THIS IS RIGHT AFTER THE MATH TEST I JUST ADAPT SOME OF IT.
ALRIGHT. ONE OF THE QUESTIONS OVER HERE,
THE PHYSICIAN ORDERS THE FOLLOWING IV'S TO BE ALTERNATED OVER 24 HOURS.
AND THEN IN PARENTHESES IT WILL SAY, GIVE ALL TWO,
THREE, FOUR, FIVE IV'S IN 24 HOURS.
IT'S NOT SUPPOSED TO BE A TRICK QUESTION.
IT'S SUPPOSED TO BE LIKE,
WE WANT YOU TO FIGURE OUT THE RATE BASED ON 1000 CC
OR 2000 OR 3000 OR 4000 OR 5000, SIMPLE AS THAT.
SO DON'T MAKE IT LIKE 1000 ONE DAY
FOR 24 HOURS AND 1000 ANOTHER 24 HOURS.
IT'S ALL OF THEM IN A 24 HOUR PERIOD.
IT WAS JUST A CREATIVE WAY TO GET YOU TO LOOK AT A DIFFERENT RATE.
SO LET'S SAY YOU HAD FOUR IV'S,
THESE FOUR IV'S, WAS WHAT, HOW THE QUESTION READ.
SO IF YOU HAVE ALL FOUR OF THESE IV'S IN 24 HOURS,
WHAT'S YOUR RATE IN MILLIMETERS PER HOUR?
RIGHT. CALCULATORS, RIGHT? BECAUSE YOU ALWAYS CARRY THEM IN YOUR POCKET.
BECAUSE ALL NURSES CARRY THEM IN THEIR POCKET.
4000 DIVIDED BY 24 EQUALS,
YOUR NEW RATE IS A 166 TO 167 MILLILITERS PER HOUR.
THAT'S A 166.666666. CORRECT. OKAY?
SO THAT'S YOUR ANSWER. ALL YOU DID,
YOU ADD THEM UP, YOU HAVE 4000, YOU DIVIDE THEM BY YOUR 24 HOURS.
AND IT'S THE SAME AS DOING YOUR OTHERS.
LIKE WHEN YOU WERE JUST WORKING OFF OF THE OTHER RATES.
OKAY. ONCE YOU'VE FIGURED OUT YOUR RATE,
HOW MANY DROPS PER MINUTE WILL THAT BE
IF YOUR DROP FACTOR IS -- AND WE WILL ALWAYS GIVE YOU YOUR DROP FACTOR,
LET'S SAY, IT'S 20?
SO IF YOUR DROP FACTOR IS 20 AND YOUR RATE IS 166
AND I STILL HAVE MY 0.666 THING. SO I'M JUST GOING TO DIVIDE BY THREE.
AND MY DROPS PER MINUTE IS 55 TO 56 DROPS PER MINUTE. OKAY?
WHAT'S THE DROP FACTOR YOU'VE TAKEN?
DROP FACTOR UP HERE IS 20.
AND IT WILL BE ANYTHING. DROP FACTOR 20 DROPS PER MINUTE.
SO, IF YOU ASK FOR JUST THREE WE JUST DO THE FIRST THREE, IS THAT RIGHT?
YEAH, IF I SAY GIVE THE FOLLOWING THREE IV'S,
YOU DIVIDE IT, 3000 DIVIDED BY 24. I MIGHT SAY TWO.
I MIGHT SAY FIVE. I DON'T KNOW...
BUT WILL YOU GIVE US LIKE FIVE IN A LIST OF THREE? - UH-HUH.
YEAH. I WILL LIST EXACTLY WHAT -- IT WILL MATCH THE QUESTION.
THE POINT IS, IT'S JUST -- ALL THE TESTS ARE DIFFERENT.
YOU MIGHT HAVE 2000, AND SHEILA MIGHT HAVE 5
AND ERIC MIGHT HAVE 3 AND IT IS WHATEVER.
THE POINT IS, WE JUST LIKE YOU TO TAKE THE WHOLE, DIVIDE IT BY 24,
THEN YOU COME UP WITH YOUR CC PER HOUR AND YOUR DROPS PER MINUTE.
OKAY. SO THAT'S FAIRLY STRAIGHTFORWARD.
HERE IS THE NEXT THING WE HAVEN'T TALKED MUCH ABOUT.
IF BAG NUMBER ONE WAS HUNG AT 9:30
AND IT INFUSES ON TIME,
WHEN WILL YOU HANG BAG NUMBER TWO?
OKAY. WE CAN DO THIS MATHEMATICALLY QUITE SIMPLY.
YOU CAN MUSCLE IT OUT OF YOUR BRAIN LIKE A TIME TAPE,
AND YOU KNOW WHAT I MEAN. AND GO 166 PLUS 166 AND ADD UP ALL YOUR HOURS.
SO LET'S DO IT QUITE SIMPLY HERE.
IF YOU HAVE 1000 CC,
GOING AT 166 PER HOUR,
IT'S JUST A 1000 DIVIDED BY 166 EQUALS
6.02 HOURS.
THAT'S BASICALLY GOING TO TAKE SIX HOURS, RIGHT, FOR IT TO GO IN.
I'M NOT EVEN WORRIED ABOUT THE 02, OKAY.
SO SIX HOURS AND SIX HOURS ONTO THERE.
WHEN WILL YOU HANG BAG TWO?
AT 1530.
SO JUST ADD YOUR HOURS ONTO THE OTHER TIME.
WHAT IF YOU HAD A BAG GOING IN AT LET'S SAY...
ARE YOU ALL GOOD TO GO WITH THIS. CAN I ERASE?
WHAT IF YOU HUNG A BAG AT 8 O'CLOCK AT NIGHT?
YOU HUNG 1000 CC.
IT'S RUNNING ON TIME AND IT'S RUNNING AT 80 CC,
CLOSE TO YOUR HEART, LET'S DO 75 CC AN HOUR.
YOU HUNG 1000 CC AT 8 O'CLOCK AT NIGHT
- IT'S GOING AT 80 CC AN HOUR. - 7 O'CLOCK.
7 O'CLOCK. THANKS. I NEEDED AN ODD NUMBER, NOW IT TURNS OUT ODD.
OKAY. HOW MANY HOURS DOES THAT TAKE?
- 5. - THAT'S NOT TOO ODD. OKAY.
IT TAKES TWELVE AND A HALF HOURS,
SO 12 HOURS AND 30 MINUTES, RIGHT?
THAT I'M GOING TO ADD TO MY 2000.
SO THE NEXT BAG IS DUE...
- DIVIDED BY 75 ISN'T 12.5. - AND 3230 HOURS?
OKAY, YOU GUYS, I'M COMING TO YOUR NUMBERS.
I DIDN'T DO IT. OKAY.
YOU WANT ME TO MESS UP?
DIVIDED BY 7.
- YOUR SENSITIVE --
WHO TOLD ME 12.5?
IT'S 13.3 -- OH, DID YOU HEAR THEIR NAME CALL OUT?
OKAY. 13.3 HOURS.
OH, THIS IS GOOD. OKAY, EVEN BETTER
WE NEED AN ODD ONE.
BECAUSE EVERYTHING DOES NOT COME OUT EVEN IN LIFE. OKAY.
IT'S GOING TO TAKE 13.3 HOURS,
AND WE HUNG IT AT 8 O'CLOCK AT NIGHT.
SO WE KNOW THE 13 HOURS PART, BUT HOW MANY MINUTES IS 0.3 HOURS? - 18.
SO LET'S JUST DO MATH FOR THOSE THAT CAN'T MUSCLE IT OUT OF THEIR BRAINS.
YOU KNOW THAT ONE HOUR IS 60 MINUTES, RIGHT?
SO 0.3 HOURS IS X MINUTES. CROSS MULTIPLY.
SO 60 TIMES 0.3 EQUALS 18 MINUTES,
THAT WAS GOOD. KEEP UP YOUR HAND.
ALRIGHT. SO WE KNOW IT'S GOING TO TAKE 13 HOURS AND 18 MINUTES TO GO IN.
ALRIGHT. IF I ADD THOSE TWO TOGETHER, I COME UP WITH 33.18.
THERE IS NO SUCH BEAST AS THE 33RD HOUR OF THE DAY.
SO ONCE YOU COME UP WITH THAT, SUBTRACT YOUR 24,
YOU GOT 18.
AT 9:18 YOU WILL HANG THE NEXT BAG,
IF WE TOOK EVERY BAG TO THE EXACT SECOND.
THAT'S AS HARD AS IT WILL EVER BE.
MOST OF MY NUMBERS COME OUT EVEN
WITH THE DROP RATES AND ALL THAT STUFF.
BUT YOU'RE GOING TO GET TWO QUESTIONS THAT SAY
IF YOU HUNG THIS BAG AT THIS HOUR AND IT'S GOING AT THIS RATE,
WHEN WOULD YOU EXPECT TO HANG THE NEXT BAG?
SO YOU HAVE TO TELL ME HOW MANY HOURS IT WILL TAKE IN THE TIME.
PLEASE USE MILITARY TIME BECAUSE IF YOU PUT 2 O'CLOCK OUT
AND IT'S SUPPOSED TO BE 2:00 IN THE AFTERNOON I WON'T GIVE IT TO YOU.
BECAUSE I DON'T KNOW WHAT YOU MEANT.
SO STICK WITH MILITARY.
AND IF YOU JUST KEEP ADDING YOUR NUMBERS IT'S REALLY EASY ON THE 24 HOUR CLOCK.
THE PROBLEM IS THAT WHEN YOU ADD YOUR NUMBERS TOGETHER
IT GOES OVER THE 24 HOUR CLOCK.
JUST SUBTRACT 24 AND YOU'LL COME UP WITH YOUR NUMBER.
OKAY? AND IF YOU RUN INTO SOMETHING THAT IS ODD,
LIKE A 0.3 HOURS OR 0.5 HOURS -- 0.5 IS EASY, RIGHT?
THAT'S 30 MINUTES, BUT ANYTHING ELSE, 0.4, 0.7,
THEN TAKE YOUR POINT HOURS
AND SEE HOW MANY MINUTES IT IS COMPARED TO ONE HOUR IS 60.
END UP JUST MULTIPLYING THEM TOGETHER AND THAT'LL GIVE YOU YOUR MINUTES.
WHERE DO YOU WANT TO BORROW WHEN 0.02 WAS NECESSARY BY THE MINUTE?
LET'S SEE WHAT IT WAS. IT WAS AT 0.02 A MINUTE. .02 TIMES 60.
- ONE TWENTY. - ONE MINUTE.
I THINK WE COULD, MAYBE, DRAW THE LINE AT ANYTHING 0 ANYTHING.
- AT LEAST GET YOURSELF TO 10. - OKAY.
YEAH, SO ANYTHING IF IT IS JUST IN THE 100S,
I DON'T REALLY CARE. BUT ONCE YOU GET TO 10,
WE GOT TO FIGURE IT OUT.
ALRIGHT. ALRIGHT, THAT'S ONE KIND OF PROBLEM.
HERE'S ANOTHER ONE.
IF YOU HAVE AN IV OF 750 MILLILITERS
AND IT WAS ORDERED TO GO OVER FIVE HOURS.
IN TWO AND A HALF HOURS ONLY 200 MILLILITERS HAVE BEEN USED.
HOW MUCH WOULD YOU HAVE EXPECTED TO GO IN, IN HALF THE TIME?
375, RIGHT? HALF OF IT.
YOU WOULD HAVE EXPECT HALF OF 750 TO HAVE GONE IN,
BUT ONLY 200 HAS GONE IN.
SO HERE IS THE RULE.
IN IV THERAPY IF THE DOCTOR ORDERS AN IV
TO BE INFUSED AT 125 CC PER HOUR
AND THE IV GETS BEHIND OR AHEAD YOU CAN'T PLAY CATCH UP OR SLOW DOWN.
YOU JUST RESET THE RATE AND CONTINUE ON.
BUT IF THE DOCTOR ORDERS 500 MILLILITERS TO BE GIVEN IN FIVE HOURS
AND YOU'RE RUNNING BEHIND, YOU GOT TO SPEED IT UP.
AND IF YOU'RE RUNNING AHEAD, YOU BETTER SLOW DOWN
BECAUSE THE GOAL IS TO GET THAT VOLUME IN IN THAT TIMEFRAME.
SO THAT'S THE ONLY TIME YOU CAN ADJUST THE RATE BASED ON A VOLUME AMOUNT.
OKAY?
SO, KNOWING THAT WE CAN ADJUST THE RATE BECAUSE WE'VE GOT TO GET 750 IN
AND WE'RE WAY BEHIND, WHAT WOULD YOUR NEW RATE BE
AND HOW MANY DROPS PER MINUTE,
IF YOUR DROP FACTOR IS...
..10?
WHERE DID YOU GET 550 WHEN ACTUALLY YOU HAVE...?
YES, SO LET'S START FROM THE BEGINNING.
YOU HAVE -- 750 WAS SUPPOSED TO GO IN AND 200 HAS INFUSED.
HOW MUCH IS LEFT IN THE BAG?
YOU HAVE 550 LEFT AND YOU HAVE HOW MANY HOURS?
- TWO AND A HALF. - TWO AND A HALF.
DIVIDE YOUR 550 BY TWO AND A HALF.
MY NEW RATE...
..220 MILLILITERS PER HOUR TO GET IN 550.
YOU CAN, KIND OF, ADD THAT UP YOURSELVES.
220 AND 220 IS 440, PLUS HALF OF THAT, 110, 550.
YOU KNOW, SEE WHAT I'M SAYING, YOU, KIND OF, MAKE IT LOGICAL.
I'M HAPPY WITH MY RATE THERE.
SO, HOW MANY DROPS PER MINUTE FOR MY NEW RATE,
IF MY DROP FACTOR IS 10?
- 36 TO 37. - 220 DIVIDED BY 6
IS 36.6666.
SO YOU CAN SAY 36 TO 37 DROPS PER MINUTE.
ALRIGHT. EVERYONE WILL HAVE A QUESTION SIMILAR TO THAT.
YOUR IV WILL BE AHEAD OR BEHIND, I DON'T KNOW WHAT IT WILL BE, BUT SOMETHING.
SO SUBTRACT WHAT WENT IN, I MEAN, WHAT'S LEFT --
WHAT WENT IN.
200 FROM WHAT WAS YOUR TOTAL TO SEE WHAT'S LEFT.
THE KEY IS YOU GOT TO GET TO WHAT WAS LEFT IN THE BAG,
DIVIDED BY THE REMAINING TIME OR YOUR HOURS,
YOUR MILLILITERS PER HOUR AND THEN YOUR DROPS PER MINUTE.
ONCE YOU GET TO THE CC, MILLILITERS PER HOUR, YOU'RE GOOD TO GO.
EVERYONE OKAY? NO STRESS? NO PAIN ON THIS?
YOU JUST WANT IT DOWN TO THE CC PER MILLILITER PER HOUR, RIGHT? - UH-HUH.
ALL OF THE QUESTIONS WILL BE IN A MILLILITERS PER HOUR MODE AND DROPS PER MINUTE.
I WILL NEVER ASK YOU ON THIS TEST HOW MANY DROPS PER FIVE SECONDS OR 15 SECONDS.
THAT'S JUST A MECHANISM OF MAKING YOUR RATE HAPPEN.
BUT ALL OF YOUR RATES WHEN YOU'RE WORKING WITH YOUR PUMPS
AND WHEN YOU'RE TALKING WILL BE IN MILLILITERS PER HOUR.
SO I REALLY WANT TO EMPHASIZE GETTING IT DOWN TO THAT COMPONENT
AND THEN THE REST IS YOUR PREFERENCE, HOW YOU MAKE IT HAPPEN.
