Sacred cows that need to be laid to rest

Marie_LPN, RN, LPN, RN · Jan 30, 2004

Originally posted by Rapheal
12 am an 4 am vitals on stable A&O patients. These people need to sleep. I would much prefer nursing documtation that these patients are sleeping with unlabored and even respirations.

I know. We have a couple of doctors that are 'Vital Sign Nazis' who will not bend on a q4 order whatsoever.

nursedawn67, LPN · Jan 31, 2004

The one that gets me....and I know the reasoning behind it but still makes no sense is.....having a 90 something year old resident come into the nursing home in failry good health, just unable to take care of themselves at home. Now this resident has ate like a pound of bacon a day, and ate like bag after bag of sugar...and now you are going to put them on a diet??? WTF....clearly they were doing something right at home to make it to () something!!!! Our facility has a policy of regular diets, unless doctor clearly orders a specific diet. I don't mean consistency of the diet (puree I, PureeII, mech soft...etc), but the actual food they can have. It works good and we have had no problems.

Marie_LPN, RN, LPN, RN · Jan 31, 2004

Speaking of pureed food, i don't know how many nurses i have heard say "pureed food tastes just the same as non-purreed food."

To quote Col. Potter from M*A*S*H: BUFFALO BAGELS!!!

I ate pureed food for 2 weeks following dental surgery involving the cutting-out of 3 molars. Pureed food is NASTY! Nothing i did to it helped any!

mare-mare · Jan 31, 2004

Where I work the most sacred cows have to do with ortho cases... they just within the last year stopped making us put a total joint pt on the OR bed out in the hallway! Don't even get me stated on pouring water for the orthapods... talk about a Dr. having a cow!

Erin RN · Jan 31, 2004

Originally posted by stevierae
Oh, Man!!!! And here I was complaining today that it was too cold to go ouside because it was raining and 45 degrees!!! I will NEVER compalin again!! Where do you LIVE, Erin? North Dakota?

Eastern WA..it gets really cold here sometimes..a couple of weeks ago it was 3 and sunny!! I thought it was a pretty funny story. I had one night where I was bringing IV supplies to a house..I was pushing the pole and pump and it kept getting stuck in the snow and ice..I finally slipped and fell and took it all down with me..ah the joys of home health!! Erin

srbaggett · Jan 7, 2005

:rolleyes: Perhaps you were never taught the reason you inflate a balloon before insertion. If you have worked in the OR for very long, you surely have been involved with doing a cystoscopy to retrieve a catheter that would not deflate. This happens. And that is the reason you inflate a balloon before inserting the catheter. I also question your technique...why would you have to test the balloon and change into other gloves. This is all done after doning sterile gloves only once. Critical thinking or just shortcuts that could harm the patient. You be the judge.

