Sunday, May 22, 2005

Nice things other nurses have done for me lately

Listen up: If you're in nursing school or a new-new nurse, you're going to learn a lot of really, really cool stuff and have a lot of folks doing you favors. At least, you will if you live in *my* universe, where nurses don't eat their young.

And if you're a not-so-new nurse (I refuse to call myself a New Nurse after three years, thanks), you'll still be learning/on the receiving end of nifty stuff. To wit:

1. A while ago, I had a patient come in through our triage center who the nurse downstairs thought might could use a blood transfusion (given that his hematocrit was something like 20, I could see that). So the nurse, in addition to starting an IV for me and hooking the patient up to normal saline, *hung that fluid with blood tubing* to save me a little time. Bless his head.

2. If you've got a person who's a really, really hard stick and you manage to get an IV on 'em, you can usually draw blood from that peripheral IV if you slap a tourniquet on the arm above it. I learned that just two days ago. For some reason, I'd never thought of the tourniquet.

3. Clearing feeding tubes is a constant bugaboo. If flat Coke doesn't work (and don't waste your time with other sodas; they're not acidic enough), magnesium citrate will. Strangely, this saline laxative, given time to dwell in a clogged feeding tube, will dissolve almost anything. Of course, you then have to deal with having fed your patient a laxative, but it's better than replacing a tube.

4. Chlorhexadine will get iodine stains out of clothing if the stains are fresh.

5. If you have a triple- or double-lumen central line with one lumen clotted off, it'll take you only thirty minutes with TPA to unclot it. If you wait until the whole thing's verklempt, you'll spend an hour mucking with TPA and saline. A stitch in time saves nine, you know.

6. Another nice thing somebody did for me: a workaholic patient came in with suspected meningitis. By the time he came up from admitting, his cell phone and Blackberry were already in Security, locked up away from him. (Meningitis patients do better with very little stimulation and stress in the early days.) Bless the admitting nurse who saved me the stress of getting his technology away from him.

7. If you're having a hard time starting a Foley on a woman, make your last pass with your iodine swab *up*. The urethral meatus in most women has a down-facing lip, and you can usually tell where the meatus is if you wipe up with iodine--it opens up a bit. Likewise, if you hit the vagina on your first try, *leave the catheter in there as a landmark* while you start the next one.

8. And finally, if your female patient has a very full bladder and you're trying to start a Foley, in-and-out catheterize her first with a tiny little catheter. For some reason I don't understand, that'll loosen things up enough that you can get a larger-bore Foley in there easily. I found that one out by accident, in desperation, and it's worked every time since.

Now that all the medical folks are nodding their heads, half are saying "She didn't know *that*??" and the non-medical folks have all crossed their legs and said "Oooooooooooo", I'm going off to iron.

Link o' the mornin' to ye!

I love this one:

Food Whore

7 comments:

Judy said...

I'm a NICU nurse -- been one a very long time. I didn't know a few of those things. I haven't slopped iodine on myself in a while, but it's nice to know how to deal with it. I hope I don't have to cath any adults any time soon, but I hope I remember that tip if I do. The last cath I assisted with was done with a 3.5 Umbilical Arterial catheter.

Wendy, S.N. said...

Yeah, and Coke will also disintegrate battery acid. Now that's scary.

W. :)

marjorie said...

Hi - new nursing grad here! Thanks for the tips! :) I'm definitely taking notes! Cheers...

Kelly said...

Just a little note: Our hospital bans drawing blood out of peripheral IVs because the blood tends to hemolyze or be clotted or whatever in the lab. They noticed this after one nurse in the ER's (who always drew out of peripheral IVs I guess) blood frequently was clotted off.

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nightRN said...

Hi Old nurse here well lets not say that lets say middle age. I have been doing this for 17 years. I just wanted to make a comment about drawing labs off of an IV catheter.
First of all drawing off a catheter should not cause the blood to hemolysie. If it would, then drawing a sample off an art line would also cause the blood to be hemolised.
In the last seven years I have drawn hundreds of labs off of already established IV catheters and have only had one that I had to redraw. If you pull back too hard or too fast it can damage the cells. The definition of Hemolysis is damaged blood cells. There for it was probably a technique problem that this nurse was having or she was drawing through a very; very small IV catheter such as a 24 ga. Drawing slowly off a 16, 18, or 20 ga should be fine.