AND YOU GOT TO AT LEAST KNOW DROPS PER MINUTE TO MAKE IT HAPPEN. OKAY?
NEXT WEEK I'LL GO THROUGH THE WHOLE TEST WITH YOU
AND JUST SO THAT YOU FEEL LIKE YOU'VE COVERED ALL THE MATERIAL.
THE ONLY OTHER QUESTION THAT WE HAVEN'T REALLY GONE OVER
AND IT'S BASICALLY A REVIEW QUESTION FROM LAST SEMESTER.
I'M GOING TO GIVE YOU A LABEL OF SOME SORT
AND IT'S GOING TO TELL YOU THE PARAMETERS OF
MILLIGRAMS PER KILOGRAM PER DAY THAT THE CHILD CAN HAVE FOR THEIR WEIGHT.
AND IT WILL SAY, ALL THE QUESTIONS ARE THE SAME,
WHAT IS THE THERAPEUTIC DOSE RANGE FOR THIS CHILD.
AND ARE THEY GETTING A SAFE DOSE?
AND SO THAT'S ONE. AND WE'LL, KIND OF, GO OVER THAT NEXT TIME.
BUT REVISIT YOUR LABELS AND MAKE SURE YOU'RE COMFORTABLE
WITH LABELS BECAUSE THERE IS ONE.
WELL, THERE'S ACTUALLY TWO LABELS ON IT.
CAN YOU GET THIS LIGHT?
IT'S THE FIRST ONE.
OKAY.
HOMEWORK. MORE MATH.
OKAY, WHITE BOOK.
BLUE BOOK.
- BLUE BOOK.
SO, THERE YOU GO, YOU GUYS IN THE MIDDLE, WHITE BOOK.
TURN IT IN NEXT TUESDAY...
- BLUE BOOK? - ...JUST ON THE BACK.
OKAY. YOU'RE GOING TO LIKE THIS WEEK.
THIS WEEK ISN'T AS HARD MENTALLY AS THIS WEEK WAS,
BUT IT'S HARD DEXTERILY.
WE'RE GOING TO HAVE TO DO SOME CO-ORDINATION ISSUES HERE.
ALRIGHT. WHAT WE ARE GOING TO DO THIS WEEK IS
WE'RE GOING TO ACTUALLY ADMINISTER
THE SAME MEDS YOU ADMINISTERED LAST WEEK, YESTERDAY.
BUT WE'RE GOING TO DO IT WITH IV LOCKS.
SO OUR THEME THIS TIME IS VENOUS ACCESS,
BUT WE'RE GOING TO BE DOING IV LOCK THERAPY
TO GIVE THE SAME MEDS THAT WE GAVE FROM A CONTINUOUS DRIP. OKAY.
SO THE FIRST THING I WANT TO DO
IS I JUST WANT TO CONVERT MY IV TO AN IV LOCK.
SO ONE OF THE STATIONS THAT YOU'RE GOING TO COME TO --
MY STATION AS A MATTER OF FACT,
IS GOING TO BE CONVERTING A CONTINUOUSLY DRIPPING IV,
WHICH IS THIS ONE...
...TO AN IV LOCK.
SO YOU CHECK YOUR DOCTOR'S ORDER WHEN THE DOCTOR WILL SAY,
CONVERT IV TO IV LOCK.
THEY WILL SAY FLUSH PER PROTOCOL OR THEY MAY SAY NOTHING.
IF THEY'VE ORDERED THE IV LOCK,
THEN WE HAVE TO MAKE THE IV LOCK TO REMAIN PATENT, THAT'S OUR JOB.
WHEN YOU HAVE AN IV LOCK -- REMEMBER, WHEN I STARTED THE IV ON SOMEBODY
AND I CAPPED IT OFF, THAT WAS AN IV LOCK.
TO KEEP THAT FROM CLOTTING OFF YOU'RE GOING TO FLUSH IT WITH SALINE.
THAT'S JUST WHAT WE DO NOW. WE USED TO FLUSH THEM WITH HEPARIN.
AND SO YOU'LL HEAR NURSES STILL CALL THEM HEPARIN LOCKS
EVEN THOUGH WE ARE JUST PUTTING SALINE IN.
WE USED TO PUT HEPARIN TO KEEP THEM FROM CLOTTING,
LOW DOSES OF HEPARIN.
BUT THEY FOUND THAT SALINE WORKS AS WELL,
AND IT'S CHEAPER AND THERE IS LESS SIDE EFFECTS RELATED TO IT.
SO SALINE LOCK.
THE GENERIC TERM IS IV LOCK.
YOU'LL HEAR ALL THREE TERMS USED, IV LOCK,
SALINE LOCK, HEPARIN LOCK AND THERE YOU GO.
SO OUR CLIENT MAY STILL NEED ANTIBIOTICS,
MAY STILL NEED SOME TREATMENT, BUT THEY DON'T NEED CONTINUOUS FLUID.
THEY DON'T NEED THE VOLUME ANY MORE. THEIR FLUIDS ARE FINE.
THEY JUST NEED A THERAPY THROUGH THEIR VEIN, ONLY NEED ACCESS TO THE VEIN.
SO WE'RE GOING TO TAKE THE TUBING OFF
AND WE'RE GOING TO PUT A LOCK ON.
WE'RE GOING TO GATHER UP OUR EQUIPMENT. HANDS ARE WASHED.
WHAT YOU NEED IS AN IV LOCK
AND THESE ARE THE BASIC TWO BRANDS THAT ARE OUT THERE RIGHT NOW.
THIS IS A SIMPLE IV LOCK.
ACTUALLY, I WANT TO SHOW YOU ONE MORE THING.
ACTUALLY THREE THINGS.
WHEN WE TAKE THE TUBING OFF, YOU KNOW WHERE YOU CONNECTED IT.
WE COULD TAKE THE TUBING OFF AND JUST PUT A CAP ON LIKE I DID.
SO HERE IS A CAP, BUT MOST OF THE TIME WE USE THESE EXTENSIONS.
AND THAT'S WHAT YOU HAVE SEEN ME HOOK ON TO ALL THE MANNEQUINS
SO YOU COULD HOOK UP YOUR IV'S TO THEM IN THE OTHER ROOM.
AND WHEN WE'D HAVE AN EXTENSION, WE NEED TO FLUSH THIS
AND THEN HOOK IT ON.
AND IT'S JUST A LITTLE EASIER TO WORK AROUND THE IV
WHEN YOU'RE NOT SO CLOSE TO THE HUB.
THEN YOU CAN WORK OFF OF THIS PIECE.
THE THING WE LIKE TO DO WHEN WE START AN IV,
WHEN I'M ON THE FLOOR AND WHEN I'M NOT RUSHED,
RIGHT WHEN I GET MY IV, YOU KNOW HOW YOU PRIMED YOUR IV TO START IT
AND YOU JUST DID YOUR PLAIN OLD TUBING,
I ALSO HOOKED ONE OF THESE ON.
SO IT'S HOOKED ON AS MY EXTENSION,
SO THAT WHEN I START THE IV I HOOK THIS ON.
AND THEN WHEN IT GETS CONVERTED TO AN IV LOCK, I'M ALREADY DONE.
I JUST DISCONNECT THE IV AND THE LOCK IS ALREADY ON THERE.
SO THEY GET A LITTLE MORE LENGTH.
WE'VE ALREADY CREATED OUR LOCK. IT'S BEAUTIFUL.
SO YOU'LL SEE IN THE HOSPITALS THAT WE DO IT THAT WAY
BECAUSE IT IS NICE.
IF THEY WANT TO TAKE A SHOWER,
WE JUST DISCONNECT THEM REAL QUICK,
WRAP THEIR ARM IN CELLOPHANE AND SAY GO JUMP IN THE SHOWER.
SO THEY'RE FREE. - THERE IS LESS TRAUMA.
UH-HUH. AND THEY HAVE THIS, YEAH, ALREADY ON.
SO YOU MAINTAIN THE SITE AND IT'S A GOOD DEAL.
SO GET IN THE HABIT WHEN YOU START YOUR IV'S
TO GO AHEAD AND PUT ON YOUR EXTENSION.
NOW THESE ARE NICE. I LIKE THEM JUST PLAIN, A LOOP IN THIS.
THIS IS THE NEW IV LOCK THAT THEY STARTED AT...
..ACTUALLY I SAW IT AT KAISER AND SAINT AGNES IS USING THESE.
AND IT ACTUALLY LOOKS LIKE THIS.
THAT'S GOT THESE TWO CAPS ON IT. AND IT LOOKS LIKE THIS.
AND IT'S SO THAT YOU CAN HOOK A CONTINUOUS LINE ON HERE OR ON HERE
AND THEN USE THE OTHER PORT FOR MEDS. AND SO YOU GOT TWO.
THE REASON I DON'T LIKE IT IS YOU GOT ALL THIS STUFF HANGING OFF OF IT
FOR JUST A LOCK.
I WENT TO VISIT A FRIEND IN THE HOSPITAL YESTERDAY.
AND SHE HAD ALL THIS PARAPHERNALIA AND THEY HAD PUT IT IN A WEIRD PLACE
AND THIS IS STICKING ALL WHACKO AND I'M LIKE, "OH THAT'S MESSY,
I DON'T LIKE THE LOOK OF THAT."
WHEN IT WAS JUST STUCK IN HER HAND, SO -- BUT IF IT IS ALL YOU GOT. WHAT ARE YOU GOING TO DO?
ALRIGHT. SO WE'VE GOT TO GATHER OUR EQUIPMENT.
BUT BEFORE I LOSE MY THOUGHT,
I WANT TO JUST SHOW YOU ONE OTHER LITTLE THING.
REMEMBER, I TOLD YOU THAT SOMETIMES THESE BREAK
IF YOU STICK A NEEDLE IN THEM OR YOU BREAK THEM OR SOMETHING.
THEY'LL START LEAKING. AND OURS START LEAKING SOMETIMES
BECAUSE WE USE THEM SO MANY SEMESTERS AND SO MANY STUDENTS
AND SOMEONE INADVERTENTLY STICKS A NEEDLE IN,
THEY FORGET OR WHATEVER, LIFE.
ALL YOU HAVE TO DO IS GET ONE OF THESE LITTLE ADAPTORS,
THE LITTLE CAP ITSELF,
CLEAN IT OFF AND YOU CAN START STACKING THESE
AND PUT THIS ON TO YOUR BROKEN SITE.
AND NOW IT'S A FIXED SITE.
BECAUSE WE'VE NOW PRESSED IN THAT DIAPHRAGM
AND SO IT'S IN ITS RECESSED MODE.
AND NOW THIS IS THE GOOD, SPRINGY ONE.
AND WE'VE GOT A PATENT LINE WHEN WE SPRING IT
AND YOU'VE SEALED UP THE PROBLEM.
SO YOU CAN START STACKING THEM PRETTY DEEP,
BUT IT'S KIND OF AGGRAVATING AND A LITTLE,
YOU KNOW, AWKWARD WHEN IT'S HEAVY. BUT IF SOME, YOU KNOW,
IF YOU FORGET OR THEY SAY, "OH, STUDENTS,
THEY BREAK OUR STUFF," AND YOU GO, "WELL, DON'T YOU KNOW HOW TO FIX IT?"
NO, THAT WOULD BE SNOTTY.
BUT TRULY YOU KNOW THEY ALWAYS SAY,
THE STUDENTS DID IT AND THE STUDENTS DID THIS, THAT AND THE OTHER THING.
SO YOU JUST SAY, "WELL I KNOW HOW TO FIX IT.
ME TOO OR "IT'S JUST THE TUBING." YOU KNOW.
BECAUSE THEY DO. THEY DO GET OLD AND THEY BREAK
OR THEY DON'T WORK AS WELL AS THEY SHOULD AFTER MANY USES.
AND THEY ARE REPARABLE.
ALRIGHT. SO HERE WE ARE BACK TO OUR ORDER.
WE NEED AN IV LOCK, I'M GATHERING MY EQUIPMENT.
MY EQUIPMENT IS GOING TO BE --
AND I'M JUST GOING TO USE THIS SIMPLE, LITTLE IV LOCK FOR NOW
AND GET RID OF MY STUFF.
MAY I JUST MENTION THAT,
YOU KNOW HOW TEACHERS HAVE THE WEEK THAT THEY DREAD,
OUR WEEK FROM HELL, IT WILL BE NEXT WEEK.
WE DREAD THIS WEEK.
IT'S JUST NOT -- IT'S NOT THAT ANYTHING IS SO HARD,
IT'S JUST THAT IT'S A HUGE, HUGE WEEK.
HUGE SETUP. IT TOOK ME ABOUT HALF AN HOUR TO SETUP.
AND I'VE BEEN DOING IT FOR YEARS.
GET HERE EARLY. AND I'M NOT EXAGGERATING.
I WANT TO SEE EVERYONE HERE AN HOUR BEFORE YOUR APPOINTMENT TIME,
GETTING YOUR SUPPLIES READY, GETTING YOUR THOUGHTS READY.
IT'S A HUGE, HUGE SETUP OF EQUIPMENT.
BECAUSE YOU GOT TO DRAW UP ALL OF YOUR SALINE FLUSHES.
ALRIGHT. I NEED A FLUSH TO CONVERT MY LOCK TO AN IV LOCK.
I'M GOING TO DISCONNECT THIS.
I'M GOING TO..
ONE MORE THING AND I DIDN'T THINK OF IT WHEN I WAS SETTING UP.
NOW I KNOW EXACTLY WHAT I NEED HERE AS I'M SITING UP.
I HAVE GATHERED MY EQUIPMENT, I HAVE MY LOCK.
I HAVE SALINE FLUSH. YOU NEED A FLUSH OF SALINE AT LEAST TWO MILLILITERS.
I USUALLY PUT TWO, TWO AND A HALF IN.
DON'T FILL IT ALL THE WAY TO THREE
BECAUSE IF YOU'RE GOING TO HOOK IT TO YOUR LOCK
AND YOU'RE GOING TO PULL BACK TO SEE IF YOU'RE IN THE VEIN
AND YOU NEED A LITTLE BIT OF SYRINGE LEFT TO PULL YOUR PLUNGER.
IF YOU OVERFILL YOUR SYRINGE THERE IS NO PLACE TO PULL BACK TO.
SO 2, 2.5 CC.
THE NICE THING IN THE HOSPITAL. IS THESE ARE PRE-FILLS
AND THEY'LL COME UP A WHOLE BIG STACK OF THEM FROM PHARMACY
AND YOU DON'T HAVE TO FILL THEM, BUT YOU CAN.
YOU CAN MAKE YOUR OWN ANY TIME WITH THESE.
I WANT TO SHOW YOU ONE OTHER LITTLE THING.
THIS IS THE NEW SAFETY DEVICE. DID I SHOWED YOU THIS, FOR VIALS?
CLEAN, CLEAN.
HOOK THIS IN.
AND NOW, YOU DON'T HAVE TO STICK NEEDLES IN HERE EITHER
BECAUSE IT'S YOUR NEEDLE-LESS CAP.
AND YOU JUST STICK IT ON TO THERE
AND YOU CAN DRAW. THEY ARE VERY SPRINGY
AND YOU CAN DRAW UP YOUR MED THROUGH THIS.
YOU HOOK IT ON TO THE VIAL TOO? - I POKED IT IN.
IT'S A VERY SHARP SPIKE.
ONCE IT POKES INTO THESE RUBBER VIALS,
YOU DON'T WANT TO PULL IT OUT BECAUSE IT RUINS THE VIAL,
MAKES A BIG, OLD HOLE IN THE VIAL.