Here are a few of mine--they are things that no one who does them can explain the rationale for, other than justifying it with these 6 words, their mantra:
"We've always done it this way."
1. Putting down a "foot sheet" (usually a drape sheet; half or 3/4 sheet) before putting down the main drape (lap sheet, transverse lap sheet, split sheet or whatever--)
My question: WTF for? Do people not trust that the surgical drape companies have put time and money into researching just how thick the surgical drapes need to be to make them impervious to strikethrough or instrument penetration?
2. "Testing" the balloon on a Foley catheter before inserting it--
Again, what is the rationale? Do they somehow think that the balloon on a Foley is prone to failure to inflate--have they ever actually SEEN one not inflate?
When I put a Foley in, I insert it all the way to the hub, inflate the balloon with the full 10cc of H2O, then pull the catheter back--it stops on its own, proving the balloon is inflated.
Never once have I seen a Foley slip out because the balloon failed to inflate--and if it did, so what? Has any harm come to the patient? Of course not! Just get a new catheter and reinsert it.
I don't think that sterile items should be handled more than necessary--putting on gloves to "test" a Foley balloon, taking them off, doing another task, and then regloving to actually perform the catheterization--often announcing to whomever they think cares: "I tested the balloon earlier" is, to me, an unnecessary practice and one that can potentially contaminate the catheter and lead to a nosocomial UTI.
3. Double gloving for every single task--even patient transport
First off, I think it is a waste of gloves, but second--everybody keeps quoting "research" that says double gloving is "safer--" I even saw a recent AORN article that quoted someone as saying something to the effect that double gloving will reduce the likelihood of needlestick or other sharp object penetration by 50%--
Now, that sounds reasonable in theory, but is it actually true in PRACTICE? Has anyone actually SEEN this research, or is it anecdotal? Does this mean that if we triple glove, we wiil reduce the chance of sharp object penetration by 70%? Should we put on 4 pairs of gloves, thus reducing the chance of needlestick by 75%? Why not just wear 5 pairs, reducing the chance to... well, you get my point.
And, while we're at it, why not just put on 2 gowns and 2 masks--hey, if one is good, shouldn't 2 be better? Where do we stop and say, "Enough, already--this is just silly."
Again, I think that, just as with the example of the surgical drapes, the glove companies have a vested interest in making gloves that are strong and durable--why should they make a product that necessitates wearing two of for safety?
I have never double gloved, and I have only been stuck once in my career--by a sharp needle that would have penetrated 2, 3, or 4 pairs of gloves; double gloving would have served no purpose whatsoever--
If people feel the need for thicker gloves to make them feel "safe," ortho gloves serve that need just fine.
OK, I know I will get flamed especially for my double glove views, but I just think we need to use a little more common sense and not rely so much on outdated "policies" and practices that MAYBE made sense in the '50s--MAYBE--but maybe, even then, they were sacred cows--
Let's hear YOUR sacred cows!!! Bring 'em on!! Remember, there are student nurses out there reading this board who can learn from us; it will be nice to provoke critical thinking in the generation that will be providing our perioperative care, possibly sooner than we think---

stevierae · Jan 8, 2005

Perhaps you were never taught the reason you inflate a balloon before insertion. If you have worked in the OR for very long, you surely have been involved with doing a cystoscopy to retrieve a catheter that would not deflate. This happens. And that is the reason you inflate a balloon before inserting the catheter. I also question your technique...why would you have to test the balloon and change into other gloves. This is all done after doning sterile gloves only once. Critical thinking or just shortcuts that could harm the patient. You be the judge.

Well--I have worked in various ORs for nearly 30 years--and, no, I have never done a cystoscopy for a balloon that didn't deflate, and I have never seen a defective balloon. In the OR, we don't usually use a syringe to deflate our Foley balloons in order to d'c the Foley--we cut the limb that goes to the balloon with a scissors, and the H2O in the balloon leaks out.

Now, if you re-read my post, you will see that I was referring to ANOTHER person in the room--that is, a PA or OR tech or other nurse or whatever--unasked, trying to be "helpful" by opening up your Foley tray (say, while you--the circulator-- were out getting the patient.)

Then, you enter the room, and this "helpful" person (who has also opened your prep tray) says, "I tested your Foley balloon for you." Great--just great. Now I have had ANOTHER pair of hands on my Foley--I HOPE they have used good sterile technique manipulating it (and, if you don't trust this person, you will have to throw out the entire tray, rather than compromise sterility and ASSUME he or she used scrupulous sterile technique) --the more hands on a sterile item, the more chance for contamination---and I have to open up ANOTHER pair of sterile gloves to INSERT the Foley when it's time, as that "helpful" person has used the pair in the set that were meant for the person (me) doing the catheterization.

Or, another scenario that I presented--circulators who subscribe to the "I must test the ballon" theory--but don the sterile gloves in the Foley tray to do it (often before the patient is even in the room) and then move on to another task. THEN, when their patient comes to the room, they must open ANOTHER pair of sterile gloves to do the catheterization, because they have already used the pair in the tray that was MEANT for that task.

