ALRIGHT. WE'RE GOING TO KEEP ADDING ON TO STARTING IV'S AND IV THERAPY.
SO IN YOUR MIND, I WANT YOU TO BE THINKING
THAT YOU'VE STARTED YOUR IV AND YOUR IV IS DRIPPING.
OKAY? SO WE'RE GOING TO HEAD INTO OUR CLIENT'S ROOM
THAT HAS AN IV THAT IS CURRENTLY RUNNING.
WHEN WE DO OUR MEDICATIONS AND WHEN YOU ARE REVIEWING YOUR BOOKS
FOR COMPATIBILITY ISSUES AND ALLERGY ISSUES AND THOSE KINDS OF THINGS,
I WANT YOU TO KEEP IN MIND THESE CRITERIA.
YOU KNOW THAT ALLERGIES OF OUR CLIENT IN THE LAB ARE WHAT?
- PENICILLIN. - PENICILLIN, SULFA, CODEINE, KEEP THAT MIND.
AND THEN, AS FAR AS COMPATIBILITIES, THE SOLUTIONS
THAT WE'RE GOING TO BE HANGING ARE ALL GOING TO BE SODIUM CHLORIDE.
JUST BECAUSE SUGAR SOLUTIONS IN MY MANNEQUINS CAUSES MOLD.
SO, ALL MY SOLUTIONS ARE GOING TO BE SODIUM CHLORIDE AND NOBODY'S ALLERGIC TO THAT.
BUT I'M GOING TO HAVE ADDITIVES IN ALL THE IV'S.
AND SO THEY'RE EITHER GOING TO HAVE A MULTIVITAMIN
OR THEY'RE GOING TO HAVE POTASSIUM CHLORIDE.
THE MOST COMMON, COMMON OF ADDITIVES WHEN YOU'RE IN THE HOSPITAL.
THOSE ARE WHAT YOU'RE GOING TO BE SEEING IN YOUR IV'S AS ROUTINE.
THERE'S OTHER MEDICATIONS AND YOU CAN DEAL WITH THOSE LATER IN PHARMACOLOGY.
YOU'VE GOT YOUR HEPARIN AND INSULIN AND THOSE KINDS OF THINGS.
SO, WHEN YOU START LOOKING --
THE DRUGS THAT WE'RE GOING TO HANG BECAUSE --
OUR PLAN THIS NEXT WEEK IS DRUG ADMINISTRATION, MEDICATION ADMINISTRATION.
I WANT YOU TO BE LOOKING AT COMPATIBILITY ISSUES WITH THE DRUG
TO THE POTASSIUM AND THE MULTIVITAMINS WHEN YOU'RE LOOKING AT THEM. ALRIGHT?
SO YOUR FIRST ASSIGNMENT,
BASICALLY, YOU HAVE THREE STATIONS YOU'RE GOING TO GO TO NEXT WEEK.
AT ONE STATION, YOU'RE GOING TO HANG A PIGGYBACK.
AT ONE STATION, YOU'RE GOING TO GIVE AN IV PUSH MED.
AND AT ANOTHER STATION, YOU'RE GOING TO GIVE MEDS THROUGH A BURETROL.
SO MEDICATION ADMINISTRATIONS THROUGH CONTINUOUSLY DRIPPING IV'S.
THAT'S OUR THEME FOR THE WEEK. ALRIGHT.
THIS FIRST STATION WHAT WE'RE GOING TO DO IS GOING TO BE
OUR ANCEF IV PIGGYBACK STATION.
SO THE DOCTOR HAS WRITTEN AN ORDER FOR ANCEF 1 GRAM,
IV PIGGYBACK, EVERY 8 HOURS.
SO, I WENT AHEAD AND WROTE THE ORDER IN 100 CC'S OF SODIUM CHLORIDE
BECAUSE THAT'S WHAT YOU'RE GOING TO CREATE YOUR BAG TO BE.
SOMETIMES, THEY WRITE WHAT IT'S TO BE DILUTED IN,
BUT MOST OF THE TIMES IT'S HOW IT COMES FROM PHARMACY.
AND SO PHARMACY THEN, WHEN THEY MAKE UP YOUR MARS,
THEY'LL SAY WHAT THE SOLU -- WHAT THE DRUG IS IN.
SO, THEY'LL SAY 50 CC'S OF D5W OR 50CC'S OF SODIUM CHLORIDE
OR 100 CC'S OF SODIUM CHLORIDE OR 100M CC'S OF D5W
HAS WHAT IT'S BEEN, YOUR MEDICATION HAS BEEN MIXED IN.
SO FOR OUR PURPOSES, WE'VE CHECKED OUR DOCTOR'S ORDERS,
ANCEF 1 GRAM Q8 HOURS IV PIGGYBACK HAS BEEN ORDERED. THAT'S HOW IT'S ORDERED.
ANCEF 1 GRAM IV PIGGYBACK Q8 HOURS. THAT'S ALL THE DOCTOR SAYS.
AT THIS PARTICULAR STATION, YOUR IV IS GOING TO BE RUNNING AT TKO.
WHAT IS TKO? WHAT'S THE RATE?
- IT'S ONE OR TWO?
- IT'S 25 CC'S PER HOUR, 25 MILLILITERS PER HOUR
TO 50 MILLILITERS PER HOUR, DEPENDING ON YOUR HOSPITAL.
VERY, VERY SLOW, BUT ENOUGH TO KEEP THE IV FROM CLOTTING OFF.
YOU HAVE TO HAVE A CONTINUOUSLY RUNNING IV OR IT WILL CLOT OFF.
UNLESS IT'S AN IV LOCK AND IT'S MAINTAINED WITH SALINE.
BUT FOR OUR PURPOSES, WE HAVE A DRIPPING IV.
WE HAVE GOT TO KEEP IT DRIPPING.
WHENEVER YOU HAVE ADDITIVES, WHENEVER THERE'S SUGAR CONTENT,
IF IT STOPS DRIPPING, IT CLOTS OFF. YOU'VE GOT TO KEEP IT DRIPPING.
SO WE'RE JUST GOING TO MAINTAIN OURS AT A TKO,
BECAUSE ALL OUR CLIENT NEEDS RIGHT NOW IS MEDICATION,
NOT REALLY FLUID VOLUMES, FLUID SUPPORT.
SO WE'RE JUST KEEPING THE VEIN OPEN, GIVING HIM A LITTLE HYDRATION.
ALRIGHT. SO THE STANDING ORDER, AND IT SAYS THAT IN YOUR SYLLABUS.
IV IS RUNNING AT TKO.
AND THE SOLUTION WE HAVE RIGHT NOW IS SODIUM CHLORIDE.
1000 CC'S OF SODIUM CHLORIDE WITH 40 MIL EQUIVALENTS OF KCL IN IT RUNNING AT TKO.
ALRIGHT. THE DOCTOR'S ORDERED ANCEF,
SO I'M GATHERING UP MY EQUIPMENT.
