Trasducer leveling

MONITORHOSPITAL · Oct 15, 2008

Its not very clear what u r asking, but if its a laser pointer that are attached to pole, we use one for the ventriculostomy pts eventhough its not a very frequent procedure. let me know if thats what it is, then I'll try to find where they bought the thing

juraviel · Oct 16, 2008

yeah sorry that's what I was talking about. I used one in a neuro/surgical icu but couldn't remember who made it.

trvlngrn22 · Oct 28, 2008

an old fashioned carpenters level works just as well. alternatively, you may look in hardware for a laser level used to hang pictures. probably less expensive than looking for one in the medical field.

getoverit, BSN, RN, EMT-P · Oct 31, 2008

one of the guys I work with bought a little laser pointer and rigged it up somehow. I can ask him where he got the materials and how much $ it cost if you're interested. All I can remember is him telling about how cheap it was and how much he loves it, it's locked up in his locker right now (I guess) and I think he's back in a few days.

anurseuk · Nov 7, 2008

Whats wrong with lining it up by sight? I know us critical care nurses are anal but...

Pediatric Critical Care Columnist · Nov 7, 2008

I use an inexpensive line level on a bathtub stopper chain. I level from the phlebostatic axis to a point on my own body, then from my "mark" to the transducer. Simple and effective.

RN1980 · Nov 7, 2008

at one hospital i work part time at they just secure the transducer to the patient. They basically pin it to the pt's gown at the axis or another refrence point. at first i was skeptical, but the result ranges were very, very close as to doing it the old fashion carpenters levels way..

trvlngrn22 · Nov 7, 2008

I worked where they taped it to the forearm. Good enough for when the patient is supine, but they would never change (relevel) it when they turned the patient. So, on the left side, pressures were low and on the right pressures high. Not a very good job of monitoring.. As far as levelling by eye sight, you can usually get pretty close. But sometimes if you "estimate" and then level you would be surprised how far off you can be. A little bit off isn't so bad with the larger numbers of the Aline, but when it comes to the PA or the CVP, it can make a big difference.

Pediatric Critical Care Columnist · Nov 7, 2008

I worked where they taped it to the forearm. Good enough for when the patient is supine, but they would never change (relevel) it when they turned the patient. So, on the left side, pressures were low and on the right pressures high. Not a very good job of monitoring.. As far as levelling by eye sight, you can usually get pretty close. But sometimes if you "estimate" and then level you would be surprised how far off you can be. A little bit off isn't so bad with the larger numbers of the Aline, but when it comes to the PA or the CVP, it can make a big difference.

I work in peds cardiac sciences. If we eyeball the level, it's usually out by sometimes several cms. In an infant or child, that can be catastrophic. I once got report on a 12 year old burn patient who had been severely hypotensive for several shifts and I was told that the patient had been stable all night, hadn't needed a drop of extra fluid and hadn't needed any prn sedation. The nurse was so pleased because she'd been able to read five chapters of the new Harry Potter... I started assessing the patient as I always do, with leveling and calibrating the transducers. OMG, the transducer was a good 5 cm below the frame of the bed... Her BP was 60/38 and she wasn't 'settled', she was obtunded. I spent the next half hour pushing volume and starting Levo.

trvlngrn22 · Nov 8, 2008

janfrn, yep, i''ve seen that too. gotta wonder what some people are thinking. one of my favorites was a nurse who had an IABP pt in reverse trendelenburg. the femoral transducer was on the pump, a good 6-12 inches too low, the radial one was hanging off the top of the bed, at least a foot too high and the cuff had fallen and was loosely around the forearm. and she couldn't figure out why the patient's numbers didn't correlate. at least with some sort of level (laser, carpenter, medical whatever..) you make a conscious effort to align things correctly.

Pediatric Critical Care Columnist · Nov 8, 2008

For the amount of time it takes to accurately level that little gadget, why would anyone put their patients' lives at risk?

While I'm venting... what about this! Our clinical educator has been telling people that when they reposition their patients that in addition to leveling they also have to recal. So basically q2h... I asked her how turning a patient from left side to right has changed the atmospheric pressure and she gave me a blank look. It was obvious to me that she didn't understand what she was doing when she recaled, or what the transducer actually does. (Of course, itf the weather changes during my shift, I'll recal, or if there's sudden change in pressures that can't be explained away...) Scary stuff! Now when I preceptor new staff, I make a point of asking them about that. They start wondering what else they've been told that's inaccurate.