So I just had to share this with people that would understand. Not a rant, just a quick story.
On my ICU floor, we have a stool like object that we use during CPR since or beds are pretty tall. I come into work to see the stool in a patients room. Apparently, she had been using it as a squatty potty. Maybe 10 minutes later, a different patient codes. While we're working on her. I tell the cna which room the stool is in for her to go get. She comes back and says that the patient wouldn't let her take it, even after she explained to the patient that we need it for a code, happening right now.
There are plenty of staff in the room (asking for the stool actually) so I run over and just grab the stool, all the while I can hear the patient making a big stink about me taking her squatty potty. I was just amazed by her selfishness. Stool should not have even been in her room.
She did complain to my charge nurse, but no one really cared.
Most of our ER stretchers don't go low enough for short patients to sit on the sides easily, when getting into bed, let alone go low for CPR. We would never (!) put a patient on the floor! How on earth do you think it would be clean, or advantageous for intubating, or for decent compressions from kneeling staff, at that? I can just see the whole team on their knees (Davey DO? visual here). (Not to mention, my knees are a bit creaky for that, LOL)
I am 6 feet tall, and occasionally have problems reaching the patient, never mind my shorter colleagues. I have gotten up onto the bed with a knee; and even shown students how to straddle a patient (manikin) on the bed to get out of the way of other activies. Step stools are hard to find at times, but utterly necessary.
I was thinking this too... the last pt I did compressions on had an IABP placed at the bedside, and then went to the OR emergently. As in, Here.I. Stand pushing epi after epi all the way to the OR, emergently.
She was already on a vent, and had arterial/CVC lines -- whose transducers were leveled/attached to the bed frame. I'm not sure how we ever would have gotten TO the floor... plus if we did move an ICU pt onto the floor, that is a SIGNIFICANT delay in compressions. I mean it would be an unacceptable delay for ANY pt, but the typical ICU pt is hooked up to so many things so would be extra delay.
I haven't even talked about who would be tasked with getting the pt UP. My discs are herniating just thinking about it!!
I'm sure in the hospital setting moving a patient to a hard surface such as the floor wouldn't ever be a necessity, but I work in a LTC facility, all of our mattresses are somewhat soft so they're not ideal for compression's. I (knock on wood....loudly) haven't participated in a code in awhile, but the last one I was part of we moved the resident to the floor.
If the bed/mattress is too soft, you should put the patients on a backboard. The headboard of our hospital beds can be used for that purpose. I've also seen boards on code carts. At the 2 minute mark, roll the patient onto the board.
We would never (!) put a patient on the floor! How on earth do you think it would be clean, or advantageous for intubating, or for decent compressions from kneeling staff, at that?
We have exam chairs in tiny rooms and super sick patients. It would be no exaggeration to say we call at least 3 RRTs or codes per week. There is no way to do compressions much less run a code in one of our rooms. We finally got a guerney for these situations but it is at the other end of the floor (shared between 4 units). I'm not going to wait to start CPR so the floor it is and I'm going to horrify you even more, we do them in the hallway. Risk vs benefit and all that. Compressions are actually easier when you are on your knees. BVM is perfectly fine until the patient is in a better position although I've done my share of intubating on my stomach. As soon as the guerney gets there we roll them on a backboard and put them on it. We have no other choice and no patient or family member has ever complained.
Most of our ER stretchers don't go low enough for short patients to sit on the sides easily, when getting into bed, let alone go low for CPR. We would never (!) put a patient on the floor! How on earth do you think it would be clean, or advantageous for intubating, or for decent compressions from kneeling staff, at that? I can just see the whole team on their knees (Davey DO? visual here). (Not to mention, my knees are a bit creaky for that, LOL)
I am 6 feet tall, and occasionally have problems reaching the patient, never mind my shorter colleagues. I have gotten up onto the bed with a knee; and even shown students how to straddle a patient (manikin) on the bed to get out of the way of other activies. Step stools are hard to find at times, but utterly necessary.
Patient on the ground, doing compressions on my knees is actually my preferred position for chest compressions, it's by far the most comfortable for by back. That doesn't mean I'm going to dump a patient off the bed and onto the floor, but it's still by preferred position for compressions. That's one thing I sort of like about having to do compressions when in the cath lab, you sort of have to get up onto the table to do compressions under the C-arm, which despite the lead is still more comfortable than doing compression on somebody in a bed in it's lowest position.
I'm not going to wait to start CPR so the floor it is and I'm going to horrify you even more, we do them in the hallway. Risk vs benefit and all that. Compressions are actually easier when you are on your knees. .
Not horrified, lol. You do what you have to do. I was referring to moving a patient from a bed to the floor. Yes compressions are easier on your knees, but I'd prefer my knee to be on the bed :) I hereby rescind the part of the post that said not to be kneeling, I intended it to be about the crowding on the floor.
LTC beds? yeah, sometimes floor is best. But there should be CPR boards available for those soft beds. I also think step stools should be available in every room. Incurable dreamer here.
Specializes in Flight, ER, Transport, ICU/Critical Care.
I don't have anything helpful or witty to add.
I might know someone that bought a Squatty Potty for her MIL and after the here-haws and guff-gaws - I hear that she would would put up a fight if anyone tried to take it from her. I also know nothing about there being surrogate Squatty Potties at the places she stays overnight - after perhaps packing that thing in a trash bag to visit her daughter.
Just saying.
I suspect, for an 80+ year old - she means BUSINESS!
So sad that this patient has no clue as to the fragility of life.
On a side note and this is real you can google it
In my area we have a licensed plumber his name.....Scotty Potty (his birth name....and destined to become a plumber). Maybe we can hook this little old lady up for her potty needs.
If the bed/mattress is too soft, you should put the patients on a backboard. The headboard of our hospital beds can be used for that purpose. I've also seen boards on code carts. At the 2 minute mark, roll the patient onto the board.
That's actually a perfect solution! As long as there's one available. Sadly our so called crash cart leaves a lot to be desired. I will mention that to the powers that be though. Who knows, it might actually do some good!
That's actually a perfect solution! As long as there's one available. Sadly our so called crash cart leaves a lot to be desired. I will mention that to the powers that be though. Who knows, it might actually do some good!
We have the small CPR backboards on each crash cart. It's part of the daily checks to ensure it's there.
Specializes in med-surg, psych, ER, school nurse-CRNP.
Prancercise? You're talking about JP Sears? OMG, that man absolutely KILLS me! The lady that does them, retina scarring is being kind. If you have not checked out JP, please do. He's a regular riot.
Specializes in med-surg, psych, ER, school nurse-CRNP.
When I worked the floor, this was common, I'm 5'3". They'd throw me up on the bed and I'd either kneel beside or heck, sometimes I'd straddle thighs. I was teeny back then so they still had access to arms and what was needed to push meds. As you said, wasn't the best look in the world but we were more worried about outcomes anyway.
Here.I.Stand, BSN, RN
5,047 Posts
I was thinking this too... the last pt I did compressions on had an IABP placed at the bedside, and then went to the OR emergently. As in, Here.I. Stand pushing epi after epi all the way to the OR, emergently.
She was already on a vent, and had arterial/CVC lines -- whose transducers were leveled/attached to the bed frame. I'm not sure how we ever would have gotten TO the floor... plus if we did move an ICU pt onto the floor, that is a SIGNIFICANT delay in compressions. I mean it would be an unacceptable delay for ANY pt, but the typical ICU pt is hooked up to so many things so would be extra delay.
I haven't even talked about who would be tasked with getting the pt UP. My discs are herniating just thinking about it!!