PHARMACY SENT ME UP A PIGGYBACK OF ANCEF.
SO WHAT I WANT YOU TO DO IS, ON THE PIGGYBACK THAT I GAVE YOU,
THAT'S YOUR SMALL VOLUME BAG, 100 CC'S,
PUT A LABEL ON IT AND CALL IT ANCEF.
IT'S ANCEF 1 GRAM. THERE YOU GO.
I'VE GATHERED IT UP. THE SAME CRITERIA AS BEFORE.
WHEN YOU GATHER UP, GET IN THE HABIT OF LOOKING FOR EXPIRATION DATES.
THERE'S GOING TO BE TWO EXPIRATION DATES.
ONE IS ON HERE THAT'S THE MANUFACTURER'S, YOU CAN HARDLY SEE IT,
BUT IT'S OCTOBER '04 ON HERE. SO MY SOLUTION IS GOOD.
BUT WHAT YOU'RE EVEN MORE CONCERNED ABOUT,
YOU WANT TO KNOW THE BASE OF IT'S GOOD.
BUT WHEN DID PHARMACY MIX IT AND HOW LONG IS THIS GOOD?
AND THIS IS ONLY GOOD FOR 24 HOURS MIXED IN SODIUM CHLORIDE.
HOW DO I KNOW THAT? BECAUSE PHARMACY TOLD ME
AND OR YOU WOULD LOOK IN YOUR BOOK OR THE LABEL, DRUG LABEL
TO SEE HOW LONG IT'S GOOD AFTER IT'S RECONSTITUTED.
ALRIGHT. SO PHARMACY HAS ALREADY MIXED IT FOR ME.
THEY'VE TOLD ME MY MEDICATION, THEY'VE GIVEN ME MY TIME AND DATE ON HERE
SO I KNOW THAT MY DRUG IS GOOD.
I ALSO KNOW THAT THIS IS THE FIRST ANCEF THAT MY CLIENT'S RECEIVED,
SO I WANT TO CHECK ALLERGIES AND MAKE SURE MY CLIENT'S NOT ALLERGIC TO ANCEF.
ANCEF IS CEPHALOSPORIN,
OR ANY OF THE ALLERGIES WE HAVE IN THE LAB IS CEPHALOSPORIN ALLERGIES.
- PENICILLIN?
CEPHALOSPORIN. PENICILLIN IS ACTUALLY A CILLIN, NOT A SPORIN.
BUT THEY'RE VERY, VERY CLOSE AND WE VERY SELDOM GIVE BOTH TOGETHER.
SO IF YOU'RE ALLERGIC TO A CILLIN, WE DON'T ALWAYS SPORINS EITHER.
- BUT THAT'S WHY WE NEED TO CHECK FOR PENICILLIN?
YEAH. SO CAUTION, BUT CHECK
WHEN YOU LOOK IN YOUR BOOKS, LOOK UNDER THE DRUG ALLERGIES,
WHO IS THIS CONTRAINDICATED FOR.
IT'S NOT A PROBLEM WITH SULFA,
IT'S NOT A PROBLEM WITH CODEINE.
OKAY?
AMPICILLIN WOULD BE OUR BIGGER ONE.
SO, SOMETIMES YOU'LL GIVE A SPORIN WITH THE CILLIN DEPENDING ON --
WITH A CILLIN ALLERGY, DEPENDING ON WHAT THEIR ALLERGY REALLY IS. SO.
- THE COMPATIBILITY CHART TOO?
- NO. IT'S GOING TO HAVE TO DO WITH CONTRAINDICATIONS.
COMPATIBILITIES IS, IS ANCEF COMPATIBLE WITH SODIUM CHLORIDE?
IS ANCEF COMPATIBLE WITH POTASSIUM CHLORIDE?
SO THAT, WHEN THESE TWO START RUNNING TOGETHER
AM I GOING TO GET A PRECIPITATE IN THE TUBING?
SO NOW YOU WANT TO LOOK FOR Y-SITE COMPATIBILITY
OR SYRINGE COMPATIBILITY. AND I LOOK IN BOTH.
THIS I GOING TO ACTUALLY BE A Y-SITE.
WE'RE GOING TO COME TOGETHER HERE WITH TWO TUBINGS.
SYRINGE, WOULD BE PUSHING IT THROUGH THE TUBING. BUT WHAT'S THE DIFFERENCE?
THEY'RE BOTH GOING TO BE MIXED IN THE TUBING.
SO I LOOKED IN BOTH OF THESE, TO SEE WHAT THEY'RE COMPATIBLE WITH.
AND THEN IT'LL LIST INCOMPATIBILITIES AS WELL.
BUT I LIKE TO LOOK FOR COMPATIBILITIES.
SO, WHICH WOULD LEAD US RIGHT TO COMPATIBILITIES.
I CHECKED ALLERGIES, I DON'T THINK I HAVE A PROBLEM HERE WITH MY CLIENT.
COMPATIBILITIES, I KNOW I'M COMPATIBLE WITH EVERYTHING, OKAY, FOR MIXING.
I'VE ALSO -- FOR GATHERING UP MY EQUIPMENT, I NEED ANOTHER TUBING.
I HAVE THIS TUBING, BUT I NEED A SECONDARY TUBING.
SO NOW YOU'RE GOING TO GET YOUR SECONDARY TUBING WHICH IS A SHORT TUBING.
LET ME SEE IF IT HAS THE INCHES ON HERE.
NO, IT DOESN'T. BUT THEY'RE SHORTER AND THEY DON'T HAVE INJECTION PORTS.
IT'S JUST A LITTLE SHORT STRAIGHT TUBING
THAT'S GOING TO GO DIRECTLY TO THE LINE.
SO, I WASHED MY HANDS PRIOR TO GETTING MY MED READY.
AND I'M GOING TO GO AHEAD AND GET IT SET UP HERE IN THE NURSING STATION.
SO YOU CAN PRACTICE WITH YOURS. YOU CAN GET YOURS LABELED.
AND YOU CAN HOOK UP YOUR PIGGYBACK THROUGH YOUR TUBING,
BEFORE YOU COME TO THE STATION.
- DO WE HAVE THAT? - YOU HAVE THIS.
SO HERE YOU HAVE YOUR SECONDARY TUBING.
WHAT ARE WE LOOKING FOR IN THE PACKAGE?
DROP FACTOR. DROP FACTOR IS 15. OKAY.
INSIDE YOU'RE GOING TO HAVE TUBING.
NOTHING SPECIAL ABOUT THE TUBING, IT HAS THE SPIKE, HAS THE VENT,
IT HAS THE DROP CHAMBER, IT HAS THE ROLLER CLAMP.
THIS IS REALLY SHORT TUBING, SO THIS IS REALLY IMPORTANT THAT YOU TURN THE CLAMP DOWN.
IF I FORGET THE CLAMP ON THE LONG TUBING, I USUALLY CAN CATCH IT BEFORE IT ALL RUNS OUT.
