What is the most complex clinical procedure you had to do in your career?

JustBeachyNurse, LPN · Mar 8, 2015

Routine tracheostomy tube change (but at the request of my pulmonolgist who happened to be attending and the blessing of my CI) not just inner cannula. A full trach change.

cheezwizz90 · Mar 8, 2015

I would have to say that it's the routine BID dressing changes of a severely burned patient. It can take 3+ hours with 2 RNs, a PCT and an RT to manage the vent. Another RN to give IV meds, plus the heat lamps and the extreme amounts of PPE. Burn ICU nursing is the most complicated type of nursing IMO. Some wound VACs or Coloplast dressings can also take hours with conscious sedation.

Keep it real.

klone, MSN, RN · Mar 8, 2015

RN delivery of a macrosomic infant with a 2-minute shoulder.

blondy2061h, MSN, RN · Mar 8, 2015

Following certain phase 1 trial protocols where you're timing the drug infuion just so, getting pharmacokinetic levels, documenting side effects religiously, getting EKG's set times after the drug hits the patient (so you need to know how many ml's of saline are primed in the tubing) and God knows what else.

calivianya, BSN, RN · Mar 8, 2015

I had a patient with necrotizing fasciitis that started in her labial area who ended up with a surgical wound stretching down into her inner thighs, up through both labia, her abdomen, and all the way up the side of her ribs by the time the removal of affected tissue was done. That was a complicated dressing change just because of the size of the wound, and the fact that she was obese to begin with, so parts of the wound were five inches deep. I think I used at least ten rolls of saline-soaked kerlix to pack it and at least 7-8 abd pads to cover it up. It took several people to hold the fat back to keep the wound from collapsing into itself while the dressing change was being done.

It was very memorable because I had her before surgery too, and the initial complaint she presented with was a black blister about the size of a silver dollar. I remember seeing it and knowing it was bad because of the obvious necrosis, but I never imagined the tissue damage was so extensive.

dirtyhippiegirl, BSN, RN · Mar 8, 2015

Big burn dressings - yeah, for all the reasons stated above plus placing the actual dressings isn't as intuitive as you would think. It's a bit like trying to piece together a jigsaw puzzle without being able to manipulate the puzzle pieces first if that makes sense.

Throw in an unstable pt who is on CRRT and pressors, and you are turning this patient from side to side frequently...blegh.

Bezoars · Mar 8, 2015

Wound vacs can get complicated sometimes. My most complicated was a pt I had once who had an abdominal surgery and they nicked the bowel. Everything got infected and there were fistulas in several places. Her abdominal wound took up the majority of her abdomen under the ribs with large gaping crevices in a cross pattern. It leaked watery excrement and we had to pack it about 6 times a shift. It was the craziest thing. She was hospitalized for months.

blondy2061h, MSN, RN · Mar 8, 2015

I had a patient with necrotizing fasciitis that started in her labial area who ended up with a surgical wound stretching down into her inner thighs, up through both labia, her abdomen, and all the way up the side of her ribs by the time the removal of affected tissue was done. That was a complicated dressing change just because of the size of the wound, and the fact that she was obese to begin with, so parts of the wound were five inches deep. I think I used at least ten rolls of saline-soaked kerlix to pack it and at least 7-8 abd pads to cover it up. It took several people to hold the fat back to keep the wound from collapsing into itself while the dressing change was being done.
It was very memorable because I had her before surgery too, and the initial complaint she presented with was a black blister about the size of a silver dollar. I remember seeing it and knowing it was bad because of the obvious necrosis, but I never imagined the tissue damage was so extensive.

Omg, that's horrible. Do you know how she eventually did?

calivianya, BSN, RN · Mar 9, 2015

Omg, that's horrible. Do you know how she eventually did?

I wish I did. I can't imagine how long it takes for a wound that large to heal. I really can't imagine coming into the hospital with one gross looking blister and ending up with that much tissue removed. The shock has got to be extreme.

HouTx, BSN, MSN, EdD · Mar 9, 2015

Managing an IABP- and ventilator-dependent patient with IICP drain --- back when everything was manual and slip-ups could have lethal conseuences. Continuously adjusting IABP timing, measuring critical parameters Q 15-30 min, including IICP pressure & drainage.... while titrating 2 pressor drugs, antiarrhythmic & fluids for optimal perfusion. GAH - absolutely exhausting, particularly for a 12 hour shift. Sooo glad that technology is much better now.

blackvans1234 · Mar 9, 2015

Waiting for the PICC Line nurses to chime in