BUT THAT'S THE POINT, IS THAT IT ACCESSES YOU,
SO THAT YOU DON'T HAVE TO HAVE A NEEDLE TO EVEN GET INTO THE VIALS.
BEAUTIFUL. AND VERY FUN.
OKAY. I HAVE DRAWN UP MY -- I JUST NEED ONE SYRINGE.
I NEED ALCOHOL SWAB. I NEED TAPE. IT'S IN MY POCKET.
I GOT ALL SORTS OF THINGS IN HERE. PLASTIC TAPE. YES, I'M GOOD.
AND A CHUX.
OKAY, I THINK I'M READY TO GO INTO MY ROOM.
NOW, I DON'T HAVE AN MAR AT THIS POINT
BECAUSE I'M REALLY NOT GIVING A MED.
I DON'T HAVE ANY ALLERGIES TO CHECK BECAUSE I'M NOT GIVING A MED.
AND THERE IS NO COMPATIBILITY ISSUE BECAUSE I'M NOT GIVING A MED.
I'VE WASHED MY HANDS. I'M GOING TO GO INTO MY ROOM.
I KNOW MY ORDERS AND I'M GOING TO JUST ASK ABOUT MY PATIENT AT THIS POINT.
SO I HAVE IDENTIFIED MY CLIENT
AS THE CLIENT WHO NEEDS THE IV LOCK. PROVIDE PRIVACY.
FIRST THING I WANT TO DO, FIRST, FIRST PRIORITY --
AND AGAIN YOU KNOW I WAS EMPHASIZING, ESPECIALLY AT MY STATION,
SOME THINGS HAVE TO BE DONE FIRST.
AND WHEN YOU'RE GOING TO CONVERT AN IV TO AN IV LOCK,
YOU MUST HAVE A GOOD IV. WHY WASTE YOUR TIME IF YOU DON'T?
MAKE SURE THAT THIS IV ISN'T INFILTRATED,
MAKE SURE IT'S NOT THREE DAYS OLD,
MAKE SURE THIS IS DRIPPING.
IF YOU'VE GOT A GOOD DRIP,
THERE IS NO SIGNS OF INFILTRATION OR PHLEBITIS,
THE DRESSING IS NOT THREE DAYS OLD, THE SITE'S GOOD,
YOU'RE BEAUTIFUL TO GO. OKAY.
BECAUSE WE'VE GOT THREE DAYS FOR OUR SITE, THREE DAYS FOR OUR DRESSING
AND THAT'S GREAT. ALRIGHT.
I WANT TO DO A COUPLE OF THINGS HERE.
NOTICE MY IV IS STILL DRIPPING.
DON'T TURN IT OFF BECAUSE YOU'RE ANTICIPATING MAKING A CHANGE
LIKE YOU DID TO DC. WE DON'T WANT IT TO CLOT OFF.
IT'S GOT TO STAY RUNNING TILL THE VERY LAST MINUTE.
OKAY. WHAT I NEED TO DO BEFORE I EVEN DO ANYTHING IS
I NEED TO FLUSH MY IV LOCK.
SO I'M GOING TO CLEAN THE TOP,
TAKE MY NEEDLE. I HAVE JUST LABELED IT WITH AN S FOR SALINE.
YOU DON'T HAVE TO WRITE A WHOLE, BIG NOVEL ON THERE,
JUST SO THAT YOU KNOW ITS SALINE. CONNECT.
AND WHAT I WANT TO DO IS FLUSH IT
SO THAT THE FLUID'S GONE THROUGH.
THAT LITTLE BIT OF AIR WONT KILL ANY ONE.
YOU'LL SEE I DIDN'T PUT AN ASTERISK BY THIS STEP.
IT'S JUST IMPORTANT.
YOU WANT TO BE IN THE HABIT OF CLEAN NURSING AND FLUSHING.
MAKE SURE WHEN YOU PRACTICE THAT YOU HAVE GOT CAPS
ON ALL THE ENDS OF YOUR LOCKS.
YOU WOULD NEVER GO TO A STATION
WITHOUT A CAP ON THERE BECAUSE YOU DON'T WANT
TO CONTAMINATE IT WHEN YOU LAY IT DOWN.
SO JUST BE AS CLEAN AS YOU CAN.
WE LOOSE A LOT OF PARTS.
SO I PUT A LITTLE BAGGIE OF SPARE PARTS THERE FOR YOU.
SO SAVE, SAVE, SAVE THESE LITTLE ENDS.
THEY ARE PRECIOUS.
ALRIGHT. SO MY LOCK IS FLUSHED,
SITE LOOKS GOOD.
I'M GOING TO GO AHEAD AND PUT A CHUX UNDER MY CLIENT, JUST FOR GOOD LUCK.
HOPEFULLY, I WON'T GET BLOOD EVERYWHERE.
THE OTHER THING I WANT TO CONSIDER HERE IS, IS MY TUBING GOOD?
AM I GOING TO NEED IT AT ALL?
IF I'M JUST GOING TO HAVE THE LOCK
AND I'M NOT GOING TO GIVE ANY MEDS WITH THIS TUBING,
THEN I'M NOT CONCERNED ABOUT WHETHER I CONTAMINATE THE TUBING END OR NOT.
BUT IF I NEED TO SAVE THIS TUBING, MAYBE, THEY HUNG IT AT 8:00,
AND THE DOCTOR CAME IN AT 10:00 AND SAID,
CONVERT IT TO AN IV LOCK AND CONTINUE THE ANTIBIOTICS.
YOU MAY STILL NEED THIS BAG AND TUBING.
SO THEN YOU WANT TO PROTECT YOUR TUBING FROM CONTAMINATION
WHEN YOU TRANSFER YOUR TWO PIECES. AND I'LL SHOW YOU WHAT I MEAN.
SO MY GOAL IS, THAT'S WHY I NEEDED THIS ONE OTHER LITTLE PIECE
AND THAT WAS SOME KIND OF A CAP TO COVER THE END OF MY TUBING
SO THAT IT'S NOT CONTAMINATED.
ALRIGHT. I WANT TO GET SOME TAPE READY AS WELL
BEFORE I GET GOING HERE.
AND, PROBABLY BECAUSE IT'S A LOT I WILL JUST NEED THIS ONE PIECE
THAT STABILIZES THE LOOP.
AND THERE WE GO.
ALRIGHT. I'M GOING TO EXPLAIN TO MY CLIENT.
WHAT I'M GOING TO DO IS I'M GOING TO DISCONNECT
THE IV TUBING FROM THIS LITTLE HUB.
I'M NOT GOING TO TAKE THE NEEDLE OUT.
WE'RE NOT GOING TO STICK YOU AGAIN.
THEY'RE CONCERNED ABOUT THAT.
SO I'M JUST GOING TO REMOVE THE TAPE
AND THEN I'M GOING TO PUT THIS LITTLE SHORT CAP ON THERE FOR YOU.
AND THEN YOU'LL BE FREE TO WALK AROUND THE HALLS WITHOUT THE POLE
AND YOU'LL BE MORE MOBILE.
AND THEY'RE USUALLY HAPPY ABOUT THAT.
SO BEFORE I TURN THE IV OFF, I'M GOING TO GO AHEAD
AND TAKE THE TAPE OFF PROTECTING THE HUB HERE.
YOU WANT TO BE CAREFUL THAT YOU'RE NOT JERKING IT
AND THEN YOU INADVERTENTLY PULL IT OUT AFTER YOU
JUST TOLD THE CLIENT, "I'M NOT GOING TO TAKE IT OUT."
AND PHEW, IT SLIDES OUT.
ALRIGHT. NOW.
I'M SO PITIFULLY RIGHT-HANDED
THAT I'M JUST GOING TO HAVE TO THINK FOR A MINUTE HOW I'M GOING TO DO THIS.
WHAT I WANT TO DO IS PUT THIS IN ONE HAND AND KEEP IT UP.
DON'T TUCK IT INSIDE YOUR HAND LIKE THIS WHERE YOU CAN'T SEE THE END OF IT.
REMEMBER, STERILE TECHNIQUE, YOU HAVE TO SEE.
SO I'M GOING TO TUCK IT,
HOW AM I GOING TO TUCK IT?
I'M DOING IT ON AN OPPOSITE ARM.
I HAVEN'T DONE THIS ARM THIS WAY FOR A WHILE.
OKAY. WHAT I WANT TO DO IS I WANT TO PUT PRESSURE ON HERE
TO KEEP THE BLOOD FROM COMING BACK,
STABILIZE THE HUB.
I NEED TO DISCONNECT THIS TUBING AND THEN SHUT IN THIS TUBING
WITHOUT CONTAMINATING EITHER END.
WE CAN DO THIS, OKAY. AND I'M READY NOW.
SO NOW I'M GOING TO TURN THE IV OFF SO I DON'T GET DRIPPING ALL OVER ME.
OKAY. SO THIS IS UP AND NOT CONTAMINATED.
THIS ONE IS ASTERISKED.
YOU CAN'T CONTAMINATE THIS ONE.
THIS ONE IS NOT ASTERISKED.
SO YOU DROP IT, YOU KNOW, IT'S NOT OUR GOAL.
I'LL TAKE OFF A POINT, BUT I'M NOT GOING TO DEEM YOU BIG
BECAUSE IT IS NOT THAT BIG A DEAL.
OKAY. THIS IS OFF.
PRESSURE.
STABILIZE HUB BECAUSE YOU GOT TO TWIST THAT LITTLE CAP THING OFF
AND DISCONNECT. AND THEN PUT THIS IN.
AND I'M HAVING TROUBLE HERE.
THAT END. OH, THAT'S BEAUTIFUL.
I'M HOOKED UP TO BLOOD. I DIDN'T CONTAMINATE.
I CAN GO AHEAD AND PUT MY CAP ON.
WELL, IN THE MEANTIME I DON'T WANT THIS TO CLOT OFF.
SO I'M GOING TO ASPIRATE AND SEE IF I GET BLOOD BACK,
THEN I'M GOING TO HOLD MY SYRINGE.
LOOK HOW MUCH AIR I GOT WHEN I PULLED UP.
I'M GOING TO INSTILL ABOUT TWO MILLILITERS.
I'M NOT GOING TO PUT IN THE LAST HALF CC
BECAUSE I DON'T WANT TO PUT IN THE AIR.
I FLUSHED IT. IT'S FINE. IT WENT IN EASILY.
AND I'M HAPPY AS CAN BE.
I DO NOT WANT TO CONTAMINATE MY IV HERE, SO.
HERE WE GO. LOCK'S GOOD.
MY LOCK IS GOOD
AND NOW I JUST NEED TO STABILIZE IT.
THIS ONE DOESN'T HAPPEN TO HAVE ONE OF THOSE LITTLE DEVICES
TO PUT IT INTO THE HUB.
SO MAKE SURE IT'S NICE AND TIGHT.
TAPE. DOUBLE STICK ON THE BACK THERE TO GIVE IT A LITTLE LIFT.
STICK IT, HOLD AND THEN YOU CAN GO AHEAD AND REMOVE THAT.
AND IT'S DONE.
CLEAN UP YOUR AREA.
TAKE OFF YOUR GLOVES, WASH YOUR HANDS. AND DOCUMENT. YES.
WE CONTAMINATE. IF WE CONTAMINATE THE TUBING,
WE JUST CHANGE TUBING OR JUST TAKE IT OFF?
YES. IF YOU DROP THIS, JUST LET IT GO.
YOU CAN WIPE IT WITH ALCOHOL DEPENDING ON YOUR HOSPITAL POLICY
OR YOU CAN REPLACE THE TUBING.
IF IT'S OLD TUBING THAT WAS DUE TO BE CHANGED,
LET IT GO AND MOVE ON.
THIS IS NOT YOUR HIGHEST PRIORITY.
THIS IS.
IF YOU CONTAMINATE THIS END, YOU'VE GOT TO WIPE IT OFF AND THEN CONNECT.
SO THIS ONE'S GOT TO BE STERILE BECAUSE THIS GOES INTO THEM.
AND YOU WILL WANT TO MAINTAIN A GOOD VOLUME.
I'M NOT REALLY UNDERSTANDING HOW IT'S NOT KEEPING IT FROM CLOTTING OFF.
BECAUSE SALINE IS STAYING IN THIS PART OF THE LOCK
AND BLOOD IS OUT OF THERE, SO IT DOESN'T CLOT OFF.
MY VISUAL MIND GOES, "WHY DOESN'T THE BLOOD CLOT COME UP IT?"
WHY DOESN'T A LITTLE BIT STICK ON?
BUT IT DOESN'T. THEY'VE JUST DONE TONS OF RESEARCH ON IT.
WE HAVE BEEN DOING THIS FOR YEARS AND YEARS AND YEARS AND IT DOESN'T.
THAT'S ALL I KNOW. IT DOESN'T.
OKAY. SO WE ARE GOING TO DOCUMENT.
LET'S DOCUMENT.
THIS IS GOING TO BE THE LINE THAT WE'RE GOING TO GIVE LASIX IV PUSH IN.
DON'T READ UP. LASIX IV PUSH ISN'T DUE YET.
ALL THAT WAS DUE WAS JUST TO CONVERT IT TO AN IV LOCK.
THE CLIENT WANTED TO WALK, GO TO THE SHOWER, DO SOMETHING.
SO ALL WE NEED TO DOCUMENT IS THAT WE FLUSHED IT.
SO WE KEEP TRACK OF THE FLUSHES ON THE MAR
BECAUSE THAT'S HOW THEY GET CHARGED FROM PHARMACY.
SO IV LOCK FLUSHED 2 CC, 2 TO 3, IT DOESN'T REALLY MATTER.
THE ORDER SHOULD READ AS OFTEN AS YOUR MED IS.
FOR EXAMPLE, IF YOU'RE GIVING LASIX EVERY EIGHT HOURS,
THEN IT NEEDS TO BE FLUSHED EVERY EIGHT HOURS.
IF YOU'RE GIVING LASIX EVERY SIX HOURS,
IT NEEDS TO BE FLUSHED EVERY SIX HOURS.
BUT HERE'S THE DEAL, ON AN IV LOCK,
LET'S SAY THEY'RE ONLY GIVING A MED ONCE A DAY IN IT,
IT STILL HAS TO BE FLUSHED EVERY EIGHT HOURS WITH SALINE.
OKAY. SO, YOU NEED TO WRITE AN ORDER
THAT MAKES SURE THAT THE LINE IS FLUSHED ENOUGH.
AND ALWAYS WRITE PRN WHEN YOU WRITE YOUR DOCTOR'S ORDERS.
SO IF YOU CALL THE DOCTOR OR YOU'RE WRITING THE ORDER NOW
FOR YOUR PROTOCOLS
WE NEED TO BE ABLE TO FLUSH IT WHENEVER WE NEED TO FLUSH IT.
IF THE CLIENT KNOCKS IT AND SAYS, "OH, MAN, I HURT MY ARM,"
YOU KNOW, I HIT MY IV, I HOPE IT'S WORKING.
I'M GOING TO FLUSH IT TO SEE,
THERE IS NO OTHER WAY FOR ME TO BE ABLE TO TELL. SO I NEED A PRN.
ALRIGHT. SO I DID THAT AT 1330 DV
AND THAT'S ALL I NEED TO DO IS THAT.
I WOULD DOCUMENT ON THE I&O THAT I HAVE CONVERTED IT TO AN IV LOCK.
YOU KNOW, DOWN AT THE BOTTOM, WHERE IT HAS THE TUBING CHANGES
AND SO FORTH.
SO IF YOU CAN DOCUMENT DOWN THERE THAT THEY'VE HAD A TUBING CHANGE.