BUT IF I DON'T ON THE SHORT TUBING,
IT'S SQUIRTING ON MY SHOE BEFORE I'VE GOT IT.
SO, REAL IMPORTANT TO GET THAT ONE CLAMPED DOWN.
THERE'S A LITTLE CLIP. WE DO NOT NEED THIS ADAPTOR CLIP.
THIS IS FOR AN INTERLINK SYSTEM OR A PRECUT, PRE-SLIT MED PORT.
OURS IS NOT A PRECUT, IT DOES NOT NEED ADAPTORS, THIS IS A DIAPHRAGM.
IT'S A DEPRESSIBLE DIAPHRAGM IN HERE THAT WE'RE GOING TO USE.
IF WE STICK NEEDLES IN TO THESE, WE BREAK THEM.
ALTHOUGH THIS ISN'T A NEEDLE,
IT'S AN ADAPTOR FOR A PRECUT RUBBER STOPPER.
I'LL SHOW YOU ONE LATER. YOU JUST DON'T NEED THAT.
ALRIGHT. YOU HAVE TWO PORTS.
AND I DON'T KNOW WHICH ONE'S WHICH HERE. ONE'S FOR MEDICATION ADMINISTRATION, ADDITIVE.
AND I GUESS THE ONLY WAY TO KNOW HERE IS TO SPLIT IT OFF.
IT'S NOT THIS ONE. THIS ONE'S YOUR RUBBER STOPPER
AND THAT'S WHAT YOU WOULD PUT MEDICATION IN.
SO, THE ONE I NEED IS THIS ONE THAT GIVES ME THE OPEN HOLE
SO I COULD PUT THE SPIKE IN IT.
ALRIGHT. TAKE YOUR SPIKE OFF.
THESE ARE SO STIFF.
BUT YOU WANT TO GET THAT ALL IN. ALRIGHT.
PULL YOUR DROP CHAMBER HALFWAY AND THAT'S ALL YOU NEED FOR NOW.
ACTUALLY, I DON'T EVEN REALLY NEED TO DO THAT.
WHAT IF YOU FILL IT UP ALL THE WAY BY ACCIDENT?
- TURN IT OVER. - TURN IT OVER AND YOU CAN SQUIRT IT BACK IN. OKAY?
ALRIGHT.
THE SAME RULE FOR THIS TUBING IS FOR YOUR OTHER TUBINGS.
THEY'RE GOOD 48 TO 72 HOURS DEPENDING ON YOUR HOSPITAL POLICY.
THE INS, INTRAVENOUS NURSING SOCIETY HAS ACTUALLY CHANGED THE CRITERIA
FOR TUBINGS THAT HAVE MEDICATION AND THEY THINK
THEY SHOULD BE RUN FOR A SHORTER PERIOD OF TIME.
SO YOU'RE GOING TO HAVE TO FALL IN LINE WITH YOUR HOSPITAL POLICY ON THIS WHETHER IT'S --
SOME MAY BE EVEN 24, BUT 48 TO 72.
WE'RE GOING TO GO AHEAD WITH THE 72 HOUR POLICY
JUST BECAUSE IT'S AN IN-HOUSE POLICY.
BUT DO WHAT THEY WANT. SO I'M GOING TO GO AHEAD AN TAG THIS LABEL.
YOU CAN SEE THAT IF THE DOCTOR ORDERED
AN IV MEDICATION THE SECOND DAY THEY WERE IN THE HOSPITAL
AND THEN SWITCHED BECAUSE IT WASN'T RESPONDING WELL TILL THE THIRD DAY.
YOU CAN HAVE TUBINGS WITH ALL KIND OF TAGS AND LABELS ON THEM.
AND SO YOU JUST NEED TO PAY ATTENTION.
YOU DON'T JUST CHANGE THEM ALL ON WEDNESDAYS OR SOMETHING.
SO, YOU HAVE TO KEEP TRACK OF IT.
ALRIGHT. WE DO NEED THIS ADAPTOR HOOK HERE, AND SO WE'LL KEEP THAT.
AND I HAVE MY ALCOHOL SWAB, I'M GOING TO GET RID OF MY TRASH.
AND I'M GOING TO GO HERE.
BEFORE WE GO TO THE NURSE'S STATION,
OR TO THE PATIENT'S ROOM, YOU NEED A PLAN.
SO WHEN YOU GO TO GIVE YOUR MED, YOU'RE GOING TO NEED TO --
I WANT MED CARDS ON ALL OF THE MEDS THAT WE GIVE FOR IV THERAPY.
AND YOU COULD BE BUILDING ON THE MED CARDS YOU DID LAST SEMESTER.
SO KEEP THEM AND JUST ADD TO NOW, BUT ADD IV CRITERIA.
EVERYTHING WE DID LAST SEMESTER WAS PO, SO, NOW IT'S IV.
THE MED IS GOING TO BE THE SAME AS FAR AS WHAT IT DOES.
IT'S JUST HOW DOES IT REACT INTRAVENOUSLY?
NOW YOU HAVEN'T DONE AN ANCEF CARD, SO THIS WILL BE ALL NEW.
ON YOUR ANCEF, YOU GO AHEAD AND YOU FIND THE SAME THINGS YOU DID BEFORE.
BUT THERE'S SOME DIFFERENT CRITERIA THAT WE NEED TO KNOW.
I ALREADY TALKED TO YOU ABOUT ANCEF AS AN ANTIBIOTIC, IT'S CEPHALOSPORIN,
I KNOW THAT IT'S SPECIFIC FOR -- IT'S THE BACTERIA.
IT'S FIRST GENERATION CEPHALOSPORIN AND SO FORTH AND YOU CAN READ ALL THAT.
AND IT'S -- IT BINDS TO BACTERIAL CELLS, GOOD FOR STREPTOCOCCUS AND SO ON.
THE ROUTES AND DOSAGES, YOU CAN LOOK FOR SIDE EFFECTS.
IN PARTICULAR, I JUST WANT TO POINT OUT THAT AN UNDERLINED
WHICH IS MOST FREQUENT ADVERSE REACTION IS PHLEBITIS.
OK, SO IT'S VERY IRRITATING TO THE VEINS.
YOU'RE GOING TO WANT TO WATCH THE VEINS OF THE CLIENT THAT'S RECEIVING THIS MEDICATION
TO SEE IF THEY'RE HAVING PAIN, REDNESS, STREAKING
RELATED PARTICULARLY TO THIS DRUG.
SO PAIN, LOCALIZED PAIN AT THE SITE.
OKAY. THEN WHAT YOU WANT TO DO IS YOU WANT TO COME OVER HERE TO CEFAZOLIN,
WHICH IS ITS GENERIC NAME
AND SEE IF THE DOSE THAT I'VE PRESCRIBED,
FALLS WITHIN A SAFE AND THERAPEUTIC RANGE.
