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Fireworks

This is hilarious and awesome and I cannot wait to hear about what happens next Tuesday!

 

And a rather disappointing update.

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PICC dressing change tips

I’ve already learned a couple of things this first week in my job!  Mostly related to changing the dressings on PICC lines.  Since I was reminded several times that “Hey, it’s just you out there in the field – no stopping Jane RN who’s passing in the hallway to ask if she can grab you a Biopatch” I thought I’d share the two main tips I learned.  (Hang in there – fun story at the bottom of the post!)

First is in regards to the statlock.  I was in the habit of taking the entire tegaderm dressing off, then fiddling with getting the statlock off and unstuck from the patient.  This sometimes jostled the PICC, which is obviously not a good thing.

I learned to take off the tegaderm until it was clear of the statlock, (but still covering the catheter at the insertion site) THEN take the statlock off.  Once that’s off, tape down the ports and finish removing the tegaderm.  This keeps the PICC nicely in place under the tegaderm while you’re messing with the Statlock.

The second thing I learned – and I am completely embarrassed to admit that I never really gave it any thought, thereby ensuring that the next person to change the PICC dressing I’d done probably cursed me – is to always put the slit of the Biopatch around the PICC line itself.  That way, when you take off the tegaderm, the Biopatch just comes right off with it.  I was in the habit of putting the Biopatch on then rotating it for whatever reason – to make sure it stayed on?  Like it was really going to go anywhere under the tegaderm?  Here‘s a great picture of what it should look like. I *KNOW* I am not the only person who does it wrong, because I have changed many PICC dressings wherein the tegaderm was stuck to the Biopatch and it took forever to get it all apart while trying to preserve the PICC line.

I was beyond (BEYOND) happy to find out that hospice nurses at this organization do not start peripheral IV’s.  We may do venipuncture for labs, but no starting IV’s.  I am very bad at starting IV’s.  I will even go so far as to admit that I have not successfully started an IV in over 5 years.  To qualify, though – I was only working one day per week in all that time, and I worked in CCU.  CCU patients have central lines and PICCs.  And I always seemed to be working with nurses who were masters at starting hard IV’s so all I had to do was ask, and someone would come do it for me.

My IV-starting mojo was damaged early on, and I will tell you why.  When I was working in my very first job as a nurse, my grandfather had to come to the hospital I was working at for carotid surgery.  I went to visit him on the med/surg floor during a break from my shift and his nurse noticed that his IV had infiltrated.  He needed a new one.  She tried 2 or 3 times, but couldn’t restart it.  Another nurse was sent in – she also tried several times without success.  With the nurse’s permission (and my grandfather’s), I then tried to start the IV.

I found a suitable vein and prepped the skin.  Right before I stuck the the needle in, I offered up a silent prayer: “Please, if the gods are listening – I really want to get this IV in.  If I never start another IV again, please PLEASE let me be able to start this one.”

I got it in on the first try…. and the gods were listening.  Although I have successfully started many IV’s since that day, I have never been very good at it overall.  Ah well.  I was good at it when it really counted :-)

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When the String is Cut

One of my colleagues recently died.

When I started at my current hospital, she was my main preceptor.  She was a stickler for getting things done correctly – no shortcuts.  When I would come across a patient or apparatus that I was unfamiliar with, all I wanted was for her to tell me what to do or show me how to operate it, but every time she insisted on having me look it up.

I came to appreciate the wisdom in that.

We worked together for several years.  She eventually went to a different department, I started working per diem, and we didn’t see each other much anymore.  But we’d run into each other here and there over the years.

She was very kind.  She wasn’t the type that was into gossip, but she did always want to know what was going on with you.

I saw her about a week before she died.  Everyone knew her time was short, including her.  Yet when you walked into the room, her face would light up and you’d get the impression that she was thinking, “Ah, just the person I was hoping to see.”  She handled the whole thing so much more gracefully than the rest of us.

I was thinking last night about how she simply isn’t in the world anymore.  And how weird that is.  I feel like we are all connected by invisible strings to the people we know, and when one string is cut, even the thinnest one, it throws you off balance.