AND THEN ON THAT OTHER THING IT SAYS TUBING CHANGE
OR IV LOCK CONVERSION AND YOU WOULD DOCUMENT THERE.
ALRIGHT.
THERE IS FIVE STATIONS NEXT WEEK.
THAT'S ONE STATION.
THEN YOU'RE GOING TO GO TO ANOTHER STATION,
WHERE THE ORDER SIMPLY READS, 'GIVE LASIX IV PUSH NOW.'
BUT YOU'RE GOING TO FIND IT'S PER AN IV LOCK.
OKAY. LAST TIME YOU GAVE YOUR LASIX
IT WAS ONE CONTINUOUS IV.
NOW WE'RE GOING GIVE LASIX, BY IVY LOCK.
SO ALL THIS IS DISPOSED OFF.
AND NOW...
..WE HAVE OUR IV LOCK.
CHECKED MY DOCTOR'S ORDERS. MY DOCTOR'S ORDER SAYS LASIX,
40 MILLIGRAMS IV PUSH NOW.
I'VE CHECK MY ALLERGIES, MY CLIENT ISN'T ALLERGIC TO SULFA,
SO I'M GOOD TO GO.
I KNOW THAT LASIX IS COMPATIBLE WITH POTASSIUM, SALINE.
BUT ARE ANY OF THOSE AN ISSUE WITH A SALINE LOCK?
NO.
UNLESS IT'S A HEPARIN LOCK, IV LOCK.
NOW MOST HOSPITALS -- EVEN IN THE NATION STILL DO SALINE,
BUT YOU'RE GOING TO FIND ONE QUIRKY, LITTLE COMMUNITY HOSPITAL SOMEWHERE,
ONE LITTLE, YOU KNOW, BACK WOODS FACILITY
THAT REALLY LIKES THEIR HEPARIN.
SO WHEN YOU'RE CHECKING TODAY,
YOU'RE GOING THROUGH YOUR MEDS AND YOU'RE LOOKING AT THE DRILLS
I WANT YOU TO CHECK COMPATIBILITY FOR ALL OF YOUR DRUGS TO HEPARIN.
JUST TO BE SURE.
THIS IS AN IV LOCK. AND SO WHAT WE DO WITH AN IV LOCK FOR GATHERING SUPPLIES,
HANDS ARE WASHED, I'M GOING TO GATHER MY SUPPLIES,
IS I'M GOING TO GET MY LASIX AND IT'S THE SAME DEAL,
40 MILLIGRAMS PER MIL.
SO I HAVE IT DRAWN UP AND I'VE JUST MARKED IT LASIX.
AND THEN THESE TWO, I HAVE FOR SALINE,
AND THEY'RE BOTH MARKED S, SALINE.
AND I KNOW THE DIFFERENCE. ONE, BECAUSE THEY ARE FILLED FULLER,
BUT NEVERTHELESS YOU WANT TO CLARIFY YOURSELF.
YOU'D BE SURPRISED EACH YEAR SOMEBODY FLUSHES WITH THEIR LASIX.
SO BE CAREFUL.
AND THEY ALL LOOK JUST LIKE THIS IN THE SYRINGES.
LASIX IS CLEAR AND YOU WOULDN'T KNOW THE DIFFERENCE WITHOUT THE LABEL.
SO, BE REALLY CAREFUL.
WHAT WE'RE GOING TO DO WITH A SALINE LOCK
IS WE'RE GOING TO GO IN AND WE'RE GOING TO LOOK AT OUR SITE.
AND THEN WE'RE GOING TO FLUSH IT WITH SALINE
TO MAKE SURE THAT IT'S PATENT AND WORKING AND THERE'S NO PROBLEMS.
THEN WE'RE GOING TO GIVE THE MED, THEN WE'RE GOING TO FLUSH IT AGAIN WITH SALINE,
BECAUSE WE'RE GOT TO GET ALL THE MED OUT OF THERE.
OTHERWISE IT'LL CLOT OFF AS WELL.
BUT THEY NEED ALL OF THEIR MEDICINES. SO, THAT'S WHY THE TWO.
IF THEY HAD HEPARIN, WE DO WHAT'S CALLED SISH OR SASH.
IF YOU REMEMBER READING THAT IN YOUR MATERIAL,
AND IT STANDS FOR THIS,
SALINE ANTIBIOTIC SALINE AND THEN HEPARIN.
AND HEPARIN IS LEFT AS THE LAST THING IN THIS LINE
TO KEEP IT FROM CLOTTING.
WHEN WE USE HEPARIN AS A FLUSH,
WE USE A VERY DILUTE HEPARIN.
EITHER 10 UNITS PER MIL OR 100 UNITS PER MIL IS HOW IT'S MANUFACTURED.
DO YOU REMEMBER HOW MANY UNITS WE GAVE WHEN WE GAVE IT SUB-CUE...
..AS AN ANTICOAGULANT?
5,000, 10,000, 20,000 UNITS.
10 UNITS PER MIL.
I MEAN IT'S LIKE HARDLY ANYTHING.
THEY'RE NOT GOING TO GET THEIR BLOOD THIN FROM IT.
IT JUST KEEPS IT FROM CLOTTING IN THAT LITTLE, TINY CATHETER.
ALRIGHT. THE OTHER THING YOU HEAR IS SISH.
AND THEY DECIDED THAT WE DIDN'T GIVE ALL OF OUR DRUGS ON ANTIBIOTICS.
FOR EXAMPLE, LASIX ISN'T AN ANTIBIOTIC.
SO THE 'I' IN SISH IS FOR INJECTION.
SO SALINE INJECTION SALINE AND THEN HEPARIN.
AND WE'RE GOING TO DO THAT ON OUR OTHER MANNEQUIN.
ALRIGHT. WE HAVE OUR SALINE LOCK. WE HAVE OUR DRUG. HANDS ARE WASHED.
WE DON'T HAVE ANY COMPATIBILITY ISSUES RELATED TO JUST SALINE AND LASIX.
WE'RE GOOD TO GO. AND I'M COMING IN.
SO, I'M GOING TO COME IN AND IDENTIFY MY CLIENT.
YOU'LL HAVE MANNEQUINS. YOU'LL GO TO YOUR BEDS AGAIN
AND YOU'LL TAKE MAR AND SAY, "ADULT CLIENT WITH AN IV LOCK."
AND LOOK AT THEIR NUMBERS AND THEIR DOCTOR.
AND YOU CAN ASK THEM THEIR NAMES IF YOU FEEL SO INCLINED.
BUT MAKE SURE MARS TO NAME BANDS.
AND THEN WE'RE GOING TO CHECK THE IV SITE.
YOU WANT TO LOOK AND SEE HOW OLD IT IS,
SEE IF AGAIN, YOU SEE ANY SIGNS OF INFILTRATION OR PHLEBITIS.
BUT MORE THAN LIKELY, YOU'RE NOT,
BECAUSE CONTINUOUS FLUID ISN'T GOING IN.
SO, IT MAY NOT INFILTRATE, RIGHT?
THEY MAY HAVE BUMPED IT. IT MAY BE --
THE DRESSING MAY BE LEAKING OR TEARING OFF OR SOMETHING,
JUST FROM BEING BUSY.
SO, LOOK AND SEE THE STATUS OF YOUR SITUATION HERE.
THEN...
..WHENEVER YOU WORK WITH A LOCK,
YOU WANT TO PUT GLOVES ON BECAUSE YOU'RE WORKING DOWN HERE TOWARDS THAT HUB.
ANY PROBLEMS WITH YOUR IV?
OKAY.
I'M GIVING A MED HERE, SO I DO WANT TO DO MY THIRD CHECK.
MY LASIX 40 MILLIGRAMS PER MIL, 40 MILLIGRAMS.
AND THAT'S GREAT.
ALRIGHT.
ANY ALCOHOL IN HERE?
I WANT TO COME TO THE LOCK.
I'M GOING TO CLEAN IT OFF.
COME ON. MAKE SURE YOU SCREW THAT ON TIGHT.
I COULD TELL, I LOOSENED THAT ONE.
GET EVERYTHING ON AND THEN YOU WANT TO ASPIRATE.
OH, I GOT GOOD BLOOD RETURN ON THAT. SO, I'M VERY HAPPY.
AND THEN, I DON'T HAVE TO CRIMP OR ANYTHING
BECAUSE THERE IS NOTHING TO CRIMP.
WHAT I NEED TO DO IS GIVE MY LASIX.
OH, NO, THIS IS SALINE. SORRY.
SO I'M JUST GOING TO GIVE ALL MY SALINE,
HOLD IT UP, SO YOU DON'T GET THAT LAST LITTLE BIT OF AIR,
AND DISCONNECT.
IT'S ALREADY CLEAN. SO I DON'T NEED TO CLEAN IT AGAIN.
I'M GOING TO HOOK MY LASIX ON.
AND I DON'T NEED TO ASPIRATE.
I ALREADY ASPIRATED. I GOT BLOOD.
I ALREADY FLUSHED, IT WENT IN EASILY, NO PROBLEMS.
NOW, I'M JUST GOING TO GIVE LASIX.
WHAT'S YOUR CRITERIA FOR LASIX? HOW FAST? - ONE TO TWO MINUTES.
ONE TO TWO MINUTES. SO, HERE WE GO.
I'M GOING TO GIVE A QUARTER OF THE LASIX.
WHERE DO YOU SUPPOSE IT IS?
IN THE TUBE. - IN THE TUBING.
SO I'M GOING TO GIVE HALF A CC OF LASIX
SO THAT THEY GET A QUARTER OF LASIX.
AND THEN I'M GOING TO WAIT MY 15 SECONDS OR 20 OR WHATEVER. SO, 20.
THEN I'M GOING TO GIVE ANOTHER QUARTER
AND I'M GOING TO WAIT 15 OR 20 SECONDS.
DONE. THEN I'M GOING TO GIVE ANOTHER QUARTER.
AND THAT'S ALL OF IT RIGHT NOW, BECAUSE WHERE IS THE LAST OF THE DRUG?
IN THE TUBING.
SO, WHILE I'M WAITING FOR THAT TO DO ITS TIME,
I'M GOING TO RECONNECT MY SALINE
AND SEE IF MY 20 SECONDS IS UP.
AND NOW I'M GOING TO PUT THE REST OF THE MED IN.
AND THEN I'LL FLUSH THE REST OF MY LOCK,
DISCONNECT, DONE.
WASH MY HANDS. TAKE MY GLOVES OFF. WASH THE HANDS,
MAKE SURE THE SITE LOOKS GOOD.
IT'S TAPED. IT'S SECURED. IT'S HAPPY.
AND YOU GET TO THE BATHROOM,
YOU KNOW, "LASIX, IT SHOULD HAVE GOT VITALS TO POUR." AND ALL THAT.
ALRIGHT.
ALL THIS NEEDS TO GO INTO SHARPS. AND LET'S DOCUMENT.
OKAY. LASIX...
..1340.
AND I GAVE A FLUSH AT 1335
AND 1340.
AND THERE THEY ALL ARE.
SO YOU CAN SEE, YOU, KIND OF, HUNG UP THAT WHOLE SQUARE TOO MUCH,
BECAUSE YOU GOT TO GET AT LEAST THREE FLUSHES INTO THAT SQUARE,
BECAUSE YOU'VE DONE THREE FLUSHES.
YOU DID THE ONE BEFORE, THE ONE AFTER AND THE LASIX.
SO MAKE SURE EVERYTHING GETS DOCUMENTED.
OTHERWISE, IN A CHART REVIEW,
IF I WAS YOU QUALITY ASSURANCE REVIEWER
AND I'M REVIEWING CHARTS, AND I SEE A LASIX,
AND I SEE ONLY ONE FLUSH ON THERE, I'M GOING, "WHAT HAPPENED?
ARE THEY NOT PRE-FLUSHING?
THIS MEANS THEY'RE NOT FOLLOWING PROTOCOLS."
SO -- AND IT WILL CHARGE YOU.
ANY QUESTIONS?
OKAY, NOW FROM ONE STATION TO ANOTHER STATION.
THEN WE HAVE ANOTHER STATION.
THIS CLIENT NEEDS TO RECEIVE ANCEF 1 GRAM,
IV PIGGYBACK EVERY EIGHT HOURS PER IV LOCK.
I'M IN THE NURSING STATION. I'VE CHECKED MY DOCTOR'S ORDERS.
I'VE CHECKED ANCEF.
I'VE CHECKED TO SEE IF MY CLIENT HAS ANY ALLERGIES TO ANCEF.
I'M GATHERING UP MY EQUIPMENT WITH MY WASHED HANDS.
AND I NEED TO START THIS ANCEF WITH A NEW TUBING.
SO I HAVE A FLUSH TIP, I HAVE LABELED IT,
AND I HAVE MY ANCEF, THE DATE IS GOOD.
CHECKED EXPIRATIONS.
I HAVE TWO FLUSHES OF SALINE,
BECAUSE I'M GOING TO HAVE TO FLUSH THE LOCK.
I'M GOING TO HAVE TO HOOK UP AN IV TO THE LOCK.
HOOK MY PIGGYBACK,
RUN IT AND THEN DISCONNECT THE WHOLE THING AND FLUSH IT AGAIN.
YOU'LL SEE WHAT I MEAN.
SO, I'VE GOT ALL OF THAT TAPE...
..AND MAR.
COMPATIBILITY. HERE'S THE ISSUE.
THIS BAG HAS 40 MIL EQUIVALENTS OF POTASSIUM,
AND WE KNOW RIGHT THAT IT'S FINE.
YOU'VE CHECKED YOUR COMPATIBILITIES RELATED TO POTASSIUM,
MULTIVITAMIN, SALINE, ANCEF. GOOD TO GO.
CHECK HEPARIN, IN CASE THIS IS A HEPARIN LOCK.
WHAT I NEED TO KNOW NOW IS HOW OLD IS THIS BAG.
THE ONLY REASON THIS CLIENT HAS THIS BAG HANGING,
IS TO FLUSH THIS, THEN I REALLY DON'T NEED A POTASSIUM BAG.
ALL I NEED IS A SALINE BAG.
BUT LET'S SAY, I HUNG THIS ALL BRAND NEW TODAY AT 8 O'CLOCK.
AND THE DOCTOR CAME IN AT 9 O'CLOCK AND SAID, CONVERT THAT TO AN IV LOCK.
WHY CAN'T I KEEP THIS BAG FOR 24 HORS
AND USE IT AS THE FLUSH
RATHER THAN THROW IT ALL AWAY AND GET A SALINE BAG?
DO YOU SEE WHAT I'M SAYING HERE?
BECAUSE WE'RE GOING TO SET THIS UP JUST LIKE THE SYSTEM YOU HAD
WHEN YOU WERE DOING YOUR PIGGYBACKS, THE HIGH-LOW DEAL
OKAY.
IF YOU DON'T LIKE THAT IDEA,
THEN YOU CAN SWITCH IT AND JUST GIVE THEM A SALINE BAG
AND GO, "THE HECK WITH IT, YOU KNOW, I DON'T LIKE THAT HANGING THERE
AND I JUST WANT SALINE." OKAY.
IT'LL SAVE THEM A LITTLE MONEY,
AND THEN TOMORROW WHEN IT'S AN OLD BAG,
WHEN THE 24 HOURS IS UP, HANG SALINE.
AND THAT WILL BE FINE.
SO THAT'S WHY YOU KIND OF WANT TO KNOW WHAT'S HANGING,
HOW OLD IT IS AND YOU HAVE TO DECIDE WHAT YOU WANT TO DO.
NOW, SOME OF YOU MIGHT BE GOING, " I DON'T KNOW WHAT'S SHE TALKING ABOUT."
