They didn't teach me this in nursing school and I could have killed someone!

BBFRN, BSN, PhD · Jul 29, 2005

2. I've noticed that many nurses "in the real world" verify placement of an NG-tube via auscultation. In nursing school we were taught that only by aspirating a small amount of stomach contents and checking PH, or an X-ray could you be satisfied with NG-tube placement (indeed our text specifically indicated that auscultation was not acceptable). Well, what's the real story?
QUOTE]
We don't check pH as much anymore, because most of your hospital patients will be on some kind of acid-reducing med (Pepcid, etc.) which could give false results on a pH strip. I've only done it once in the past several years, and it was when I got pulled to a bariatric surgery floor. Auscultation/aspiration should be enough to determine placement.

chicagrl72 · Jul 29, 2005

"Also, my school spent more time majoring on the minor things like bedmaking and bedbaths. Don't misunderstand I know we needed to know these things, but with all there is to learn these things fall short on my list"
LOL...I still remember the hoopla surrounding the bedbath and bedmaking...it was SOOOO ridiculous how anal those instructors were. We had to do it JUST SO...

In the "REAL" world , do they really check for mitered corners on the bed? :uhoh3:

laurakoko · Jul 29, 2005

I have seen many times nurses pushing medications thru lines with something else running.

Back in my LPN days, I asked an RN to give a push for me, the pt was nauseated. I had IVF- like NS hanging, and an Ancef abx piggybacked, and running. She didn't check anything, walked into the room, and pushed the antiemetic thru the primary line, and walked out. I followed behind her, and realized the line was completely white, with crytals in it. I unhooked the patient, and stopped it before it reached her.

Many years later, and am an RN...

Since then, I learned, always, just unhook the primary line, flush the IV, push the medication (however long), flush again, and hook back up the primary line. I have NEVER had an interaction, or had to spend time looking up to see if meds are compatible. It really takes less time, and is the safe way.

And as far as I know, nothing is to be piggybacked into TPN, BUT lipids. It's in our policy at our facility.

NoCrumping · Jul 29, 2005

In the "REAL" world , do they really check for mitered corners on the bed?

This reminds me of nursing school, first year, in the "nursing arts lab". It was bedmaking 101, and were all talking and making our beds, and then we came to the pillow cases. There had to be a certain way we put the cases on. Nobody could get it quite right.... one girl said... "I think I am going to have to practice this at home....." Another class mate burst out laughing and loudly said.... " People, relax, its just a pillow!!!!!!!!!" We all never forgot that. We still all laugh at it......ahhhhh those good ole days where we stressed out about learining how to make a bed and put a pillow case on a pillow with the proper technique...........

bluesky, BSN, RN · Jul 29, 2005

In the ICU access becomes an issue. Sometimes I have a patient with 3 triple lumens,and it is still an issue. .

WOW! That's pretty impressive... our unit does CVVH, IABP, VAD, you name it but I don't think I've ever seen a pt with 3 tripple lumens! How many drips did you have running?

Sorry, off topic, I know. But I just had to ask.

Nurseinthemaking · Jul 29, 2005

Unfortunately, the story was told to me about four months ago (first hand) and I've just gotten around to posting the subject. I do not know if mixing the medications would have actually caused an embolism or some other negative reaction. I only know that the person who related the incident said that she was told that it could/would have caused an embolism. When she told me this story I remember thinking "that could be me" because I was also unaware of the procedures regarding TPN/ IV piggybacks/drugs. Furthermore, just to clarify I was told that it was a double lumen PICC and that she didn't stop the TPN (and obviously didn't flush). I realize that in theory you should read the compatibility of all medications multiple times carefully before administration. However, in talking to many nurses who "work in the real world" sometimes with five or more clients each on many medications, this doesn't always happen and even when nurses do check for contraindications et. things are still missed (obviously if something goes wrong their licenses are in grave peril). Stated still another way if I were the "academic curriculum tsar" to a major undergraduate nursing program and had the ability to emphasize several commonly overlooked aspects of clinical skills (which can cause negative client outcomes) what might they be? For example I have read that a common error for new doctors/residents is to give too high an Oxygen flow rate to patients with long standing COPD spectrum disorders. Because, people with COPD often rely upon a state of perpetual hypoxgenination (hypoxic rather than hypercapnic drive) to stimulate breathing, giving too much oxygen can cause problems. Well, I am looking for nursing versions of this type of "newbie" error/scenario.

Weird because I am a soon to be GVN and I knew that. I just assumed all new grads would know the issues with COPD and 02. Maybe what it was, was that our instructor had an issue with this herself or something, cus we have had this pounded in our heads multiple times.

christvs, DNP, RN, NP · Jul 29, 2005

I wish our nursing school would have taught more about mainenance of peripheral IV sites and central lines. They taught us how to do a PICC dressing change; but we were never allowed to do a flush of any kind in clinicals. Not even a saline flush on a peripheral line. It became a catch-22 when we'd try to get experience inserting a new IV site, as they would let us attempt that...but then we'd need to have a floor nurse or clinical instructor to actually push the flush!
So I've had to play catch up after I was hired in the real world. My preceptor at the hospital (who was a great preceptor) got a kick out of the look on my face when she told me to go ahead and flush a peripheral line. It was so drilled into us to not do a flush...it was like asking me to jump off a cliff! :rotfl:
I agree one has to take personal responsibility to look meds up and hospital protocols. However, my school could have done a better job informing us about general IV maintenance other than the PICC dressing change. I wonder how common it is for schools to not allow students to do any flushes.