AND IT SAYS HERE, FOR MOST INFECTIONS, 250 MILLIGRAMS TO 1.5 GRAMS
EVERY SIX TO EIGHT HOURS IS COMMON.
SO MY ONE GRAM EVERY EIGHT HOURS, FINE.
ALRIGHT, MOVING ALONG IT TELLS YOU HOW IT'S AVAILABLE AND SO FORTH.
WHAT YOU WANT TO DO NOW IS YOU WANT TO COME OVER HERE
INTO THE IMPLEMENTATION SECTION.
IMPLEMENTATION. AND IN IMPLEMENTATION,
IT TALKS ABOUT PO, IM, IV AND SO FORTH.
WHEN YOU COME OVER TO CEFAZOLIN,
IT TALKS TO YOU ABOUT WHAT YOU CAN DILUTE IT WITH.
THIS IS WHERE I FOUND OUT MY SYRINGE INCOMPATIBILITIES
AND COMPATIBILITIES OVER HERE,
BUT I'M ALSO LOOKING FOR SOME OTHER PIECE OF INFORMATION.
HOW FAST DO YOU GIVE ANCEF?
DOCTOR DIDN'T SAY, DID HE? SHE, WHOEVER.
THEY JUST SAID, ANCEF 1 GRAM, IV PIGGYBACK EVERY EIGHT HOURS.
AND THAT'S ALL THEY'LL EVER SAY.
YOU HAVE TO GO TO THE BOOK AND YOU HAVE TO FIND SAFE ADMINISTRATION TIMES
FOR YOUR DRUG SO THAT YOU GIVE IT AT A SAFE TIME.
THERE'S TWO WAYS TO GIVE ANCEF.
YOU CAN GIVE A DIRECT IV WHICH IS THROUGH A SYRINGE AND PUSH IT
OR YOU CAN GIVE IT INTERMITTENT.
MOST OF THE TIME WE GIVE OUR DRUGS INTERMITTENT
BECAUSE IT'S IN A LARGER SOLUTION AND IT'S NOT QUITE AS IRRITATING
AND WE TEND TO NOT BLOW UP THE VEINS.
SO WE GIVE THEM AS A DRIP.
IT MAINTAINS A SIMILAR PRESSURE IN THE VEIN
AND THEY TEND TO RESPOND BETTER TO IT.
YOU CAN GIVE A PUSH IF YOU'RE IN A HURRY.
THEY NEED TO GO TO SURGERY, YOU'RE GIVING A PRE-OP,
IT'S GOOD TO KNOW THAT YOU CAN MIX THIS IN 10 CC'S
AND GIVE IT OVER FIVE MINUTES AND JUST PUSH IT IN, SPEED-WISE.
ALRIGHT, WE'RE GOING TO GIVE OURS PIGGYBACK. SO YOU'RE GOING TO COME UP HERE
TO INTERMITTENT AND YOU'RE GOING TO LOOK AT THE SAFE RATE OF ADMINISTRATION.
AND IT SAYS THAT IT SHOULD BE ADMINISTERED OVER 30 TO 60 MINUTES.
ALRIGHT, THAT'S WONDERFUL.
SO WE NEED A PLAN.
YOU HAVE 100 CC'S OF FLUID,
WITH A 15 DROP FACTOR THAT YOU NEED TO INFUSE OVER 30 TO 60 MINUTES.
30 BEING THE FASTEST, AN HOUR BEING THE SLOWEST.
IF IT GOES FASTER THAN 30. WHAT MIGHT HAPPEN?
- MIGHT HAVE ADVERSE DRUG REACTION.
- IRRITATION.
IT ACTUALLY TALKS ABOUT SEIZURES IN THERE.
SO LOOK AND SEE. WELL, WHY COULDN'T I GO FASTER?
ASK WHYS WHENEVER YOU'RE GIVING MEDICATION.
I KNOW IT'S NOT THERAPEUTIC COMMUNICATION TO ASK YOUR CLIENT THAT,
BUT IT'S THE BEST QUESTION YOU CAN EVER ASK YOURSELF.
WHY AM I DOING IT THIS WAY? FIND THE ANSWER.
ALL RIGHT, WHY WOULDN'T WE WANT TO GIVE IT OVER AN HOUR AND A HALF OR TWO HOURS?
- WOULDN'T WORK?
- IT'S NOT AS EFFECTIVE. IT'S NOT AS POTENT.
AND YOU NEED IT TO BE CONCENTRATED ENOUGH FOR THE CLIENT TO
EFFECTIVELY ATTACK THOSE -- THE BACTERIA THAT WE'RE TRYING TO GET TO.
SO, YOU'VE GOT TO STAY WITHIN THOSE SAFE PARAMETERS.
I USUALLY TRY TO GO IN THE MIDDLE,
IN CASE THE IV IS RUNNING SLOW, THEN I DON'T GET TOO, BUT -- BEHIND.
AND IF THE IV'S OFF A LITTLE, AND IT GOES TOO FAST,
AND I DON'T GO TOO FAST, I JUST KIND OF AIM FOR IN THE MIDDLE.
ALRIGHT, LET'S GO WITH EASY MATH HERE AND START.
YOU HAVE 100 CC'S TO PUT IN AN HOUR. WHAT'S YOUR RATE?
- 100 CC'S OVER AN HOUR.
- YES, THAT'S IT. 100 CC'S PER HOUR, OKAY.
THAT WASN'T A TRICK QUESTION.
OKAY, OUR RATE IS 100 CC'S PER HOUR.
WE WANT TO GET IN THIS 100 CC'S IN ONE HOUR.
IF OUR DROP FACTOR IS 15,
AND I'LL LET YOU WORK WITH YOUR DROP FACTOR ON THIS ONE, AT THIS STATION.
HOW MANY DROPS PER MINUTE TO ADMINISTER 100 CC'S IN ONE HOUR?
- 25. - 25.
- 25 DROPS PER MINUTE.
AND THEN YOU CAN BREAK IT DOWN INTO
A FIFTEEN SECOND OR A FIVE SECOND INTERVAL, OKAY?
WHAT IF I WANT MY 100 CC'S TO GO IN, IN 30 MINUTES. WHAT'S THE RATE?
- 25.
- BE BRAVE.
200 CC'S PER HOUR, RIGHT?
IT WOULD HAVE TO RUN AT 200 CC'S AN HOUR TO GET 100 CC'S IN, IN 30 MINUTES.
HOW DID I FIGURE THAT OUT?
-- RATIO IS DOUBLED THERE?
- YOU HAVE TO TAKE 100 AND DIVIDE IT BY 30.
- NO. - YOU HAVE TO TAKE 100 CC'S IN HALF THE TIME.
- UH-HUH. THAT'S TWICE AS FAST.
IT'S MADE AN EQUAL -- WHICH MADE AN EQUAL RATIO.
YEAH, 100 CC'S GOES IN, IN ONE HOUR,
THEN HOW MANY CC'S PER 0.5 HOURS?
