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.