AND THAT'S OKAY. BECAUSE YOU WILL IN A MINUTE.
YOU MIGHT BE THINKING, IF YOU'RE JUST GOING TO GIVE ANCEF,
WHY WOULDN'T YOU JUST HANG ANCEF IN A STRAIGHT LINE
AND JUST GIVE IT AND FLUSH IT?
BECAUSE YOU'RE A BUSY NURSE.
BUSY. VERY BUSY.
AND YOU'RE GOING TO HANG THIS, AND IT'S GOING TO HANG FOR HOW LONG?
- 1 HOUR. - 30 TO 60 MINUTES.
AND SO ARE YOU GOING TO SIT AROUND AND WATCH HIM FOR 30 TO 60 MINUTES?
NO, YOU'RE GOING TO GO AND SEE YOUR OTHER 6, 8, 10, 12 PATIENTS.
SO, THIS, IF IT RUNS DRY AND YOU'RE NOT STANDING RIGHT THERE TO CATCH IT,
THIS IS GOING TO CLOT OFF.
SO YOU'VE GOT TO HAVE A SYSTEM THAT WILL TAKE OVER
AND KEEP DRIPPING
SO THAT IT WILL BE NOT CLOTTED OFF BY THE TIME YOU GET BACK.
THAT'S WHY YOU EITHER NEED A SOLUTION
OR YOU NEED A SALINE SOLUTION TO KEEP IT RUNNING.
NOW EVERY NOW AND THEN, LIKE IN THE ER,
WHEN ALL THEY'RE GOING TO GIVE IS LIKE A ONE-TIME DOSE OF SOMETHING,
THEY'LL JUST DO A STRAIGHT LINE AND THEY WON'T HOOK UP A BIG DEAL LIKE THIS.
BUT ON THE FLOORS, WE ALWAYS DO.
BECAUSE YOU NEED THAT CONTINUOUS DRIP, SO YOUR LINES DON'T CLOT OFF.
IF IT'S A ONE TIME DOSE, AND IT DOESN'T MATTER,
THEN THEY DON'T REALLY CARE WHAT HAPPENS TO IT WITH THE ONE DOSER.
OKAY.
I HAVE A PLAN. I HAVE A MED.
I'M GOING TO RUN IT OVER WHATEVER I DECIDE WHEN I GET THE 30 TO 60 MINUTES.
MY DROP FACTOR IS 15. I'M HAPPY.
I'M IN THE CLIENT'S ROOM NOW.
I'M GOING TO IDENTIFY MY CLIENT, WHOEVER IT IS.
I'M GOING TO CHECK MY NAME BAND TO MY MAR.
'ADULT CLIENT WITH AN IV LOCK.'
I'M GOING TO CHECK ALLERGIES TO MAKE SURE THERE IS NO PROBLEMS.
AND WE'VE ALREADY DISCUSSED THE COMPATIBILITY ISSUES.
MY HANDS ARE WASHED. PROVIDE PRIVACY.
OKAY. FIRST THING YOU'RE GOING TO DO?
CHECK THE LINE. ALWAYS, FIRST THING.
THIS LINE IS LOOKING PRETTY ROUGH HERE, MR. IV LOCK.
IT LOOKS LIKE YOUR CATHETER'S A LITTLE CRIMPED THERE.
I HOPE IT'S DRIPPING OKAY.
CAN YOU SEE THE LITTLE CRIMPED OUT?
SO IT MAY WORK, IT MAY NOT.
IF IT'S RUNNING, IT'S RUNNING, AND I'M HAPPY
EVEN IF IT'S STICKING OUT A LITTLE BIT.
AS LONG AS THIS HAS GOT A NICE EXCLUSIVE DRESSING AND IT'S RUNNING.
I MIGHT WANT TO RE-TAPE IT A LITTLE AND STRAIGHTEN IT OUT.
SO THAT IT WON'T BE CRIMPED AND RUNNING. BUT WE'LL SEE WHAT HAPPENS.
OKAY. GOING TO GET MY TUBING SET HERE
AND AGAIN, BECAUSE I'M WORKING WITH A LOCK...
..I'M GOING TO GET GLOVES.
CLEAN THE LOCK OFF.
WHEN I FIRST CHECK, IT'S JUST MY SALINE CHECK TO MAKE SURE IT'S RUNNING.
SO CONNECT.
I'M GOING TO ASPIRATE TO SEE IF I GET ANY BLOOD RETURN.
BEAUTIFUL. THAT'S JUST A REASSURING SIGN.
NOT ABSOLUTE, BUT VERY REASSURING.
AND I'M GOING TO GO AHEAD AND PUT THIS IN AND AGAIN,
CHECK FOR EASE OF FLUSH.
DO YOU HAVE ANY PAIN? NOTICE IF THERE IS ANY SWELLING
AND PUT IN ALL, BUT THAT LAST HALF CC AND DISCONNECT.
OKAY.
NOW, I'M GOING TO GET MY TUBING
WHILE I KNOW MY SITE'S STILL GOOD SO I DON'T HAVE TO CLEAN IT OFF.
TAKE THE CAP OFF...
..AND CONNECT.
AND I LIKE IT WHEN THEY HAVE THOSE LITTLE PIECES ON THE TUBING
WHERE YOU CAN SCREW IT ON THERE AND THAT HOLDS THEM STABLE.
OKAY, I HAVE MY TAPE.
I'M GOING TO HAVE ENOUGH TO STABILIZE THIS
BECAUSE THE TUBING IS HEAVY HANGING OFF THAT LINE.
SO, GO AHEAD AND OUT ONE MORE PIECE OF TAPE UP HERE...
..SO THAT IT DOESN'T FLOCK AND PULL YOUR IV LOCK OUT.
- SHOULD WE START TAPING...
- IT SHOULD BE OKAY. REMEMBER THERE'S SALINE IN THERE,
SO IT'S NOT GOING TO CLOT OFF.
AND SO NOW I'M GOING TO GO AHEAD AND GET IT RUNNING
AND MAKE SURE IT'S GOING TO DRIP AS AN IV.
SO, I'M GOING TO OPEN IT UP AND GET IT RUNNING.
AND I'M GOING TO JUST PUT IT AT A TKO FOR NOW
UNTIL I GET MY PIGGYBACK GOING. AND THAT LOOKS GOOD.
SO, LET'S GET YOUR PIGGYBACK. LET'S DO THIRD CHECK.
ANCEF, 1 GRAM. GOOD.
PUT THIS ON A LOWER HOOK.
FLUSH ON HERE. SAVE THAT.
CLEAN MY PORT.
NOTICE I ALWAYS HOLD MY ENDS AWAY SO THEY STAYING STERILE
AND ARE NOT GETTING CONTAMINATED.
CONNECT THE END ON THERE.
AND THEN BACK FILL.
REMEMBER TO HOLD IT STRAIGHT UP
SO THEY CAN SEE WHAT'S HAPPENING THERE.
GET A LITTLE PRESSURE IN THE BAG,
FILLS UP THE DRIP CHAMBER A LITTLE WAYS.
AND STOP.
OKAY. CAN GO AHEAD AND OPEN THIS UP FULL BLAST.
AND NOW, I WANT TO REGULATE MY DRIP BY THIS.
AND I THINK I WOULD LIKE THIS 100 CC TO GO IN
IN 45 MINUTES. MY DROP FACTOR'S 15.
HOW MANY DROPS PER MINUTE?
HOW MANY CC PER HOUR.
LET'S START THERE. - HOW MUCH ANCEF IS IT?
100 CC OVER 45 MINUTES.
HOW MANY CC PER HOUR, IS MY RATE?
LET'S THINK LOGICALLY HERE.
IF A 100 CC GOES IN, IN 30 MINUTES..
200 CC PER HOUR.
IF A 100 CC GOES IN IN AN HOUR, A 100 CC PER HOUR.
SO IF WE'RE GOING TO GO IN 45 MINUTES, 150 CC PER HOUR.
SO IF YOUR RATE'S 150 CC PER HOUR,
YOUR DROP FACTOR'S 15, HOW MANY DROPS PER MINUTE?
- 37.45.
OKAY. DIVIDED BY 12, SO THAT'S 3. RIGHT.
- THREE. - EVERY FIVE SECONDS.
AND THERE YOU GO. I LIKE 45 MINUTES.
BECAUSE THEN IF IT GOES A LITTLE FAST, I'M OKAY.
IF IT GOES A LITTLE SLOW, I'M OKAY.
ESPECIALLY ON THESE GRAVITY DRIPS, YOU KNOW.
SO, WORK YOURSELF A RATE AND THERE YOU GO.
SO, I STILL HAVE MY SALINE FLUSH FOR WHEN I NEED TO DISCONTINUE IT.
BUT MY PLAN HERE IS, THEN TO TAKE OFF MY GLOVES,
WASH MY HANDS AND DOCUMENT THE MED THAT I GAVE.
ALRIGHT. I'M A BUSY GIRL,
AND I WENT AND I DID MY THING AND I COME BACK IN AN HOUR AND VOILA,
THIS IS DONE AND THIS HAS TAKEN OVER.
OKAY, SO I COME AND I TURN IT OFF.
SHOULD HAVE LEFT MY GLOVES ON.
LET'S TALK A MINUTE.
IF THIS HAS POTASSIUM IN IT, DO I NEED TO FLUSH THE LINE?
YES. BECAUSE IT NEEDS TO BE JUST PLAIN SALINE
TO KEEP IT FROM CLOTTING OFF.
IF THIS WAS A SALINE FLUSH,
THERE WASN'T -- IF YOU JUST HUNG UP A PLAIN, OLD SALINE BAG NOW,
BECAUSE YOU'RE JUST NEEDING TO FLUSH,
YOU NEED TO FLUSH THIS?
- NO. - HOW DO YOU KNOW SALINE'S IN THERE?
- CAN'T WE TELL? - YOU DON'T KNOW.
UNLESS YOU'VE DONE A GOOD I&O AND YOU CAN VISUALLY
TELL THAT 50'S GONE IN AND YOU'RE PROBABLY GOOD TO GO.
BUT YOU DON'T REALLY KNOW WHAT'S IN THAT LINE.
YOU KNOW THIS IS STOPPED AND YOU KNOW THIS HAS STARTED,
BUT YOU DON'T REALLY KNOW HOW MUCH IS IN THERE.
SO, TO BE SAFE, YOU'RE GOING TO ALWAYS FLUSH IT.
UNLESS, YOU JUST KNEW TOOK YOU TWO HOURS AND 100'S GONE IN
AND IT'S DRIPPING FINE, WHY WASTE A SYRINGE ON IT.
OKAY.
BUT OURS HAS POTASSIUM AND WE DON'T HAVE THAT LUXURY.
SO, THE MED'S ALL IN.
AM I STILL DRIPPING? YES.
I DIDN'T TURN IT OFF YET, BECAUSE I'M NOT READY.
WHY DID YOU THAT TAPE OUT?
I DON'T KNOW.
I'M GOING TO HAVE TO RE-TAPE IT AND BE MAD AT MYSELF FOR DOING THAT.
I'M GOING TO TURN THIS OFF.
AND I NEED TO RE-CAP IT WITH MY NEW STERILE NEEDLE
OR CAP OR SOMETHING SO THAT THIS IS GOING TO BE STERILE.
AND NOW, I'M GOING TO GET AN ALCOHOL SWAB.
GET MY LAST SALINE.
ON.
ASPIRATE IF YOU WANT, BUT YOU DON'T NEED TO,
JUST TO GET ALL THE AIR TO THE TOP.
FLUSH IT. DOES THAT FILL OKAY? IT GOES IN SO EASY.
IF THEY'RE INFILTRATED, THEY OFTEN BURN AND THEY -- IT'S HARD TO PUSH.
BECAUSE IT'S GOING INTO TISSUE, NOT INTO VEIN.
TAKE IT OFF AND I'M GOOD. AND I THOUGHT --
I WOULD SAY THE SAME THING TO MYSELF, "WHY DID I DO THAT?" I DON'T KNOW.
STABILIZE. THROW ALL THIS STUFF AWAY INTO SHARPS, TRASH.
WASH YOUR HANDS, CLEAN UP YOUR AREA AND DOCUMENT.
NOW, IF THEY ONLY GOT THIS MED....
..ONCE A SHIFT,
YOU CAN GO AHEAD AND FINISH YOUR I&O,
RIGHT NOW FOR THE NEXT SHIFT,
BECAUSE YOU'RE NOT GOING TO USE THIS BAG ANYMORE ON YOUR SHIFT.
SO, ONCE AGAIN, YOU GET TO REVISIT, DOCUMENT AN I&O.
OKAY. SO, I'M GOING TO DOCUMENT WHEN I GO TO THE NURSING STATION,
BUT I JUST KEEP TRACK OF MY I&O.
AND SO WHAT I DO IS I COME AND I SEE HOW MUCH IS LEFT IN BAG.
I COUNT UP. ONE, TWO, THREE, FOUR, FIFTY IS LEFT IN BAG.
I DON'T EVEN KNOW WHAT MY CREDIT IS, SO LET'S GO AND SEE OVER HERE.
OKAY, I'M GOING TO GO AHEAD AND SIGN OUT MY ANCEF.
I GAVE IT, LOOKS ABOUT 1345 DV.
I DID MY FIRST FLUSH AT 1345 DV.
AND THEN I DID MY SECOND FLUSH AT 1355 DV.
OKAY? YOU DON'T WANT TO TAKE A DING ON THIS ONE.
AGAIN, YOU KNOW, DOCUMENTATION IS ASTERISKED,
BECAUSE IT'S CRITICAL. AND YOU'LL MISS YOUR POINTS,
IF YOU DON'T GET ALL YOUR FLUSHES IN THERE.
YOU GOT TO HAVE THEM ALL IN A SLOT.
- SO WANT US TO DO IT AFTER AN HOUR?
YES, THAT WOULD MAKE MORE SENSE, BUT I'M BASICALLY LOOKING FOR TIME.
YOU GOT TWO TIMES AND THAT YOU'RE APPRECIATING YOU FLUSHED TWICE.
WHEN DO YOU DO IT? SO, LOGICALLY, YES, IT WOULD BE AN HOUR LATER.
ALRIGHT.
SO LET'S REVISIT I&O ONE MORE TIME.
WE SHOULD SEE 100S ALL AROUND ON I&O NEXT WEEK.
OKAY. IT APPEARS I GAVE MYSELF 800 LEFT IN BAG
THAT WAS THE CREDIT FROM THE SHIFT WHEN I CAME ON.
AND THIS IS WHAT I'M GOING TO GIVE THEM FOR 8 O'CLOCK.
SO AT 9 O'CLOCK TONIGHT, THEIR CREDIT IS, WHAT DID I SAY? 450?
THAT'S 0.9% SODIUM CHLORIDE WITH 40 OF KCL.
ALRIGHT. SO THAT'S THEIR CREDIT.
THEY GAVE ME 800 CREDIT, SO HOW MUCH WENT IN ON MY SHIFT?
350.
ALRIGHT. BUT I ALSO HUNG MY PIGGYBACK AND I DON'T WANT TO FORGET THAT.
SO MY 100.9% SODIUM CHLORIDE WITH ANCEF.
AND I WANT TO SEE YOUR DOSES NEXT WEEK 1 GRAM
AND 100 WENT IN.
MY PEN'S TOO FAT AND UGLY TO WRITE IN THIS LITTLE THING.
SO THE TOTAL THAT WENT IN FOR MY SHIFT, 450.
WHO WAS IT THAT WAS BRILLIANT AND TOLD ME DAY SHIFT TOTALS 22100?
I SUPPOSE YOU COULD ADD YOUR 350 AND YOU 100
AND YOU COULD HAVE 450 ON AND YOUR 1300 AND HAVE 1750.