AND IT WOULD BE 200.
SO 200 CC'S PER HOUR WILL GET THIS IN, IN 30 MINUTES.
YOU DON'T WANT TO SAY 50 CC'S PER HOUR,
RIGHT. BECAUSE THEN IT WOULD TAKE TWO HOURS.
AND THAT'S OUR TENDENCY IS WE'RE DOING IT HALF AS FAST,
SO PEOPLE TEND TO GO BACKWARDS WITH IT, OKAY, SO.
IF YOUR RATE IS 200 CC'S PER HOUR,
AND YOU DROP FACTOR IS 15. HOW MANY DROPS PER MINUTE?
- 50. - 50, YOU DIVIDE BY 4, RIGHT?
BECAUSE 15 TIMES 4 IS 60, SO OUR DIVISOR IS A 4.
DIVIDE YOUR RATE BY 4.
AND THAT'S ALL THERE IS TO IT. THERE'S OUR PLAN.
ALRIGHT, LET'S SAY, OUR IV WAS INFUSING AT 125 CC'S AN HOUR.
I KNOW RIGHT NOW IT'S TKO.
BUT LET'S SAY THE DOCTOR ORDERED THIS IV, 1000 CC'S WITH
40 MIL EQUIVALENTS OF KCL TO INFUSE CONTINUOUSLY AT 125 CC'S AN HOUR.
AND WE'RE GOING TO HANG OUR PIGGYBACK
WOULD YOU CHANGE THE RATE FOR YOUR PIGGYBACK TO BE
THE 30 MINUTE OR AN HOUR RATE
OR WOULD YOU LEAVE IT AT 125 CC'S PER HOUR?
- IS THIS CASE BY CASE BASIS, I MEAN?
IT IS FINE, BUT YOU COULD LEAVE IT AT 125 CC'S PER HOUR
TO MAINTAIN THE SAME FLUID VOLUME FOR YOUR CLIENT ON THAT HOURLY RATE,
HOW LONG WOULD IT TAKE THE MEDICATION TO GO IN AT 125 CC'S AN HOUR?
IF 100 CC'S GOES IN, IN ONE HOUR, 125 CC'S WILL GO IN,
AND YOU CAN DO IT IN A SIMPLE PROPORTION,
IN ABOUT 50 MINUTES, 45-50 MINUTES. IS THAT ACCEPTABLE? YES.
ANYTHING BETWEEN 30 AND 60 MINUTES IS ACCEPTABLE.
SO YOU CAN LEAVE YOUR IV RUNNING AT ITS PRIMARY RATE
OR YOU CAN CHANGE IT TO GET IT IN SLOWER OR FASTER DEPENDING ON HOW YOUR CLIENT'S TOLERATING IT.
LET'S SAY, THEY COMPLAIN OF BURNING WHEN YOU PUT THIS MED IN.
WELL, THEN DO IT SLOW. DO IT AS SLOW AS YOU CAN, BECAUSE THEN THERE WILL BE LESS BURNING.
IF THEY NEED TO GO TO SURGERY, AND YOU NEED TO HAVE YOUR MED IN,
IT'S A PRE-OP MED, YOU GET IT IN IN 30 MINUTES. GET ON WITH IT.
SO YOU HAVE ROOM TO PLAY AROUND, YOU'RE IN CHARGE.
YOU CAN DECIDE WHAT'S BEST FOR YOUR CLIENT.
ALRIGHT, SO OUR PLAN,
YOU WORK IT, YOU CAN HAVE ANY PLAN YOU WANT.
BECAUSE THE IV IS RUNNING AT TKO,
YOU'RE GOING TO GET THIS IN A SAFE ADMINISTRATION TIME.
SO, I JUST THINK I'LL PUT MINE IN, IN OVER AN HOUR.
ALRIGHT, I HAVE A PLAN, I HAVE MY SUPPLIES, I HAVE MY MAR,
I CHECKED MY DRUG TO MY MAR, I CHECKED MY ALLERGIES, MY COMPATIBILITIES,
I THINK I'VE JUST DONE ALL I COULD POSSIBLY DO.
SO, I AM GOING INTO MY CLIENT'S ROOM.
YOU WILL BE DOING CLIENTS AT BED STATIONS,
I DON'T KNOW WHICH BEDS YOU'RE GOING TO GET
BECAUSE IT'LL ALL BE FAIR GAME, SO.
ALL I SAID ON HERE IS ADULT CLIENT.
SO, YOU'RE JUST GOING TO HAVE TO TAKE YOUR MAR TO YOUR ADULT CLIENT.
GOOD MORNING, WHOEVER ARM.
AND I'M DIANE. I'LL BE YOUR NURSE TODAY.
AND I HAVE YOUR IV ANTIBIOTIC FOR YOU.
SO I JUST NEED TO CHECK YOUR NAME BAND. COULD YOU TELL ME YOUR NAME?
ADULT CLIENT, AND I CHECK MY MAR TO THE NAME BAND AND ALL IS WELL HERE.
I WOULD AGAIN CHECK THE ALLERGY BAND
AND THIS WILL BE YOUR LAST CHECK FOR ALLERGIES
BECAUSE YOU'LL KNOW WHEN YOU GET TO THE BED WHICH ALLERGY THEY REALLY HAVE,
WHETHER IT'S INDICATED FOR THEM OR NOT.
ALRIGHT, BEFORE I HANG THIS I'M JUST GOING TO DO MY THIRD CHECK HERE
AND MAKE SURE AGAIN THAT I HAVE THE RIGHT MED FOR THE CLIENT
I'VE JUST IDENTIFIED AND I DO ANCEF.
SO, I'M GOING TO COME OVER HERE, AND THE FIRST THING I WANT TO DO REALLY EVEN BEFORE
I HANG THIS MED IS I WANT TO ASSESS MY IV SITE.
WE'RE ALWAYS CHECKING THE IV SITE, EVERY HOUR.
YOU TALKED ABOUT -- WHEN AFTER YOU STARTED YOUR IV.
WELL, HERE'S WHERE IT COMES INTO PLAY.
AND WE'RE GOING TO LOOK AT YOUR IV SITE PRIOR TO HANGING THIS
AND MAKE SURE ITS NOT INFILTRATED, MAKE SURE THAT THERE'S NO SIGNS OF...
..SWOLLEN, HARD, PAINFUL SKIN, NO REDNESS, NO STREAKS. LOOK FOR LEAKING.
SOMETIMES THE IV MAY NOT BE INFILTRATED BUT THE SITE IS JUST OLD
AND IT'S JUST NOT DOING WELL, AND FLUID IS JUST LEAKING OUT.
THE SITE'S NOT GOOD. CHECK YOUR DRESSING,
MAKE SURE YOUR DRESSING'S INTACT, THAT THIS IS STABLE, THAT THE IV IS DRIPPING,
THAT IT'S RUNNING THE RATE YOU WANT IT TO RUN,
IT'S FLOWING WITHOUT ANY DIFFICULTY, IT'S NOT AN OLD SITE.
