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What are some questionable/old-fashioned nursing interventions?

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by DarkestSamus DarkestSamus (New) New

Hello all,

What are some questionable/controversial/old-fashioned Nursing actions currently in use right now? I need to find a topic to write about. I don't have a lot of clinical experiences and really don't have the ability to tell if something is old or incorrect.

The examples that I was given to help direct my search are:

1. The use of chlorahexadine vs. betadine

2. Saline flushes vs. herparin for IV locks

3. The use of saline bullets for trach/ET suctioning

As you can see, the kind of topics I need are "this vs. that" or "do vs. do not". I'm having a very hard time with my private searching and thought I would ask more experienced nurses.

Thanks!

- Brad

AnewerRN

Specializes in Tele, LTC, Medsurg, Float.

2. Saline flushes vs. herparin for IV locks

This topic is of particular interest to me. I work 2 jobs and each hospital has their own protocol for saline vs. heparin flushes. Interestingly enough in some areas the protocols of these hospitals are completely opposite. For instance one hospital calls for heparanized PICC line flushes and saline port flushes, and the other calls for saline PICC line flushes and heparinized port flushes. I don't know anywhere that flushes peripheral iv's with heparin. I think it would be very interesting to find what evidence based practice has to say about these matters.

I know, I find it interesting as well, but given as how that was one of the "examples", chances are I can't use it :/

NanikRN

Specializes in Oncology, Rehab, Public Health, Med Surg.

Inflating the foley balloon before inserting it and when cathing-never drain more than 750cc at a time

Are there arguments against those? I know the rationales - inflating the balloon is to test if it works, and the draining thing is to prevent bladder spasms. Is there up and coming evidence against those? If there is, that would be an interesting subject.

tyvin, BSN, RN

Specializes in Hospice / Psych / RNAC.

The suctioning with saline bullets is a good one; another one where there is much controversy is wet to dry drsging's.

For both or whatever you decide; do an internet search for juried articles concerning the practices. That's where you will find your evidenced based info in nursing journals or medical journals.

Why can't you drain more than 750 mls of urine from a foley. If the pt was peeing its not like they would be able to stop at 750 ccs and just hold the rest!

Hello all,

What are some questionable/controversial/old-fashioned Nursing actions currently in use right now? I need to find a topic to write about. I don't have a lot of clinical experiences and really don't have the ability to tell if something is old or incorrect.

I don't have any great ideas for you, just making an aside that this is an example of how sometimes nursing education sometimes seems to put the cart before the horse. Of course, we want professionals who can look at real practice and continously question and build upon current knowledge and practice. As the OP noted, to a total newbie, probably at least 80% of what they observe every day in clinical was not covered specifically in school and therefore is questionable since students are taught to never accept something is correct just because someone says it is. Having students learn about acknowledged controversies and how to access and evaluate resources on it would seem an appropriate and useful exercise for a beginner level assignment, but requiring that they come up with their own examples just doesn't seem useful at that level. It would be great in a class with students with more substantial clinical experience already. The problem is that many clinical rotations do not allow students as much opportunity and exposure as would be ideal, so even students close to graduation too often don't feel like they've seen or done much.

casi, ASN, RN

Specializes in LTC. Has 3 years experience.

I've heard that putting people in trendelenberg for low BPs is no longer the in thing to do.

Are there arguments against those? I know the rationales - inflating the balloon is to test if it works, and the draining thing is to prevent bladder spasms. Is there up and coming evidence against those? If there is, that would be an interesting subject.

There is evidence against pretesting ballloons, urologists and catheter manufacturers do not recommend it 1. the manufacturer already pretests the balloons 2. inflating and deflatiing the ballon prior to insertion can cause the balloon to form a crease and this can lead to urethral trauma when the catheter is inserted. 3. pretesting does not ensure the ballloon will deflate prior to removing it from the bladder.

http://www.o-wm.com/content/indwelling-catheter-management-from-habit-based-evidence-based-practice

The nursing rationale that interupting the drainage will prevent bladder spasms does not have scientific evidence to support it. If there is a high volume, urologists advise to drain the urine all at once as there is evidence to show that relieving the bladder distention prevents potential secondary complications such as hydronephrosis, bladder spasms, pain.

dishes

Edited by dishes

Mandychelle79, ASN, RN

Specializes in Psych. Has 2 years experience.

Why can't you drain more than 750 mls of urine from a foley. If the pt was peeing its not like they would be able to stop at 750 ccs and just hold the rest!

Most people would urinate before they hit the 750 cc mark. When I was doing a 24 hour urine sample I completely filled the jug in 24 hours, and was usually the amount added at a time was 450-500 cc's. However in my facility we drain no more than 1000 cc's at a time.

How about coke to unclog a feeding tube? No idea what the ruling on that would be with regards to evidence based practice but it's definitely considered an old nursing trick. I remember reading an article not so long ago regarding the need (or rather lack of need) for sterile instead of just clean technique for dressing changes.

brownbook

Has 36 years experience.

Putting an ice bag (we have soft cloth covered ones) on a patient's throat/neck after tonsillectomies. I asked an ENT once if he wanted an ice bag on the patients neck. Just seems strange to me? He kind of smiled, shrugged, and said, "If it makes you feel better do it."

nurses that take the air bubble out of the pre-filled Lovenox injectables...

I've heard that putting people in trendelenberg for low BPs is no longer the in thing to do.

I was told that in school also. But nurses still do it. Does anyone know what the rationale for not doing it is?

nurses that take the air bubble out of the pre-filled Lovenox injectables...

I was told to leave the little air bubble. What are others take on this?

Re: lovenox. I remember reading instructions to leave the bubble at the plunger behind the medicine and push the plunger all the way down to ensure that the entire dose clears the needle prior to removal from the skin.

It might also be thought to reduce potential bruising (?).

I've seen many a nurse get the air bubble out prior to injecting.

My instructor was teaching us about coke in the feeding tube to break up a clog. Im not sure if this is good nursing practice so I let it go in one ear and out the other:confused: