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

[DarkestSamus]

Hey guys,

Although I do LOVE that my post is sparking such interest and getting people talking, remember that in my case, I need to be able to find evidence-based nursing journal articles and write a paper on the subject. I don't mind if you continue to discuss all of the various questionable actions you've seen, but if you're trying to answer my question, it needs to be something that somebody might have actually researched and written about, and I can write a 6-page paper on.

Thanks guys! Keep up the discussion!

[AOx1]

When to bathe newborns (some sources base on temp, others on time), what if anything to use for cord care, males: to circumcise or not. Not all are interventions though :)

[nurse simmy]

I had one instructor tell me we don't do Homan's any more to test for DVTs because if they have one, it may break it off. Another instructor does Homan's all the time, but if it is positive, it doesn't get repeated.

Today in class we were discussing pain meds for pancreatitis. Morphine vs Demerol. A recent change, as in from last edition of the text to this one says to use Morphine and doesn't mention Demerol at all. But all our previous classes said Morphine is a no-no, because it has negative effects on the sphincter of Oddi.

~Simmy

[CBsMommy]

How about the debate of a patient who is having a reaction to blood products. Do you run NSS to KVO or do you run it wide open.

[canesdukegirl, BSN, RN]

Hmm...some things that I have seen that I don't like:

1. Shaving with a razor before prepping. This is WAY old school and is not recommended by AORN. Clippers should be used instead. However, some of our surgeons DEMAND this practice. I simply refuse.

2. Placing a pillow behind the knees for comfort. I was taught that this can impede the blood flow at the popliteal artery. This was also a question on the NCLEX.

3. The practice of covering a sterile field with a towel if some part of it (let's say the right corner of your back table within the sterile field) becomes contaminated. This was a big deal recently and led to an all out war in the OR one day. The circulating nurse demanded that the entire table be broken down. The surgeon stated that since only one corner was contaminated, a sterile towel can be used to cover the contaminated area. We all looked through AORN standards and could not find anything regarding this scenario. I am curious as to how others here will respond to this.

4. We all know to put air into a vial prior to drawing it up. DON'T do it with Lymphazurin. It will explode all over you. I don't see anything about this on the vial itself.

OP, I have probably helped you exactly NOT AT ALL! Sorry about that, but I hope you can get some ideas nevertheless.

[klone, MSN, RN]

Inflating the foley balloon before inserting it

I literally learned just last month that this was no longer being done. That's how it was taught to me in nursing school, and it's how I've always done it. I just inserted my first foley last week without first inflating the balloon.

[klone, MSN, RN]

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

My understanding is that manufacturer insert instructs you to leave it in.

[mmm cdiff]

Injecting air into an NG tube to check for placement. I was taught in school that this is no longer evidence-based - check the pH of the aspirate instead. However, when my uncle was in the hospital recently, everyone checked via air injection & stethoscope.

[klone, MSN, RN]

I had one instructor tell me we don't do Homan's any more to test for DVTs because if they have one, it may break it off. Another instructor does Homan's all the time, but if it is positive, it doesn't get repeated.

I believe there is no evidence for Homan's being dangerous. It's no more dangerous than a pt ambulating, and we don't tell them not to do that.

[canesdukegirl, BSN, RN]

My understanding is that manufacturer insert instructs you to leave it in.

This is also my understanding. I think the rationale is that ALL of the medication will be delivered appropriately.

[Gluteus Maximus]

Hey guys,

Although I do LOVE that my post is sparking such interest and getting people talking, remember that in my case, I need to be able to find evidence-based nursing journal articles and write a paper on the subject. I don't mind if you continue to discuss all of the various questionable actions you've seen, but if you're trying to answer my question, it needs to be something that somebody might have actually researched and written about, and I can write a 6-page paper on.

Thanks guys! Keep up the discussion!

You've received a lot of good ideas here, but nobody is going to do the research for you.

You can do that part yourself.

[BacktoBasics]

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

I read something, years ago, that mentioned not doing this because your abd contents push up against your diaphram resulting in a barorecepter release.

I believe I got that right, but then again, I can't find the article.