I GUESS IT DEPENDS ON THE HOSPITAL,
BUT EVERY PLACE I'VE WORKED, WE DID IT IN EIGHT HOUR INCREMENTS.
SO, I DIDN'T TAKE OFF. BECAUSE I THINK THAT THAT WAS PROBABLY A RIGHT INTERPRETATION.
DAY SHIFT TOTAL'S 22100.
SO WHAT'S THE TOTAL NOW WITH THAT SHIFT ADDED ON TO THIS SHIFT?
WHEN IN ROME, DO WHATEVER THEY WANT YOU TO DO.
I MEAN, I DON'T KNOW, BUT I'VE ALWAYS DONE IT PER SHIFT.
SO WHATEVER. YES.
DO YOU ADD THE SALINE TO THE...
THE FLUSHES? NO. BECAUSE THEY'RE NEGLIGIBLE,
THEY'RE 2 CC. BECAUSE THE TRUTH OF THE MATTER IS
I DON'T KNOW IF I REALLY HAVE 450 IN THAT BAG OR 454 OR 442.
I MEAN, I CAN'T REALLY SEE. SO NO ONE REALLY CARES ABOUT THE 1 CC.
JUST TO THE NEAREST 25. OKAY.
- WHERE IS THE IV LOCK YOU SHOWED US? YOU SAID THAT WE WERE GOING TO NEED TO DOCUMENT THAT?
THE IV LOCK FLUSHES WERE UNDER MAR.
- RIGHT. AND THEN YOU SAID I&O WHEN YOU CONVERT.
WHEN YOU CONVERT, THIS ONE DOESN'T HAVE IT AS GOOD,
OTHER THAN CHANGING OF TUBING DOWN HERE AT THE BOTTOM.
BUT THE FORM I GAVE YOU WHEN YOU WERE DOCUMENTING,
THE DAY WE STARTED IV'S, DOWN IN THIS BOTTOM PART,
IT HAS CONVERT TO IV LOCK, CHANGE TUBINGS,
AND IT HAS LOCK EXTENSIONS AND PRIMARIES ALL DOWN THAT LINE.
AND YOU CAN JUST DOCUMENT REAL QUICK ON THERE THAT YOU CONVERTED.
OTHERWISE, YOU HAVE TO WRITE IN YOUR NURSE'S NOTE, IN THE NARRATIVE.
CONTINUOUS IV CONVERTED TO IV LOCK. AND THAT'S ALL YOU HAVE TO SAY.
OKAY, IS EVERYONE CLEAR ON I&O? GOOD TO GO? OKAY.
SO THERE IS SO FAR FOUR STATIONS, RIGHT?
ANCEF STATION, I&O STATION,
CONVERT IV TO IV LOCK STATION, LASIX PUSH STATION AND THEN FINALLY,
YOUR FIFTH STATION.
YES, IT IS SO MANY. WHOEVER SAID THAT. THIS IS A HUGE, HUGE WEEK.
THE LAST STATION.
OH, I HAD OTHER SHOWS AND TELLS FOR YOU.
SHOWS AND TELLS.
IN SOME OF THE HOSPITALS, THEY HAVE A SYRINGE
ADMINISTRATOR FOR ANTIBIOTICS OR FOR MEDICATIONS.
AND SO WHAT HAPPENS WITH THESE IS
PHARMACY SENDS YOU A SYRINGE WITH YOUR MEDICATION IN IT,
AND A LABEL THAT SAYS ANCEF 1 GRAM.
AND IT'S IN A SYRINGE, INSTEAD OF A PIGGYBACK BAG.
SO WHAT YOU HAVE TO DO WHEN YOUR SYRINGE COMES UP
IS YOU HAVE TO GET YOURSELF SOME KIND OF TUBING.
AND IT HAS TO BE AN EXTENSION TUBING.
IT'S NOT A DROP FACTOR TUBING
BECAUSE THERE IS NO DRIPPING TO FIGURE OUT.
SOME KIND OF EXTENSION.
I'M JUST GOING TO SHOW YOU WITH THIS LITTLE SHORT GUIDE,
JUST FOR THE PURPOSES OF WHAT WE NEED TO DO.
THIS HAS A LITTLE BACK-CHECK VALVE. I WOULD TAKE THIS OFF.
TAKE THIS OFF, AND CONNECT NOW TO HERE.
AND THEN I WOULD CONNECT THIS, IT WOULD BE LONGER OF COURSE,
AND CONNECT IT TO MY CLIENT'S IV LOCK
OR TO THEIR CONTINUOUS LINE, DEPENDING ON WHAT THEY HAVE.
THEN THEY HAVE THESE LITTLE THINGS
AND THEY'RE CLIPPED EITHER TO AN IV POLE OR SOMETIMES,
THEY'RE JUST LAYING ON TABLES OR WHATEVER.
AND WHAT YOU DO IS, YOU HAVE TO LOAD IT INTO HERE.
THERE IS A LITTLE THING THAT YOU CAN ADJUST
FOR THE PLUNGER PIECE RIGHT HERE,
OPEN UP THE CLIP -- THIS IS HARD TO DO WITH ONE HAND.
AND YOU WANT TO PUT THE SYRINGE IN,
IF I CAN GET IT IN. I NEED A FOURTH HAND HERE.
YOU WANT TO GET YOUR PLUNGER IN THERE AND THIS HOLDING YOUR --
I MEAN, YOUR BARREL IN. AND THIS HOLDING...
OKAY, OH-H, THAT WAS TOUGH.
SEE, YOU'VE GOT TO STABILIZE YOUR PHALANGE ON HERE.
HOLD YOUR THOUGHT UNTIL I GET IT ALL DONE.
YOUR PHALANGE IS IN HERE,
YOUR MEDICATION IS HERE CONNECTED TO YOUR EXTENSION TUBING
AND THE PLUNGER IS HERE.
THE MACHINE KNOWS BECAUSE OF HOW LONG THE PLUNGER IS,
HOW FAST TO PUT IT IN.
SO IT'S ALREADY PRE-CALCULATED BY PHARMACY, THE DOSE.
SO, YOU DON'T EVEN FIGURE THE DOSE WITH THE SYRINGE APPLICATORS.
IT JUST GOES IN BY HOW FULL IT IS, THE MACHINE KNOWS.
AND YOU JUST AUTOMATICALLY TURN IT ON.
IT'S ON.
'ON WITH ALARM, ON.' THERE WE GO.
OKAY. YOU CAN SEE IT WAS BLINKING.
IS IT STILL BLINKING? INFUSING?
I CAN'T SEE. IT DOESN'T SHOW VERY GOOD FROM UP HERE.
AND THEN IT BEGINS TO INFUSE IT. AND THIS ONE WILL TAKE 40 MINUTES
BECAUSE OF HOW TALL THE PLUNGER IS.
AND IT'LL INFUSE YOUR MED.
SO IF THIS WAS ANCEF IN A SYRINGE, IT JUST GOES IN.
THAT'S WHY YOU'RE SEEING THEM A LOT MORE.
THEY'RE USING THESE AT SAINT AGNES.
I SAW IT -- I VISITED A FRIEND IN KAISER, THEY HAD ONE SETUP AT KAISER.
- CAN IT DO IT LONGER THAN 45 MINUTES?
IT CAN'T. UNLESS THE -- THERE ARE NEWER MACHINES.
THIS IS A HOME UNIT THAT SOMEONE GAVE ME.
IT'S AN OLD MACHINE THAT'S RUN BY A BATTERY.
AND THEY HAVE SOME THAT ARE RUN ELECTRONICALLY.
BUT THEY'RE REALLY EASY.
YOU'RE STILL GOING TO SEE PIGGYBACKS,
BECAUSE I ALSO NOTICED THAT SAME INSTITUTION
SAW THE PIGGYBACKS HANGING FROM THE BAGS.
SO YOU'RE STILL GOING TO DO A LOT OF PIGGYBACKS.
AND WE'LL WORK WITH THOSE MORE WHEN WE DO THE PUMPS IN A COUPLE OF WEEKS.
BUT THIS IS AN INTERESTING DEVICE
THAT YOU'RE GOING TO SEE FOR PIGGYBACK.
- IT KNOWS HOW FAST TO GO IN BY VOLUME, BUT NOT BY DRUG.
UH-HUH. SO THE PHARMACIST HAS TO KNOW
WHAT THEY'RE PUTTING IN THE SYRINGE
BECAUSE THEY KNOW HOW FAST IT WILL BE ADMINISTRATED BY THIS MACHINE.
DID THAT ANSWER YOUR QUESTION?
- KIND OF LIKE. THAT'S JUST AN EXTENSION TUBE?
YES. THIS WOULD BE LIKE A PIGGYBACK.
SO IF THIS WAS A CONTINUOUSLY DRIPPING IV,
YOU WOULD JUST -- IT WOULD HOOK ON THE POLE LIKE THIS
AND THEN YOU JUST HOOK IT IN.
AND IT GIVES THE MED THROUGH YOU'RE CONTINUOUS DRIP.
AND SO YOU DON'T HAVE TO DO GRAVITY SETUP OR ANYTHING.
IT JUST PUSHES IT IN.
AND THAT'S NOT IN OUR BAG THAT --
NO, I'M JUST SHOWING YOU ANOTHER THING THAT
- YOU'RE GOING TO SEE OUT THERE. - ALRIGHT.
SO I'M NOT TESTING YOU. IT'S JUST AN FYI.
YOU DON'T HAVE TO TAKE THAT BAG AND DROP IT LOWER OR ANYTHING?
NO, YOU DON'T HAVE TO DO ANYTHING BECAUSE THIS IS PUSHING IT IN.
- OH, PRESSURE.
YEAH, BY THIS. THIS THING'S MOVING, PUSHING IT DOWN.
THAT'S WHY YOU HAVE TO STABILIZE YOUR SYRINGE,
THE PHALANGE INTO THIS GROOVE SO THAT IT'S STABILIZED,
AND THEN THE MOVEABLE PART IS THIS PUSHING THE PLUNGER DOWN.
AND SO THAT'S SETTING THE RATE, THE PLUNGE.
AND IT'LL TAKE 40 MINUTES.
AND IT'S JUST HOOKED UP. NO GRAVITY. NO NOTHING.
YOU GOT A BACK-CHECK VALVE HERE SO THAT IT DOESN'T --
THE PRIMARY FLUID DOESN'T COME OUT UP AND CAUSE IT TO QUIT DRIPPING.
AND YOU GOT A BACK-CHECK VALVE HERE SO THAT ON YOUR CONTINUOUS DRIP
IT WON'T PUSH IT UP, THE BAG. IT CAN'T.
IT CAN ONLY GO DOWN.
AND SO THAT KEEPS DRIPPING AND THIS GOES IN AND -- PRETTY GOOD DEAL.
- IT HAS AN ALARM ON IT? - UH-HUH.
- SO THE ALARM WILL LET YOU KNOW THAT THE MEDICATION'S RUNNING OUT
- OR SOMEONE'S TRYING TO RIP IT. - OR IT WON'T GO IN.
- OH, SO IF IT RECEIVES BACK PRESSURE THEN...
- UH-HUH. IF IT GETS INFILTRATED, THEN IT WON'T PUSH,
IT'S MEETING RESISTANCE, IT WILL ALARM.
SO THAT YOU CAN COME IN AND CHECK IT. - CAN IT BE TAMPERED WITH?
OH, YEAH, ANYBODY. I COULD WALK IN AND JUST PULL IT OUT.
BUT MOST PEOPLE DON'T, THEY'RE AFRAID OF EVERYTHING IN THE HOSPITAL.
NO, REALLY. AND THEY'RE NOT TOUCHING ANYTHING, SO.
OKAY.
ALRIGHT. TO STATION NUMBER FIVE.
STATION NUMBER FIVE IS GOING TO BE OUR PORTACATH, OUR INLINE CATHETER.
AND OUR GOAL ON THIS ONE IS TO FLUSH IT.
WE NEED TO ACCESS IT TO FLUSH IT.
THERE ARE VARYING PROTOCOLS IN THE HOSPITALS,
SO I CAN'T GIVE YOU AN ABSOLUTE ON THIS.
BUT ON THESE, THEY NEED TO BE FLUSHED
EVER TIME THE CLIENT HAS A PROCEDURE OR MEDICATION.
SO IF THEY DRAW BLOOD FROM THE --
WELL, LET ME JUST PRACTICALLY SHOW YOU WHAT I'M TALKING ABOUT.
THIS IS THE CATHETER. IT'S SURGICALLY IMPLANTED INTRAVENOUSLY
INTO A CENTRAL LINE AND IT'S UNDERNEATH THE SKIN.
SO THE PORT IS PLACED OVER THE RIBS TO STABILIZE IT.
IT'S SUTURED DOWN AND THEN THE SKIN IS OVER THE TOP OF IT,
SO THAT YOU CAN GET TO THE CLIENT WITHOUT HAVING TO STICK VEINS.
THEY RUN OUT OF VEINS, THEY'RE GETTING FREQUENT LAB DRAWS,
THEY NEED MEDICINE ALL THE TIME.
AND IT JUST GIVES US GOOD, EASY ACCESS TO THAT.
ON THESE, INSIDE HERE --
WELL, THIS CHAMBER -- THIS IS LIKE A VIAL TOP. IT'S LIKE A RUBBER TOP.
AND SO, WE'RE GOING TO ACCESS THROUGH THAT.
AND THEN IN HERE, +THIS CHAMBER,
DEPENDING ON THE BRAND THAT'S USED ON CLIENTS...
..LIKE MEDIPORTS, I THINK, IS WHAT THEY ARE USING IN CHILDREN'S HOSPITAL.
AND THEY'RE A BIGGER DISK SIZE,
HOLD VARYING AMOUNTS OF SALINE IN HERE TO KEEP THEM FROM CLOTTING OFF.
SO WHAT WE NEED TO DO IS MAINTAIN THE SALINE IN HERE
SO THAT IT DOESN'T CLOT OFF.
I WAS SAYING THAT IT NEEDS TO BE FLUSHED AFTER LAB DRAWS.
AFTER YOU'VE TAKEN BLOOD OUT,
YOU NEED TO FLUSH THE BLOOD BACK OUT.
IT NEEDS TO BE FLUSHED AFTER MEDICATIONS.
IT ALSO NEEDS TO BE FLUSHED ROUTINELY.
AND THAT'S WHERE IT BEGINS TO VARY.
I FLUSH THEM EVERYDAY, EVERY WEEK, EVERY MONTH.
IT JUST DEPENDS ON THE BRAND AND THE REASON IT'S BEING USED
AND HOW IT'S BEING MAINTAINED.
I'VE ALWAYS DONE EVERYDAY AND NO LONGER THAN A WEEK.
AND I HAD A STUDENT SAY, "WELL, MY MOTHER OR SOMEBODY HAD ONE,
AND SHE NEVER FLUSHED IT." SHE HAD IT FOR A MONTH
SHE ONLY FLUSHED IT WHEN SHE WENT IN FOR HER LAB DRAWS.
AND WENT, "YOU'RE KIDDING."
MY MOM'S AT THE END OF HER CHEMO AND THEY ONLY FLUSHED IT RIGHT BEFORE
THEY DO A CHEMO, EVERY TWO WEEKS.
YEAH. SO IT JUST VARIES DEPENDING ON THE BRAND,
THE POLICY, PHYSICIAN PREFERENCE.
SO YOU NEED TO FIND OUT WHAT THEY WANT YOU TO DO ON THESE.
LIKE I SAID, I'VE DONE VARIED THINGS,
AND I DON'T HAVE AN ABSOLUTE ANSWER FOR YOU ON THAT.