I’m feeling a bit off-kilter for sure.

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I Don’t Know How You Can Do This

Or the other statements, “I could never do this” and “It takes a special person to be able to do this.”

These words are usually uttered by family members who walk into an ICU room to see me calmly managing a patient on drips and vent, hooked up to monitors and other various tubes and wires.  I’m sure these words are spoken many many times every day all over the world.

I appreciate hearing it, but it always makes me think of the jobs that I could never do. Sure, there are lots of jobs that I’d simply be unhappy doing, but there are a few that I’d almost rather starve than do.

I could never be a dentist or hygienist.  I cannot handle dealing with teeth.  If I see my that my intubated patient has a loose tooth, I’m done for.

I could never be an exterminator.  In fact, I was talking to an exterminator the other day (If you don’t live in California, you are probably not aware that it is, in fact, resting atop a gigantic ant hill).  He was friendly and chatty and I myself mentioned that I don’t know how he was able to do what he does because I literally shiver with disgust at the mere PICTURE of a large bug.  He then asked what I did and I replied that I was a nurse.  He looked at me for a moment and said that the site of blood completely freaks him out.  There’s no way he’d ever work in the medical field.

Within my own profession, I can imagine doing almost any type of nursing.  That isn’t to say that I’d enjoy it or even be good at it.  But there is one branch of nursing that I will never go into.  There is one patient population that I cannot even begin to cope with taking care of, and that is burn patients.  I don’t know how you can cause someone so much pain day in and day out, even if it’s in the name of healing.   Any burn unit nurses out there?  How on earth do you work in such a unit?

What are some jobs that you could never do?

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Where’s Our Bailout?

Here’s a very thought-provoking post from edwinleap.com:

So the money is flowing from the taxpayers to the industries in order to keep all of them solvent.  Mind you, we in medicine have asked for some crazy things like: increases in reimbursement for actual work on actual people; tax credits for uncompensated care; limits on malpractice awards.  As a result, Medicare payments fluctuate along with Medicaid.  Care is still free.  Malpractice litigation sails along as smoothly as the Love Boat.

Great post!

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When You Look Up

This post might be a little weird, but here goes. I was thinking the other day about when you’re concentrating on something in front of you, and you look up for no particular reason and are faced with something dreadful or funny.

For instance, once I was at work charting and heard a mechanical noise next to me. I didn’t really think anything of it (I’m surrounded by machines!) but decided to look up when I heard the noise stop. In ICU rooms, there are monitors mounted to the wall next to the beds. They’re high up, maybe 6 1/2 feet. I’m 5’5″ and I always have to reach way up to adjust alarms, etc. When I looked up, I saw that my patient had found the button that raises the entire bed – all the way up to the monitor. He could have started playing with it if he’d had the inclination. I didn’t realize that the beds could go that high.

Other things I see aren’t so humorous. This just happened the other day and it always makes my stomach drop with dread. I walked into my patient’s room, looking at her medications as I did so, and looked up to see a pool underneath her bed – of liquid poo. When there is so much poo that it actually starts falling off the bed to form a puddle below, things have simply taken a turn for the worse.

It’s always a treat to look up and see your vest-and-wrist-restrained patient hanging upside down over the side rail of their bed. Completely tangled.

This last one didn’t happen to me, but I heard plenty about it. We had a patient who fell at home and broke his neck. The doc decided that he needed Gardner-Wells tongs (scroll down a bit for a picture) until surgery could be done. These are tongs that are secured into the head to provide traction for the cervical spine. I don’t know if they’re screwed into the skull, but suffice it to say that you don’t want those suckers comin’ out.

Can you see where this is going? The night shift nurse looked up and saw her previously flat-on-his-back patient sitting up in bed, tongs off to the side of the bed. The patient stated that they were really bothering him and he felt much better having them off, thank you. He also relayed that it was really difficult to get them off, but it was worth it to be free of them!

No harm done; the patient had his tongs replaced, had surgery later that day and did just fine. Still… what a sight.

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Alltop. I don't know how I got there either.


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    Profile for geenaRN

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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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