tests/procedures (please help!)

[Miller86]

Hello everyone,

I was wondering if you ladies and gentleman could help me with something that I personally feel I am struggling with! It is my 4th month as a nurse and I am learning tons of new things daily but certain things are not clicking quick enough!

I tried looking up certain books/sites but nothing seems to be clear as to what is needed.

I keep sending patients down for tests/procedures without normal saline running or sometimes with it running and I always get called from whatever unit they got sent down to with a "why did you do this and that?" I am grateful they called to yell at me otherwise I would never know of my mistakes.

It makes me feel incompetent every single time! I always make sure they have a saline lock but never know which tests require a solution to be running without a specific order?

For example: I had a patient going down to the O.R and I knew to send him/her down with a saline lock so I started one but then I had another patient going for a bronchoscopy and the transporter gave me hell for not having ns already running! ("I was wasting his time", then the charge nurse gave me the look of death). I feel like I am sinking in the smallest areas.

How am I suppose to just know this information, in the manual for procedures it doesn't mention preparation related to IV solutions required.

What tests/procedures require a standard ns running tkvo?

I constantly think about this now and when I ask questions no one seems to be giving me clear directions, I just want to be good at what I do and I feel like this is causing me unnecessary stress. Literally unnecessary.

Thanks for any feedback!!

[canesdukegirl, BSN, RN]

An order should always be written before each procedure/test as to what the doc would like. You should NOT have to guess...and if an order is not written, page the doc and ask. It is THEIR responsibility, not yours.

[merlee]

You need a dr's order for these things, you cannot just 'guess' or 'know'. Call the area where the procedure will be done and ASK someone there, or grab your charge nurse.

If there is no order, or standing order, then this is not on you.

ASK !!!!

[Miller86]

See that's what I believed when I freshly started and kept my "but what about the order!". Our facility doesn't do orders for tkvo. It's just based on someone's assumption which makes no sense to me. Some nurses do 50 cc/hr, others 15, some do 30. All based on some guess and that's why I am in a state of confusion. But from now on I will be more persistent and get an order for it if that is what they want!

Would it be a terrible thing if I mentioned a policy change on this? (I'm still on probation for another month!).

[Miller86]

By the way thank you for the feedback I really appreciate it!

[canesdukegirl, BSN, RN]

I think it would be a great idea for you to start to establish a policy regarding KVO orders. Do your research first and then come up with something that you can present to your NM. This will take some time, and by the time you are ready, you won't be on probation anymore! Win-win, my friend!

[PAERRN20]

I really think these people are being a little tough on you, especially as a new nurse. So you sent someone to the OR without saline running. So what. It takes all of 30 seconds to spike and hang a bag of fluids. Once they get to the OR they have not only a dedicated surgeon and nurse, but an anest. provider that is more than capable of taking care of this. If these are the biggest mistakes you are making you are a fine nurse. Don't sweat the small things!

[mybrowneyedgirl, BSN, RN]

I agree that they are being way to hard on you and that their should be a procedure for each one. That being said, I think it would be safe to assume you will need KVO for any procedure that could lead to blood loss or need for emergent medications. If someone bleeds out, you can bolus them to compensate for fluid volume loss and assist in maintaining their blood pressure.

I would ask your charge nurse. Do not beat yourself up about this. It's their failure not yours. Just follow up and learn how you're supposed to know when it's needed.

Good luck

[ObtundedRN, BSN, RN]

See that's what I believed when I freshly started and kept my "but what about the order!". Our facility doesn't do orders for tkvo. It's just based on someone's assumption which makes no sense to me. Some nurses do 50 cc/hr, others 15, some do 30. All based on some guess and that's why I am in a state of confusion. But from now on I will be more persistent and get an order for it if that is what they want!

Would it be a terrible thing if I mentioned a policy change on this? (I'm still on probation for another month!).

At my facility, we don't need an order for KVO fluids, however I just wanted to say that 50mL/hr isn't KVO. KVO is typically 8-15mL/hr. I have seen people put 20mL/hr, however that is typically for a person with an introducer/Cordis.

[BrnEyedGirl, BSN, MSN, RN, APRN]

I think much of what you are asking will be dependent on the facility you work. For instance our cath lab likes an 18g in the L ac, NS at tko (offically 15ml/hr where I work) with extension tubing. This is because of the physical lay out of our paticular cath lab. Look at your procedure manuals, they should have this info spelled out for you. You have to have an order for an IV or for TKO fluids if you want to charge for them, so this has to be written down some where, ask your charge to help you find out where!

[nursej22, MSN, RN]

We consider any IVF a medication and therefore needs an MD, NP or PA order. Otherwise, it is considered practicing medicine without a license. It is up to the provider to order IVF, period.

And, we cannot charge for it without an order. There is no way our pharmacy would dispense any med without a correct and complete order (med, dose, route,freq.)

Specific departments want particular fluids as well. Imaging may want a bicarb gtt for a renal insufficiency, OR likes LR, endo likes normal saline. And procedures are seldom done on schedule, so you have to potential to overloadi a heart failure or anuric pt because someone is running late.

I would question your pharmacy and/or BON about starting IVF without an order or protocol. I would hate to see you put your license in jeopardy just to keep people from rolling their eyes.

[Elvish, BSN, DNP, RN, NP]

If you know what the most common procedures are for your unit it might not be a bad idea to grab the P&P book/website as someone else mentioned and go over those common ones. That way, when you know your patient is schedule for XYZ procedure, you can anticipate what they'll need; if you have to call the MD for maintenance fluids or anything else, you'll more or less know what you're talking about. Good MDs will appreciate a nurse who has his/her stuff together ahead of time.

The less frequent stuff, the stuff you may see only once or twice a year if that, at least anticipate some sort of prep. Once you do it a few times you'll get more familiar with who needs what and when.

I felt the same way you do now when I was a brand new nurse almost 10 (!) years ago. If those are the worst mistakes you're making, you are doing really well. A few years from now you won't recognize yourself. Promise. :)