YOU HAVE TO CHANGE THIS EVERY THREE DAYS TO KEEP PHLEBITIS DOWN.
I GAVE YOU TWO WONDERFUL ARTICLES ON PHLEBITIS
AND MEDICATIONS THAT CAUSE PHLEBITIS.
IT TALKS ABOUT MECHANICAL PHLEBITIS.
I FIND IT INTERESTING THAT WOMEN ARE MORE PRONE TO PHLEBITIS THAN MEN.
INTERESTING.
MECHANICAL PHLEBITIS.
WE CAN CAUSE PHLEBITIS BY JUST PUTTING IN TOO LARGE A CATHETER.
SO THAT'S WHERE WE GOT OUR RECOMMENDATION
TO PUT ALWAYS THE SMALLEST CATHETER IN SO THAT...THE CATHETER
ITSELF ISN'T CAUSING PHLEBITIS AND IRRITATION.
AS WELL AS HOW WE STUCK THE VEIN] AND HOW WE PUNCTURED IT.
BUT WE CAN ALSO CAUSE MEDICINAL PHLEBITIS,
AND SO OUR MEDICATIONS CAN BE IRRITATING TO THE VEINS AND CAUSE THE SAME THING.
SO IF OUR CLIENT'S BEEN ON ANCEF FOR A WHILE,
YOU WANT REALLY BE WATCHING THIS VEIN TO SEE HOW IT'S HOLDING UP.
ALRIGHT. SO OUR SITE LOOKS GOOD. MY IV TUBINGS, MY VEINS,
EVERY THING IS BEAUTIFUL. THIS WAS JUST HUNG TODAY.
MY TUBING'S GOOD FOR A WEEK -- FEW MORE DAYS.
THIS HAS JUST BEEN HUNG TODAY, SO EVERYTHING LOOKS GOOD ON THIS CLIENT.
ALRIGHT. I NEED TO NOW GET MY PIGGYBACK GOING,
SO WHAT I NEED TO DO IS SET UP A SYSTEM
THAT WILL ALLOW THE PIGGYBACK TO GO IN.
SO, THE FIRST THING I WANT TO DO IS I WANT TO HANG
MY PRIMARY BAG ON THIS HOOK,
SO THAT IT'S HANGING LOWER THAN WHAT MY SECONDARY BAG IS GOING TO HANG.
YOU WANT YOUR SECONDARY BAG,
YOU CAN HANG IT ON THE SAME HOOK, YOU CAN PUT IT OVER HERE.
YOU WANT IT TO HANG HIGHER
SO THAT THIS IS GOING TO BE DRIPPING AND OVERRIDE THIS ONE.
ALRIGHT. HAVE YOU NOTICED THAT I HAVEN'T PRIMED MY TUBING IN,
IS THAT WORRYING ANYONE YET? OKAY, DON'T WORRY, YET.
OKAY, THE FIRST THING I WANT TO DO IS I WANT TO CONNECT MY TUBING TO MY --
MY SECONDARY TUBING TO MY PRIMARY TUBING BEFORE I PRIME IT.
AND THIS IS WHY. LET ME JUST SHOW YOU HOW TO CONNECT HERE FIRST.
YOU'RE GOING TO CLEAN YOUR PORTS JUST LIKE YOU WOULD A MEDICATION VIAL,
TAKE THE CAP OFF. SAVE THESE BLUE CAPS BECAUSE THEY'LL KEEP YOUR ENDS STERILE
AND YOU CAN SIMULATE STERILITY.
TO MAKE THESE WORK, NOTICE RIGHT NOW THAT NO FLUID IS PASSING BACK AND FORTH.
BUT MY TUBING NOW IS GOING TO GO IN HERE
AND IT'S GOING TO PUSH THE DIAPHRAGM DOWN,
SQUEEZE IN AND NOW I HAVE A PATENT SYSTEM.
AND THAT'S AS SIMPLE AS IT IS. I LOVE IT.
IT'S MY FAVORITE ONE. NO NEEDLES, NO ADAPTORS, NO PARTS.
YOU JUST HOOK UP TO TUBING.
ALRIGHT. WHAT I WANT TO DO NOW IS I WANT TO TAKE
MY SECONDARY TUBING AND I WANT TO PRIME IT WITH MY PRIMARY TUBING.
IT'S CALLED BACK FILLING.
AND WE'RE GOING TO TAKE AND LET THE AIR FROM THIS TUBING GO UP INTO THE BAG
AND ACTUALLY PUT A LITTLE MORE PRESSURE IN THE BAG
SO THAT IT WILL FLOW. IT'S IMPORTANT FOR A GRAVITY SETUP.
YOU'RE GOING TO NEVER SEE NURSES DO IT THIS WAY TO HOOK IT UP TO A PUMP
BECAUSE A PUMP PULLS THE FLUID OUT.
BUT WHEN WE'RE JUST DOING IT BY GRAVITY,
WE NEED A LITTLE EXTRA PRESSURE IN THERE TO OVERRIDE THIS BIG BAG.
SO, WE'RE JUST GOING TO OPEN UP THE CLAMP.
I LIKE TO KEEP MY SETUP... FACING UP.
IF I TURN IT UPSIDE DOWN, THEN I TEND TO OVERFILL THE DROP CHAMBER.
PUT IT BELOW, OPEN UP THE CLAMP ALL THE WAY,
AND THEN THE FLUIDS COME IN. YOU CAN SEE THE AIR BUBBLE IN,
UNTIL IT COMES UP AND IT STARTS FILLING UP YOUR DRIP CHAMBER HALFWAY.
AND THEN CLOSE IT DOWN.
SO NOW I AM PRIMED AND I HAVE A LITTLE BIT MORE PRESSURE IN MY BAG.
ALRIGHT.
- I'M SORRY. THIS MAY SOUND DUMB, BUT WHAT JUST HAPPENED?
DID SOME OF THE PRIMARY IV FLUID GO BACK INTO --
- YEAH, BECAUSE THEY'RE TOTALLY COMPATIBLE, THAT'S NO PROBLEM.
WE JUST DON'T WANT IT TO FILL UP THIS BAG AND DILUTE IT OUT
BECAUSE THEN YOU DON'T KNOW HOW MUCH FLUID IS IN THERE
AND IT'S HARD TO MAKE SURE THAT THAT 100 CC'S COMES OUT IN AN HOUR.
BUT AS LONG AS YOU JUST KEEP AN EYE ON IT, AND THEN YOU JUST PRIME TO YOUR DROP CHAMBER,
IT DOESN'T CHANGE YOUR VOLUME AT ALL IN YOUR BAG.
BUT IT PUT THAT LITTLE BIT OF AIR UP HERE, TO GIVE US A LITTLE MORE PRESSURE.
KIND OF, THE SAME AS PUTTING AIR IN A VIAL
SO THAT YOU CAN GET THE FLUID OUT.
