What are some questionable/old-fashioned nursing interventions?

[DarkestSamus]

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

[brownbook]

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."

[JoblessNewGradRN]

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

[Mommy of 2]

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?

[Mommy of 2]

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?

[jjjoy, LPN]

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.

[JazzysMama]

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:

[rnmi2004]

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.

The manufacturer specifically states to leave the air bubble in the syringe.

Lots of great questionable ideas here. How about activity level for patients with a DVT? They're not all bedrest anymore.

[kristandrews]

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?

my clinical instructor told us that trendelenberg decreases lung expansion, so we shouldn't use it when a patient vagals. i haven't researched it, though.

[tyvin, BSN, RN]

Another interesting one is head injury patients staying awake vs letting them close their eyes and rest. Seems to be some controversy about that one as well; that making them stay awake in some cases actually puts more strain on the person and can further injure them.

Another one could be wrapping patients in blankets whom display high fevers vs simple sheet and less clothing. We know now days "not" to wrap up the person too excessively (brings to mind a mental picture of a mother carrying her infant into the docs office wrapped in several blankets and thermal clothes claiming the child has a fever) that in fact can raise the temp vs cooling measures to control and help bring the fever down.

[indigonurse]

Whenever you are considering a topical solution for the skin you need to consider what type of microbes they are effective against and the toxicity to healthy tissues. Betadine is very effective against a broad spectrum of microbes, but can harm healthy tissue, also can cause a severe allergic reaction in anyone allergic to iodine. Chlorahexadrine IMHO is not as effective against microbes as betadine, is less harmful to healthy tissue, also can produce an allergic response but not as much as betadine can.

Saline is safer than hep. but hep is more effective in terms of keeping a vein open. Hep can get into the blood steam and be unsafe especially if someone is on an anticoagulant or has a low platelet count.

As far as saline for suctioning is concerned if someone has thick mucous that is occluding their airway I do not know of any better way to thin out the secretions so they can be suctioned and removed from the airway so the persons airway can be cleared. As long as a person does not use any more than is absolutely necessary.

[Otessa, BSN, RN]

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.

Some catheter manufacturers say NOT to inflate the balloon prior to placing.

[Alnitak7]

What comes to mind right away is the old idea of making someone put their head back when they have a nosebleed.

This makes blood go down to your stomach and from what I have heard, can cause vomiting.

The new protocol is to lean forward, or anything but putting your head back.