Get it?

I suspect that any balloon that does NOT deflate easily is for this reason: in the OR, we usually put the entire 10 cc. of H2O in the balloon. On the floors, many nurses only put 5cc. When they attempt to deflate the ballon with a 5 cc syringe, it does not deflate fully. If they used THEIR critical thinking skills, it might occur to them that there is more than 5 cc in the balloon--and attempt to aspirate the residual, or cut the limb to the balloon, as we do. The remaining water will leak out, and the Foley will slip right out.

I still believe it's a sacred cow--I think it goes back to the '50s, when Foleys were made of lower grade latex (these days, due to potential latex allergies, most ORs in which I work have switched to all silicone Foleys.)

Here's another Foley sacred cow---believing that if one does not hang a Foley bag below bed level, it can reflux into the bladder--which can present reflex arc problems with quadriplegic patients.

Now, it's true that it might not DRAIN as well (forces of gravity and all that--) however, Foleys have, for MANY years, had anti-reflux valves built into them--so this is no longer an issue.

shudokan-RN · Jan 23, 2005

wiping down a room w/ alcohol for latex alergies

I recently became the latex "queen" and our policy was to wipe all surfaces of the room w alcohol and wait 20 minutes befoe bringing in a patent in with a latex allergy.

I had to ask why is this our policy

well all you need is one complete air exchange in the room. our slowest room is 4 minutes.

now we use that free time to perform the latex dance :rotfl:

stevierae · Jan 23, 2005

wiping down a room w/ alcohol for latex alergies
I recently became the latex "queen" and our policy was to wipe all surfaces of the room w alcohol and wait 20 minutes befoe bringing in a patent in with a latex allergy.
I had to ask why is this our policy
well all you need is one complete air exchange in the room. our slowest room is 4 minutes.
now we use that free time to perform the latex dance :rotfl:

Don't any of your rooms have laminar flow?

Mimi2RN, ASN, RN · Jan 23, 2005

Well--I have worked in various ORs for nearly 30 years--and, no, I have never done a cystoscopy for a balloon that didn't deflate, and I have never seen a defective balloon. In the OR, we don't usually use a syringe to deflate our Foley balloons in order to d'c the Foley--we cut the limb that goes to the balloon with a scissors, and the H2O in the balloon leaks out.

I had a foley catheter balloon stay inflated, when I was the patient. The RN was very puzzled, called for help from her charge nurse. She cut the foley tubing, left it leaking, as the balloon still didn't deflate. Next in was the intern. He clamped the foley with a kelly clamp. Then the chief resident showed up, he took me for an ultrasound......yes, the balloon was inflated. He thought he could pop it with a supra-pubic stick, but that didn't work. A couple of hours later, the chief urologist showed up, with junior right behind him. In his hand he carried a BIG needle, he showed the resident what to do, and then let him pop the balloon.

Of course, I went home the next day with a bladder infection. :rolleyes:

oregonnurse · Feb 24, 2005

Great thread.

A few months ago in the AJN, an infection control expert debunked the myth that gloves are necessary for SQ injections. Makes sense. Whoever bled from an insulin injection?

stevierae · Feb 25, 2005

Great thread.
A few months ago in the AJN, an infection control expert debunked the myth that gloves are necessary for SQ injections. Makes sense. Whoever bled from an insulin injection?

I've never given an injection--whether intradermal, sub-Q, IM or IV---wearing gloves. Do floor nurses do that, nowadays? I sometimes feel really out of the loop, working in the O.R.---it's like we are our own little world.

For that matter, I used to do senior foot care, and I never wore gloves---after all, I was nto exposed to blood or body fluids, and I washed my hands very carefully between patients, as I would in any patient contact situation.

But the other day I read a post on allnurses (another section) in which one foot care nurse was criticizing her colleague for not wearing gloves, as was their policy. I wonder what their rationale for that policy was?