SO, WE JUST KNOW, FOR OUR ASSIGNMENT, IT'S FLUSH DAY.
WHATEVER DAY THAT IS, WE'RE FLUSHING TODAY, SO.
- MA'AM, I'M PROBABLY A LITTLE BIT AHEAD,
BUT I ASSUME WE'RE GOING TO USE A NEEDLE WHEN WE'RE ABLE TO DO THAT.
THAT WOULD BE GOOD.
- I'M THINKING TO MYSELF -- - FILL IT IN.
WON'T WE CAUSE SOME SKIN PROBLEMS?
THAT'S THE COOL THING ABOUT THESE.
YEAH.
ALRIGHT. WE ARE GOING TO CHECK OUR DOCTOR'S ORDERS
AND FIND OUT THAT IT'S FLUSH DAY
AND FIND OUT WHAT THE FLUSH PROTOCOL IS.
THIS PARTICULAR PORT, BECAUSE IT'S MY PORT AND IT'S MY FLUSH DAY,
IS GOING TO BE A HEPARIN FLUSH.
ALRIGHT. SO I WANTED YOU TO HAVE THE EXPERIENCE OF WORKING WITH
SOME HEPARIN AND DOING THAT SORT OF THING.
SO, I CHECKED MY DOCTOR'S ORDERS,
I'M GOING TO FLUSH WITH HEPARIN. AND THE DOCTOR ORDERED 10 UNITS PER MIL
AS THE CONCENTRATION.
5 CC FOR MY CENTRAL VENOUS ACCESS DEVICE AND THAT'S GENERIC TERM.
YOU'RE GOING TO BE CALLING IT A PORT.
BECAUSE THAT'S WHAT I'VE ALWAYS CALLED IT.
IT'S A CENTRAL VENOUS ACCESS DEVICE, WHICH COULD BE A HICKMAN.
IT COULD BE A PICC LINE. IT COULD BE A MEDIPORT.
ALRIGHT. SO THIS IS A MEDIPORT PORT.
WE'RE ALSO GOING TO FLUSH WITH SALINE 8 CC.
SO IF YOU'RE THINKING OF YOUR SISH/SASH METHOD,
WHAT DO YOU SUPPOSE I'M GOING TO FLUSH FIRST WITH -- FLUSH WITH FIRST?
SALINE. AND THEN I'M GOING TO LEAVE THE HEPARIN BEHIND.
THAT WILL BE THE SECOND. AND HEPARIN IS WHAT'S GOING TO STAY IN HERE.
BUT YOU DON'T WANT TO TRY TO FLUSH SOMEONE WITH A MED,
IN CASE IT INFILTRATES, IT LEAKS INTO THEIR TISSUE.
YOU WANT TO BE FLUSHING WITH SOMETHING BENIGN.
SO THAT'S WHY WE'RE GOING TO FLUSH WITH SALINE,
IN CASE IT LEAKS INTO TISSUE OR IT DOESN'T GO IN CORRECTLY.
SO THAT'S WHY THE SALINE.
ALRIGHT. SO I'VE GATHERED MY EQUIPMENT.
I WANT YOU TO HAVE 10 CC SYRINGES.
THESE ARE ALL SO PRECIOUS, WE USE THEM FROM SEMESTER TO SEMESTER. SO SAVE THESE.
10 CC. I'VE DRAWN UP MY HEPARIN, I HAVE 5 CC IN THERE,
AND YOU CAN JUST MARK YOUR VIAL AS 10 UNITS PER MIL.
CONNIE, I THINK, HAS SOME VIALS THAT WE'VE LABELED AS 10 UNITS PER MIL.
5 CC, AND THEN I HAVE MY SALINE AND JUST PUT AN S ON IT.
AND IT'S 8 CC OF SALINE. IT COULD BE 6. IT COULD BE 10.
THAT'S NOT SO CRITICAL. WHAT'S MORE CRITICAL IS THAT AGAIN,
I HAVE SOME FLUID, I HAVE SPACE IN MY SYRINGE TO PULL BACK
SO THAT I CAN SEE IF THERE'S IS SOME BLOOD IN THE LINE.
IF I OVERFILL THIS TO 10 CC,
YOU'VE GOT NOWHERE TO GO, AND THAT'S IMPORTANT.
OKAY. I'M GOING TO NEED TO CLEAN THE SKIN,
SO I NEED MY 3 ALCOHOL, 3 BETADINE.
AGAIN, I GAVE YOU A WONDERFUL ARTICLE
ON PREVENTING INFECTIONS FOR CENTRAL VENOUS ACCESS DEVICES.
AND THEY SPEAK TO THE ISSUES OF BETADINE AND ALCOHOL VERSUS CHLORHEXIDINE.
I'VE CHECKED WITH HOSPITALS,
THEY HAVEN'T REALLY BOUGHT INTO THE CHLORHEXIDINE YET.
I'M NOT SEEING A LOT OF IT ON THE FLOORS.
BUT YOU WILL. AND IF YOU DO CHLORHEXIDINE,
THEN THAT'S JUST ONE PRODUCT THAT YOU HAVE TO USE ON THE SKIN.
WE'RE GOING TO USE THESE FOR NOW.
I ALSO NEED A NEEDLE,
AND THIS NEEDLE IS DIFFERENT THAN ANY NEEDLE THAT WE'VE USED SO FAR.
IT'S CALLED A HUBER NEEDLE.
BECAUSE MR. HUBER CREATED IT.
DON'T YOU WANT TO CREATE SOMETHING AND JUST CALL IT AFTER YOUR NAME?
I WANT TO HAVE A BENEFIEL SOMETHING, I DON'T KNOW.
WHEN YOU SEE IT, GO, "SHE DID IT. SHE FINALLY GOT IT."
YOU NEED YOUR HUBER NEEDLE. AND THE KEY TO THE HUBER NEEDLE IS THIS.
IT'S A NON-CORING NEEDLE.
REMEMBER, I TOLD YOU THAT THIS HAS A RUBBER TOP LIKE A VIAL.
YOU KNOW, HOW YOUR VIALS HAVE BEEN
AFTER YOU'VE USED THEM AND USED THEM AND USED THEM?
YOU HAVEN'T USED THEM THAT MUCH, RIGHT?
THEY'RE LEAKING ALL OVER THE PLACE.
BECAUSE WE'RE PUTTING STRAIGHT NEEDLES IN THAT TAKE CORE OUT.
THEORETICALLY, THEY CAN.
THEY CAN TAKE A LITTLE PIECE OF THE RUBBER OUT.
THIS NEEDLE DOESN'T CORE. IT DOESN'T TAKE OUT RUBBER
BECAUSE OF HOW IT'S BENT. IT'S BENT TWO WAYS.
IT'S A STRAIGHT NEEDLE OFF OF THE BUTTERFLIES HERE,
BUT SEE HOW IT'S -- I'LL HOLD IT REAL STILL FOR YOU IN A SECOND.
SEE HOW IT'S BENT RIGHT THERE?
CAN YOU SEE IT? EVER SO SLIGHTLY, THERE'S A BEND?
THAT'S WHAT CAUSES IT TO BE NON-CORING.
SO, WHENEVER YOU ACCESS ONE OF THESE PORTS,
YOU HAVE TO USE A NON-CORING NEEDLE.
AND THE BRAND OR THE TRADE NAME, IF YOU WILL, IS HUBER.
THIS ONE IS CALLED NON-CORE PLUS PORT INFUSION SET.
NON-CORING IS WHAT THEY WANT YOU TO APPRECIATE ABOUT THIS.
OKAY. THE OTHER THING I WANT YOU TO APPRECIATE IS
THE LITTLE CAP THAT GOES OVER THE NEEDLE.
GOING TO STICK MYSELF.
WE GOT TO SAVE THESE BECAUSE YOU WOULD HAVE A STERILE SET
AND THIS LITTLE TUBE THAT FITS OVER THE NEEDLES ISN'T SEALED AT THE END,
SO THAT WHEN YOU PRIME IT, IT'LL SQUIRT OUT.
SO THAT YOU DON'T HAVE TO TOUCH IT AND TRY TO GET IT BACK ON.
IT'S TOO HARD TO DO IT WITHOUT STICKING YOURSELF.
SO YOU GOT TO SAVE THESE AFTER YOU PRACTICE,
AND MAKE SURE YOU PUT IT BACK ON.
THERE ARE SOME FEATURES ABOUT THIS NEEDLE,
I ALREADY SHOWED YOU ABOUT THE BEND AND THE CORE.
THERE IS THE BUTTERFLY WINGS TO GRIP IT WITH.
YOU HAVE A MED PORT FOR ACCESS. YOU HAVE A CLAMP,
AND OFF IS FINE. AND THEN YOU HAVE THE OPENING OF THIS.
WHEN WE ACCESS THE PORT,
WE STICK OUR NEEDLE IN, YOU CAN ACTUALLY PUT A DRESSING OVER IT
AND THEN USE IT AS AN IV SITE SO THAT YOUR IV FLUIDS CAN GO IN.
YOU JUST CONNECT TO IV FLUIDS
AND THEN IT'S A CONTINUOUS DRIPPING IV WITH AN EXTENSION.
AND THEN YOU HAVE THIS PORT SITE TO PUT MEDS IN.
SO THAT'S BEAUTIFUL. BUT WE DON'T NEED ALL THAT.
WHAT WE NEED TO APPRECIATE IS,
WHEN WE'RE ACCESSING THIS,
WE'RE GOING TO BE TAKING SYRINGES ON AND OFF.
BECAUSE OF THE PRESSURE IN THE CLIENT AND THE PRESSURE IN THE ROOM,
THESE CAN EITHER SUCK AIR OR THEY CAN HEMORRHAGE OUT,
DEPENDING ON WHOSE PRESSURE IS GREATEST.
SO WE NEED TO CREATE A SYSTEM THAT DOESN'T ALLOW
THE EXCHANGE OF AIR OR BLOOD, EITHER WAY.
SO TO DO THAT, I'M GOING TO CLAMP THIS OFF AS A SECURITY,
BUT PEOPLE FORGET THIS SOMETIMES.
I'LL TELL YOU A HORROR STORY, IF YOU REMIND ME.
WHAT WE NEED TO DO IS WE NEED TO PUT A CAP ON THIS
THAT WILL PREVENT THAT BACK FLOW.
SO WHAT I WANT YOU TO DO IS MAKE SURE THAT ALL OF YOUR LINES
HAVE ONE OF THESE SAFETY CAPS ON.
AND A LOT OF THEM COME PREPACKAGED.
WE JUST BOUGHT THIS FROM A DIFFERENT VENDOR. IT'S A NEW BRAND.
AND THIS PARTICULAR BRAND DOESN'T HAVE IT, OKAY?
SO I NEED TO ADD THIS.
SO THAT NOW, WHEN I HOOK THIS UP TO HIM,
IF I FORGET TO PUT A CLAMP ON OR A SYRINGE,
BLOOD WON'T COME GUSHING OUT,
AND BY THE SAME TOKEN, IT WON'T SUCK AIR
SO THAT THEY GET AN AIR EMBOLUS. I HAVE SEALED IT OFF.
- SO IF YOU SEAL IT OFF, DO YOU STILL TO DO THAT?
I DO, AS A SAFETY MECHANISM. I THINK IT'S A GOOD HABIT FOR YOU TO GET INTO
BECAUSE YOU MIGHT INADVERTENTLY BE WORKING WITH A SYSTEM
WITHOUT ONE OF THESE AND YOU DON'T WANT TO GET CAUGHT.
- SO BEFORE THEN, YOU DON'T KNOW WHAT'S IN THERE AND YOU CAN'T --
UH-HUH. I'M GOING TO PRIME IT HERE IN A MINUTE.
BUT BEFORE I DO ANYTHING, I WANTED TO GET THIS CAP ON HERE.
AND IT DIDN'T COME WITH IT, IN THIS KIT.
NOW I WANT TO SHOW YOU ANOTHER BRAND THAT SAINT AGNES IS CARRYING,
OKAY. THIS IS A HOMECARE SET THAT I JUST GOT A HOLD OF.
THIS IS SAINT AGNES' AND IT'S THE SAME THING.
IT'S A NON-CORING NEEDLE.
BY THE WAY THESE NEEDLES COME IN DIFFERENT GAUGES
AND THEY COME IN DIFFERENT LENGTHS.
THE LENGTH IS WHAT IS CRITICAL. YEAH, THIS IS REALLY BAD.
MY SETUP HERE, BECAUSE THE RUBBER IS KIND OF THICK
AND THE NEEDLE HAS TO GO ALL THE WAY TO THE BASE OF THE PORT,
I NEED TO HAVE A THREE-QUARTER INCH TO ONE INCH NEEDLE
TO CLEAR ALL THE SKIN.
BUT YOU MAY ONLY NEED A HALF INCH NEEDLE.
WHEN YOU SEE THESE ON PEOPLE,
THEIR SKIN IS SO TAUT OVER IT
THAT YOU CAN SEE THE WHOLE IMPRINT OF THE PORT.
AND IT'S THIN. AND SO, REALLY, YOU ONLY NEED, SOMETIMES,
HALF OF AN INCH OF A NEEDLE
TO TOTALLY GET THROUGH SKIN AND HIT THE BASE OF THE PORT.
SO BE CONSCIOUS OF THE LENGTH,
ALRIGHT. SO HERE'S YOUR NON-CORING NEEDLE.
BUT THIS ONE HAS A COUPLE OF FUN FEATURES.
YOU HAVE THE CLAMP, BUT THE MED PORT NOW
HAS YOUR DIAPHRAGM SUPPORT MED PORT,
AND IT'S ALREADY GOT A MED -- OH, NO, THIS ONE DOESN'T EITHER.
I SEE. I'D HAVE TO PUT ANOTHER ONE ON HERE.
THERE WAS A BRAND THAT WE HAD THAT HAD A CAP ON HERE.
SO THIS ONE AGAIN DOES NOT HAVE THAT PORT ON HERE.
YOU WANT A PORT LIKE THIS ON THIS END.
SO, WE'LL JUST ADD ONE AGAIN.
- WHY WOULDN'T THEY ALL JUST HAVE STANDARD CARE?
THEY'RE GETTING THAT WAY.
THIS IS ALL NEW. AND THESE ACTUALLY JUST CAME OUT WITHIN THE YEAR,
THE SAFETY LOCK DEVICE THAT I'M GOING TO SHOW YOU, SO.
GO AHEAD AND ADD THIS ON TO THIS ONE.
NOW THIS ONE HAS ANOTHER FEATURE THAT THE OTHER ONE DIDN'T HAVE,
AND IT'S THE SAFETY LOCK.
WE NEED A -- REMEMBER USHA SAID THAT
WE HAVE TO HAVE A NEEDLE SAFET+ DEVICE ON ALL THE NEEDLES NOW.
AND THE HUBER, THIS ONE, DOESN'T HAVE ONE.
WHEN I PULL THIS OUT, IT'S BARE, BLOODY NEEDLE.
THIS ONE, WHEN YOU PUT IT IN AND YOU PULL IT OUT,
WHEN YOU SQUEEZE THESE TABS,
IT COVERS IT AND SO YOU'RE NOT EXPOSED TO THE NEEDLE.
I DIDN'T LOCK IT, SO MAYBE I CAN GET BACK UP HERE AGAIN WITHOUT STICKING MYSELF.
OKAY, SO YOU PUT IT INTO THE CLIENT,
AND THEN WHEN IT'S TIME TO RELEASE IT, YOU GO CA-CHINK! AND LOCK IT.
AND THAT WAY YOU'RE NEVER EXPOSED TO THAT NEEDLE AS WELL.