- AND THAT LOWER POSITION CAUSES IT?
- UH-HUH. YEAH, BELOW THE MAIN LINE.
ALRIGHT. MY MAIN LINE IS STILL DRIPPING BECAUSE I DON'T WANT TO --
YOU JUST DON'T TURN IV'S OFF.
IF YOU DO, THEY CLOT OFF. YOU GOT TO KEEP THEM --
DON'T MESS WITH THIS PART RIGHT NOW.
ALRIGHT, I'M GOING TO OPEN THIS UP THIS NOW...TOTALLY.
OKAY? THIS IS TOTALLY OPEN.
AND I'M GOING TO REGULATE MY DROP BY THE PRIMARY LINE CLAMP.
AND THAT'S REALLY IMPORTANT. YOU DON'T REGULATE IT BY THIS ONE
BECAUSE YOU CAUSE A PRESSURE IN HERE,
AND I CAN'T EXPLAIN IT TO YOU PHYSIOLOGICALLY.
ALL I KNOW IS THAT IF YOU DON'T OPEN THIS ALL THE WAY,
AND YOU REGULATE BY HERE, BOTH DRIP,
AND EVENTUALLY THIS QUITS DRIPPING BECAUSE THE PRESSURE'S EQUALIZED,
AND THIS NEVER EMPTIES AND THIS TAKES OVER.
YOU HAVE TO OPEN THIS ALL THE WAY
AND YOU HAVE TO REGULATE YOUR DRIP BY THIS ONE.
SO, WE'RE GOING TO COME UP HERE, AND ARE RUNNING IT AT 100 CC'S PER HOUR,
SO 25 DROPS PER MINUTE DIVIDED BY 12 IS GOING TO GIVE ME TWO,
ALMOST MAYBE THREE, MOSTLY TWO EVERY FIVE SECONDS.
ONE..
TWO. BEAUTIFUL.
HERE. OKAY, NOTICE THAT THIS ONE'S DRIPPING.
ALWAYS LOOK AT YOUR SYSTEM AND MAKE SURE THAT THIS OF THIS IS DRIPPING.
THIS ONE IS NOT.
IT TOOK OVER. BECAUSE IF I HAVE THIS ONE DRIPPING AT 100 CC'S PER HOUR,
AND THIS ONE DRIPPING AT 100 CC'S AN HOUR,
THEN THEY'RE GETTING 200 CC'S AN HOUR.
AND NOBODY ORDERED THAT.
SO, ONLY ONE THING SHOULD DRIP AT A TIME.
IF YOU HAVE IT REGULATED BY THIS CLAMP,
THEN WHEN THIS ONE EMPTIES, THIS ONE TAKES OVER
AND IT WILL START DRIPPING AT 100 CC'S AN HOUR.
AND THAT WAY YOUR LINE NEVER GOES DRY AND IT DOESN'T CLOT OFF.
SO IT JUST KEEPS DRIPPING, DRIPPING, DRIPPING.
SO I CAN GET IT DRIPPING. I CAN LOOK AT MY CLIENT
AND I CAN SAY EVERYTHING'S GOING OKAY.
I CAN COME OVER HERE, I CAN SIGN MY MED OUT.
AND I CAN GO ON MY MERRY WAY AND THEN KNOW
THAT IN AN HOUR OR SO, THIS MED SHOULD BE IN.
ALRIGHT.
WE NEED TO TALK ABOUT DOCUMENTING BUT IN AN HOUR OR SO --
WASH MY HAND, GO DOCUMENT.
I'LL COME BACK, I'LL LOOK UP,
I'LL SEE THAT THE MED IS ALL IN, IN AN HOUR.
THIS, WHAT HAPPENS IS, IT COMES DOWN TO ABOUT HERE AND IT STOPS.
SO THEY ACTUALLY DON'T GET MAYBE 2 CC'S OF WHAT'S IN THE TUBING,
BECAUSE ONCE IT EQUALIZES WITH THIS BAG, IT QUITS.
THIS BAG TAKES OVER.
WHEN YOU COME BACK IN THE ROOM,
THEN YOU'RE GOING TO TURN THIS ONE OFF.
YOU'RE GOING TO HOOK THIS ONE BACK UP HERE,
YOU'RE GOING TO JUST LEAVE THIS CONNECTED
FOR THE NEXT TIME THE MED IS DUE.
AND THEN YOU'RE GOING TO RESET YOUR RATE OF THE PRIMARY BAG FOR WHAT YOU WANT IT.
SO NOW I WANTED IT TKO, WHICH IS... - 25.
- 25 CC'S PER HOUR DIVIDED BY 4.
6 DROPS PER MINUTE.
IT'S LIKE HARDLY DROPPING. SO I'LL PROBABLY DO 50.
SO ABOUT A DROP EVERY FIVE TO 10 SECONDS.
AND THERE I AM. I'M HAPPILY DRIPPING IT TKO.
AND THEN THAT'S HOW YOU LEAVE IT.
SO NOW WHEN THE MED IS DUE IN EIGHT HOURS,
YOU'RE GOING TO GO TO THE MED ROOM
AND PHARMACY IS GOING TO HAVE ANOTHER BAG FOR YOU.
YOU'RE GOING TO GET THE NEW BAG,
COME IN HERE, DO ALL YOUR CHECKS,
TAKE OFF THE OLD BAG, PUT ON THE NEW BAG,
HANG IT ON THE SAME TUBING.
AND THEN OPEN, DROP, REGULATE.
OKAY?
QUESTION?
- AFTER THE SECOND, THE NEW MEDICATION,
THEY'LL ALSO BE RE-PRIMED BY LOWERING AND FILLING THE AIR IN --
- OKAY, IT'LL BE HALF FULL.
SO, THEY'LL GET SOME OLD STUFF IN THERE.
BUT YOU DO THE SAME THING,
BACKFILL, GET THAT AIR OUT.
GET IT.
WHAT WE DON'T DO IS WE DON'T PUT DIFFERENT MEDS ON THE SAME TUBING.
SO, IF THEY'RE GETTING LIKE A MYCIN, LIKE A TOBRAMYCIN
A GENTAMICIN AND A CEPHALOSPORIN, THEY EACH HAVE THEIR OWN TUBINGS.
SO, IF THEY WERE GETTING THEIR --
MYCIN OR TOBRAMYCIN EVERY EIGHT HOURS,
AND IT'S LIKE IN TWO MORE HOURS, SO I COME,
I'M GOING TO DISCONNECT THIS AND PUT A CAP ON IT.
THEN I'M GOING TO HOOK MY TOBRAMYCIN UP HERE, RUN IT, LEAVE IT CONNECTED
AND THEN WHICHEVER MED COMES UP NEXT IS HOW I'M GOING TO SWITCH IT BACK.
BUT YOU DON'T JUST KEEP LOADING UP MEDS TOGETHER.