Hi! I'm a new RN. When I was doing my senior student internship last semester I was allowed to flush peripheral lines with saline & could also give meds by IV push. However I have never inserted an IV before-although my school never said we could not do it if the opportunity came up.

gizelda196 · Jul 31, 2005

WOW! That's pretty impressive... our unit does CVVH, IABP, VAD, you name it but I don't think I've ever seen a pt with 3 tripple lumens! How many drips did you have running?
Sorry, off topic, I know. But I just had to ask.

oh boy levo neo tpn propofol ns antibx lab draws.cvp pressures(don't ask no swan) we are a small community hospital we cant do CVVH or IABP but we do allot of Quinton's. and push ALLOT of bicarb,It is usually one surgeon we have this issue with . we have brought him to ethics a bazillion times .These patients never make it and he cant let go he dances around the family questions and so on. It is always nursing trying to educate family and push "what would your dad have wanted?" If you came to our unit and asked Who is the grandstanding jerk(nice way to put it) Who will just keep adding lines and tubes and is IMPOSSIBLE they will all answer you with the same answer.It is difficult as times to work community we have Boston residents floating through and they do allot of stepping on the old time surgeons toes( we like it) We usually tell medical doctors when they write for a surgical consult to use Boston vs. our long standing old time jerk(again im being polite)But community is allot different then major hospitals you use what you have and improvise allot.

I was just in Boston (my dad is their) So I quizzed the nurses about their working conditions and if they like working for Boston, most unit nurses have a max of 2 patients The hospital has an iv team who will draw off cvp, residents do the ABGS ,cardiology techs do EKGS , and so on. In my hospital we are the IV team ,Lab , ekgs tech and the secretary,unit aide we have no monitor techs(I am not even sure I know What that is)I was amazed I have been thinking of a job change .you just get so comfortable where you are.But I would be worried about losing all my skills like phlebotomy and picc lines and such. We also make allot of decisions as we wait for the md to call back (we have no ICU doc. ) We remove all Piccs,Midlines, Alines,Swans,Cvps. We assist in floating swans and temp internal paces,we are the recovery room for the entire hospital on the weekends and night shift. We do all conscious sedation and we assist in all UGI, lower Gis ,Bronchs,TEE's WE are the code team. It gets hairy at times but I have learned allot over the years. I wont be really surprised as they consolidate if we also became the cath lab.But if you read thru my post we have no staff we have allot of travel nurses and international nurses . we had a manager that replaced a manager who was there for 22 years(fired when the new CEO came in)She basically was a union buster. We lost a total of 400 years nursing experience in a 6 month span.We were a great unit with a great staff at one time ,it is so sad. We have been unable to fill their places. And what we get for travel and international nurses isn't good enough, some are really good ,some are their to make money. They don't float ,they don't do charge , they don't know a thing about the community so, on. So some day I might make it to a unit like yours.It would be fun to learn continuous hd or balloon pumps. Or to be in either a sicu or micu . I don't know why or how I got off topic but I hope I answered your question

not now, RN · Jul 31, 2005

I have so far (knock on wood) avoided a crisis by following one rule: If I haven't done the procedure before (or in quite some time) I ask an experienced nurse what to do. At the very least I will run through what I'm going to do "So first I..." so the nurse can correct me if/when I'm wrong. I've never had a nurse complain since they'd rather take a few seconds to help me than have to deal with an emergency later.

DAREINGTX · Jul 31, 2005

I heard of a nurse in AZ that had a pt that was npo. Doc ordered MOM and the nurse put it through the central line.

I don't know if this is true or just an urban legend type story, but i've met some nurses that I could see doing something like this. SCARY

pricklypear · Jul 31, 2005

I heard of a nurse in AZ that had a pt that was npo. Doc ordered MOM and the nurse put it through the central line.
I don't know if this is true or just an urban legend type story, but i've met some nurses that I could see doing something like this. SCARY

Sounds like urban legend to me. I can't even imagine it.

barbb51405 · Aug 5, 2005

What things "didn't" you learn in nursing school or during orientation that could have resulted in a patient being harmed? I knew a person who said that she was never taught that certain (any?) IV medications cannot be given during a TPN feeding in the same PICC line. She had a situation where she was going to push a med using a free lumen on the same double lumen PICC line while TPN was running, and was stopped at the last second by another nurse who just happened to come into the room. I cannot remember the med, but she was told that it would have likely caused an embolism had she proceeded. This caused me to ponder what other sort of "common knowledge" that is sometimes missed in school and on orientation, but that could result in real client harm. What would your "top three" things be that fall into this category?

you have to look up compatability of any meds and this also goes with iv meds and iv lines also.