YOU'LL APPRECIATE NOW WHEN I SHOW YOU HOW WE'RE GOING TO PULL IT OUT.
OKAY.
NOW WHAT HAPPENED TO THAT LITTLE THINGY?
DID YOU GUYS SEE WHERE I PUT IT?
GOT TO HAVE ALL YOUR STERILE ENDS.
OKAY. THIS IS ANOTHER BRAND THAT I HATE.
WE HAVE A FEW OF THEM. WE GOT THEM CHEAP AND WE DIDN'T REALIZE
THAT THEY WERE SO DIFFERENT IN BRANDS.
IT ALSO DOESN'T HAVE A SLIP IN IT.
I HATE THIS ONE.
SEE THIS NEEDLE. SEE HOW IT'S BENT RIGHT THERE.
AFTER YOU GUYS HAVE USED IT TWO OR THREE TIMES,
IT STARTS LOOKING LIKE THIS. IT STARTS BENDING LIKE THIS.
IT'S JUST NOT VERY STURDY. AND THE WINGS TWIST,
SO THAT YOU NEVER FEEL REALLY STABLE WITH IT.
AND YOU CAN'T TOUCH IT, YOU HAVE TO STAY STERILE.
IT'S GOT A RUBBER STOP AND IT DOESN'T HAVE THE CAP.
AND I REALLY HATE THEM. BUT WE HAVE A FEW OF THEM.
AND IT'S BETTER THAN NOTHING IF YOU REALLY NEED TO ACCESS A PORT.
SO APPRECIATE SOME OF THE DIFFERENT BRANDS AND KNOW YOU CAN DO BETTER
THAN SOME OF THESE. SOME OF THESE ARE CRUMMY.
I WONDER HOW THEY STAY IN BUSINESS, TO BE PERFECTLY HONEST.
OKAY.
BACK TO GATHERING EQUIPMENT.
I'VE GOT MY SYRINGES, MY CLEANER, MY STUFF,
YOU'RE GOING TO NEED STERILE GLOVES. SO GET YOUR STERILE GLOVES OUT.
AND YOU WOULD ALSO WEAR A MASK TO ACCESS THE CENTRAL LINE.
BUT JUST SAY IT
BECAUSE I DON'T -- CAN'T HEAR YOU VERY GOOD WHEN YOU PUT MASKS ON.
OKAY. MY HANDS ARE WASHED, I'VE GATHERED MY EQUIPMENT.
I JUST WANT TO DO ONE OTHER THING
BEFORE I GET GOING INTO THE CLIENT'S ROOM.
IF I HAD PULLED THIS STRAIGHT OUT OF HERE
AND I DIDN'T TOUCH THIS, THIS WOULD BE STERILE.
BUT BECAUSE I PROBABLY HAVE NOT HANDLED IT WELL,
I'M GOING TO CLEAN THE TOP OF IT.
AND I WANT TO GO AHEAD AND ATTACH MY SALINE SYRINGE TO IT
AND FLUSH IT AND THEN IT WILL TOTALLY BE READY
FOR WHEN I GO INTO THE CLIENT'S ROOM.
OKAY. SO, ATTACH, AND THEN I CLAMPED IT.
SO, GO AHEAD AND FLUSH.
SO IT'S FLUSHED AND I'M HAPPY.
THE END IS CAPPED, I DON'T NEED TO WORRY ABOUT STERILITY THERE.
BUT I DO LIKE TO KEEP THEM IN MY PACKAGE
JUST SO THEY'RE NOT CONTAMINATED.
OKAY. I'M GOING TO GO INTO MY CLIENT'S ROOM,
I'M GOING TO IDENTIFY MY CLIENT WITH THE MAR.
MARS WILL BE AT ALL THE STATIONS, JUST LIKE WE DID BEFORE.
ALLERGIES, IT'S USUALLY NOT AN ISSUE.
WHEN I CONSIDER HEPARIN, WE'RE NOT GIVING A MED.
COMPATIBILITY IS NOT AN ISSUE. WE DON'T HAVE ANY ISSUES ON THAT ONE
THAT NEED THINKING ABOUT IT AND PROVIDE PRIVACY.
OKAY. THE FIRST THING I WANT TO DO WHEN I COME IN THE ROOM,
I'M JUST GOING TO FACE YOU LIKE THIS...
I WOULD FACE THE OTHER WAY.
THE FIRST THING I WANT TO DO IS ASSESS THE SITE,
AND I WANT TO MAKE SURE THAT IT LOOKS OKAY,
THAT THERE'S NO SIGNS OF INFECTION,
THAT THERE'S NO PAIN AT THE SITE WHEN I PALPATE,
THAT THERE'S NO CREPITUS AT THE SITE, THAT THERE'S NO LEAKING,
THAT CRUNCHINESS UNDER THE SKIN OF AIR OR FLUID.
I'M THEN GOING TO LOCATE THE SITE AND MAKE SURE I KNOW WHERE IT IS.
SO YOU WANT TO PALPATE THE BORDERS.
YOU DON'T REALLY NEED GLOVES AT THIS POINT BECAUSE THE SKIN'S INTACT.
UNLESS THEY'RE OOZING OR SOMETHING, BUT IT'S JUST SKIN.
SO YOU CAN FEEL THE BORDERS AND MAKE SURE YOU KNOW WHERE IT IS.
AND YOU'RE GOOD THERE, SO.
THE FIRST THING I WANT TO DO -- AND NOW I WANT TO PUT ON MY STERILE GLOVES
JUST BECAUSE I DON'T LIKE GETTING THE BETADINE ALL OVER MY FINGERS.
WE'RE GOING TO CLEAN THE SITE
WITH THREE ALCOHOL SWABS AND THREE BETADINE SWABS.
AND BE VIGOROUS FROM INSIDE OUT.
IF YOU'RE GOING TO PUT A DRESSING ON THE SKIN,
YOU NEED TO CLEAN EVERYTHING THAT WOULD BE UNDER THE DRESSING.
IF WE'RE JUST CLEANING TO DO THE PORT,
WE REALLY JUST NEED TO DO A COUPLE OF INCHES
FOR WHERE WE'RE ACCESSING.
SO, A GOOD CLEAN -- NOTICE I USED THE FLATS OF THE ALCOHOL SWABS
SO THAT I GET GOOD COVERAGE. AND I'M PRESSING FIRMLY,
SO THAT I GET IT NICE AND CLEAN.
YOUR ALCOHOL NEEDS TO DRY ABOUT 30 SECONDS.
SO GIVE IT PLENTY OF DRYING TIME WITHOUT BANDING OR BLOTTING.
AFTER 30 SECONDS IS UP,
YOU'RE GOING TO GET YOUR BETADINE SWABS,
GIVE THEM A LITTLE SQUEEZE. AND THEN THE SAME THING YOU'RE GOING TO CLEAN.
AND BETADINE NEEDS TO DRY ABOUT TWO MINUTES BEFORE YOU STICK.
SO YOU COULD ACTUALLY DO YOUR CLEANING
AND THEN DO SOME OF YOUR SETUP IF YOU WANTED SOMETHING TO DO,
WHILE YOU'RE IN YOUR CLIENT'S ROOM.
I'M NOW GOING TO PUT ON MY STERILE GLOVES.
AND IT'S NOT BECAUSE I REALLY NEED TO BE STERILE.
IT'S BECAUSE IF I WANT TO TOUCH ANYMORE AROUND THAT SITE,
YOU CAN'T INTRODUCE ANYTHING HERE.
SO, STERILE GLOVES IS STILL PRETTY MUCH THE PROCEDURE
EVEN THOUGH EVERYTHING I TOUCH IS GOING TO BE CONTAMINATING ME.
THIS NOT GOOD. IT'S SO STUCK, I CAN'T EVEN GET MY HAND IN.
OKAY, NOTICE, I'M ABOVE MY WAIST. I'M OUT. I'M HIGH.
DON'T WORK DOWN LIKE THIS BECAUSE YOU TOUCH THINGS.
I JUST TOUCHED THAT PAPER, SO I DON'T KNOW IF I'M CONTAMINATED OR NOT.
I THINK THE PAPER'S STERILE
OKAY, NOW, THE POINT OF THE GLOVES IS,
IS IF YOU NEED TO TOUCH ONE MORE TIME TO FIND WHERE THAT PORT IS,
YOU'RE GOING TO DO IT WITH YOUR STERILE GLOVES.
SO, I'M CONVINCED IT'S RIGHT HERE, AND I'M OKAY.
BUT YOU CAN'T GO TOUCHING THE SITE,
AFTER YOU CLEAN IT WITH NON-STERILE GLOVES.
I KNOW PEOPLE THAT DELIVER AT MY IV START STATION,
IF THEY CLEAN AND THEN THEY TOUCH THE VEIN,
I GO, "OH, YOU GOT TO CLEAN AGAIN."
BECAUSE YOU CAN'T TOUCH, IF YOU'RE NOT STERILE.
ALRIGHT. I'M GOING TO SACRIFICE MY --
I DON'T KNOW WHICH END HERE, MY LEFT HAND.
I'M GOING TO GRAB THIS WITH MY RIGHT, IT'S STILL STERILE.
AND WHAT I NEED TO DO IS STABILIZE ON THE OUTSIDE HERE, THE PORT.
YOU DON'T WANT TO JUST PUSH THIS IN WITHOUT HOLDING IT STEADY.
SO I'M GOING TO STABILIZE AND PRESS IN
UNTIL I FEEL THE BOTTOM OF THE PORT. AND THEN RELEASE.
OKAY. MY CLAMP IS OPEN, THAT'S FINE. I'M GOING TO ASPIRATE.
WAIT A MINUTE.
RUN OUT OF...SYRINGE TO GET THE BLOOD,
BUT I'M STARTING TO GET BLOOD BACK HERE, IT WASN'T IN THE BANK.
SO I DON'T HAVE BLOOD. I'M GOING TO GO AHEAD AND INSTILL EVER SO GENTLY
SEE HOW MY SYRINGE IS POINTED UPWARD.
AND I GOT ALL THAT AIR IN THERE.
WE'RE GOING TO GO AHEAD AND INSTILL. IT GOES IN VERY EASILY.
I'M GOING TO PUT IN 7, 7.5 CC OF SALINE.
NOW, HERE IS WHERE I WAS TALKING ABOUT THE PROBLEM.
BECAUSE I HAVE THIS PORT ON,
IT'S PROBABLY NOT GOING TO EXCHANGE AIR OR BLEED.
BUT TO BE SAFE, I WANT YOU TO STILL GO AHEAD AND CLAMP,
DISCONNECT YOUR SYRINGE AND THEN HOOK ON THE HEPARIN.
I'M GOING TO -- BECAUSE THIS IS A MED,
I'M JUST GOING TO DOUBLE CHECK. YES.
I DON'T NEED TO ASPIRATE AGAIN. I COULD, I SUPPOSE, BUT I DON'T NEED TO,
BECAUSE I FLUSHED AND IT'S FINE.
AND I'M GOING TO INSTILL THE HEPARIN. OH, IT WON'T GO IN. WHY?
BECAUSE I'M CLAMPED. UNCLAMP,
AND PUT 4.5 CC'S OF HEPARIN IN.
WE NEVER PUT THAT LAST HALF CC IN.
OKAY, I'M GOING TO CLAMP.
DISCONNECT. OKAY, NOW TO DISCONTINUE THIS,
YOU NEED TO STABILIZE THIS PORT. REMEMBER, IT'S SUTURED IN,
SO YOU DON'T WANT TO JUST BE YANKING ON IT,
THAT WILL TRAUMATIZE THOSE SUTURES.
STABILIZE, PULL OUT.
THIS GOES IN SHARPS, IT'S ALL DISPOSABLE.
AND THEN YOU WANT TO CLEAN UP THE SITE.
HOWEVER, WE'RE USING IT OVER AND OVER AND OVER.
WHERE'S THAT LITTLE WHITE THING?
WELL, STILL LOSING THOSE LITTLE WHITE THINGS.
YOU GUYS SEE WHAT I DO WITH IT?
NEVER RECAP, GOES IN SHARPS. I'LL FIND IT LATER. SHARPS CONTAINER.
OKAY. THEN YOU WANT TO CLEAN UP THE SITE,
BECAUSE NOW,
THEY'RE DONE. SO GET ALL OF THAT BETADINE OFF OF THEM.
TAKE OFF YOUR GLOVES, WASH YOUR HANDS.
AND DOCUMENT WHAT YOU DID.
- DO I PUT THE NEEDLE INTO THE SHARP CONTAINER?
NO, I WANT YOU TO SAY YOU PUT IT INTO SHARPS.
BECAUSE THESE ARE VERY EXPENSIVE. THEY'RE LIKE 10 BUCKS.
AND SO, WE GOT TO SAVE THEM AND USE THEM
OVER AND OVER AND OVER UNTIL THEY'RE DEAD.
SO THEN I'LL HAVE YOU FIND YOUR LITTLE WHITE CAP
LIKE I'M GOING TO FIND MY LITTLE WHITE CAP ON HERE SOMEWHERE.
AND THEN THAT WILL BE SETUP FOR THE NEXT TIME.
SO, WHEN YOU COME TO TEST, THEY PROBABLY ALREADY WILL BE PRE-SETUP,
WITH A LITTLE CAP ON, AND READY TO GO WITH OUR CAPS.
AND WE WILL ALREADY HAVE THESE AT THE STATION FOR YOU.
YOU DON'T HAVE TO GATHER THAT UP.
WHAT YOU'RE GOING TO HAVE TO GATHER FOR NEXT WEEK IS ALL OF YOUR FLUSHES,
ALL OF YOUR MEDS, YOUR PIGGYBACK
AND THEN THE MARS WILL BE AT THE STATION.
SO THAT'S THE HUGENESS OF THE SETUP.
BECAUSE WE HAVE FIVE STATIONS, WE WON'T BE BEHIND.
IN FACT, WE'LL BE AHEAD BECAUSE WE CAN PULL IN A LOT OF PEOPLE UP.
WE'LL ALL BE RUNNING THREE, AT ALL FIVE STATIONS
SO THAT WE CAN KEEP IT MOVING IN THERE.
SO, HONESTLY WE WANT YOU READY TO GO.
GET YOUR TIME IN A LITTLE BEFORE, SO THAT WE CAN KEEP GOING.
BECAUSE IT'S SUCH A HUGE SETUP. IT'S A HUGE CLEANUP FOR US.
AND WE HAVE CLASSES IN THE EVENING AND WE HAVE GOT TO GET OUT OF THERE.
4 O'CLOCK, PEOPLE, WE GOT TO GET YOU MOVING A LITTLE FASTER.
WHOEVER YOU ARE, I DON'T KNOW.
WE'LL PROBABLY BE PULLING YOU IN AT 3:30,
SO THAT WE'RE OUT. BECAUSE IF WE'RE RUNNING TOO LATE,
WE'RE RUNNING INTO CLASSES IN THE EVENING.
OKAY. ANY QUESTIONS? FIVE STATIONS.
REALLY, NONE OF IT IS TOO HARD.
THE MAIN THING THAT YOU NEED TO DO IS, YOU NEED TO
HANDLE THIS EQUIPMENT SO THAT YOU'RE NOT CONTAMINATING THINGS
FROM HAND TO HAND. AND YOU NEED TO
HANDLE THE EQUIPMENT TO CONVERT THAT IV TO IV LOCK.
BECAUSE IT'S AWKWARD MAKING THAT TRANSFER
OF THOSE TWO TUBES WITHOUT CONTAMINATING.
SO GET YOUR HANDS ON IT.
AND YOU'LL BE GREAT.
OKAY, HOMEWORK. DON'T FORGET.