THEY'RE NOT USUALLY COMPATIBLE,
THE DIFFERENT MEDS TOGETHER.
OKAY, SO THAT'S WHY YOU'LL SEE TWO OR THREE BAGS SOMETIMES
HANGING FROM ONE PERSON'S POLE BECAUSE THEY'RE GETTING DIFFERENT THINGS.
WHAT I DON'T WANT TO SEE EVER AND IF YOU SEE IT, IT'S JUST BAD PRACTICE.
IS YOU'LL SEE, I HOPE YOU WON'T SEE IT, I'VE SEEN IT.
YOU'LL SEE A CAP TAPED ON HERE
SO THAT YOU CAN KEEP HOOKING ON YOUR PIGGYBACK. SO --
- I'M LOST.
YOU'LL SEE A CAP, THIS IS TURNED OFF.
I NEED A NEW PIGGYBACK, SO THEY'LL TAKE THIS AND THEY'LL GO...
..AND THEY'LL STICK IT IN HERE.
NOW, HOW STERILE IS THIS?
IT'S BEEN SITTING HERE ON A POLE TAPED FOR TWO DAYS.
ABSOLUTELY HORRIBLE, HORRIBLE PRACTICE.
IT'S WRONG, IT'S JUST WRONG. YOU SHOULD WRITE THEM UP,
PULL THOSE OFF, WRITE IT AGAINST YOUR REPORT AND MOVE ON. OKAY, IT'S JUST BAD PRACTICE.
AND THEN THEY PUT THE NEW ONE ON AND THEN THEY TAKE THE NEXT ONE OFF AND THEY HOOK IT.
IT'S NONSENSE. YOU CAN'T DO THAT.
YOU HAVE TO MAINTAIN THESE ENDS AS STERILE.
YOU HAVE TO GET SOME KIND OF ADAPTOR,
AND THAT'S WHEN THIS MIGHT FALL INTO PLACE.
YOU GET A CLEAN STERILE NEEDLE OR ADAPTOR HERE TO PROTECT THE END.
AND THIS IS ALL STERILE, AND YOU HOOK IT ON.
AND THEN IT CAN HANG.
BUT YOU JUST CAN'T KEEP USING THE SAME THING.
AND I KNOW IT'S STERILE, BECAUSE I HAVE A CAP ON HERE.
BUT SOMETHING STERILE HAS TO BE ON THE ENDS OF ALL THESE TUBINGS.
OKAY?
BUT IF IT'S JUST ONE MED, JUST LEAVE IT CONNECTED FOR ALL DOSES.
WE HUNG OUR ANCEF AT 13:40.
DB. MY NAME.
AND THAT'S ALL THERE IS TO IT.
TIME, AND YOUR INITIALS.
YOU DON'T HAVE TO PUT A SITE BECAUSE THE SITE IS IV
AND IT'S ALREADY SPECIFIED ON YOUR ROUTE OF ADMINISTRATION.
SO ALL YOU NEED IS TIME AND INITIALS AND YOU SIGN IT WHEN YOU HANG IT.
YOU DON'T SIGN IT AFTER IT'S BEEN HUNG.
SO LET'S SAY IT INFILTRATES HALFWAY THROUGH. RIGHT?
YOU GO IN, IT'S NOT DRIPPING. THEY DON'T GET IT.
THEN YOU WOULD CIRCLE IT AND SAY INFILTRATED AND DEAL WITH THAT LATER.
AFTER YOU RESTART, MAYBE YOU CAN GET IT GOING BEFORE THE HOUR'S UP OR WHATEVER.
BUT FOR THE MOST PART, WHEN WE HANG IT,
WHEN IT'S DRIPPING, WE SIGN IT OUT. OKAY.
YOU'RE ALSO GOING TO DO I&O AT THIS STATION.
ALRIGHT, SO YOU'RE GOING TO GET A SHEET THAT LOOKS LIKE THIS.
THAT'S BEEN FILLED OUT FOR THE DAY.
YOU'RE THE AFTERNOON SHIFT, RIGHT?
SO THIS IS WHAT HAPPENED IN THE MORNING.
THEY ACTUALLY HAD AN IV OF D5 OR GOING.
1000 CC'S WENT IN.
BUT THE DOCTOR DECIDED TO CHANGE --
WELL, A COUPLE OF THINGS HAPPENED.
WE GAVE OUR ANCEF THIS MORNING AT 6 O'CLOCK,
100 CC'S OF 0.9% OF SODIUM CHLORIDE, ANCEF 1 GRAM AND 100 CC'S WENT IN.
AND THEN AT 12 O'CLOCK, THE DOCTOR SWITCHED THE IV SOLUTION
TO SODIUM CHLORIDE WITH 40 MIL EQUIVALENTS KCL.
ALRIGHT, THE DAYSHIFT.
SO JUST FIGURE THAT YOU'RE COMING IN AT 1 O'CLOCK, WHICH YOU ARE.
1 O'CLOCK, YOU'RE THE AFTERNOON SHIFT.
AT 1 O'CLOCK, WHEN WE COLLECTED I&OS, THIS IS WHAT HAPPENED.
AT 1 O'CLOCK, THEY HAD HUNG THIS BIG BAG OF 1000 CC'S AT NOON.
AT 1 O'CLOCK, 100 CC'S HAD GONE IN.
SO THEY'RE GIVING YOU A -- 100 CC'S WENT IN FOR THEM.
SO ACTUALLY, FOR THIS SHIFT 1200 CC'S HAS GONE IN.
BUT THEY HAD TO GIVE YOU A CREDIT.
REMEMBER I TALKED ABOUT LEFT IN BAG, THE LIB FOR YOUR SHIFT,
YOU'RE COMING ON AT 1 O'CLOCK, HOW MUCH FLUID IS IN THE BAG FOR YOUR SHIFT?
HOW DO YOU KNOW HOW MUCH WENT IN OR WILL HAVE GONE IN ON YOUR SHIFT?
SO THEY LEFT YOU A CREDIT.
IF 100 CC'S WENT IN OF A 9 -- 1000 CC'S, HOW MUCH IS LEFT?
900. SO AT 1 O'CLOCK, OF THE SECOND BOTTLE,
900 CC'S IS HANGING OF SODIUM CHLORIDE 40 MIL EQUIVALENTS OF KCL.
OKAY, SO YOUR CREDIT FOR YOUR SHIFT IS 900.
ALRIGHT. LET'S JUST SAY IT'S 2 O'CLOCK.
AT 2 O'CLOCK, I HUNG MY 100 CC'S OF 0.9 SODIUM CHLORIDE --
SO HARD TO READ, SORRY.
WITH 40 OF KCL.
HOW MUCH WENT IN?
100 BECAUSE MY BAG IS DONE.
REMEMBER I SAID IT WAS DONE.
SO YOU CAN PRETEND THAT YOUR BAG HAS ALL GONE IN.
YOU HAVE TO PUT ON THE I&O WHAT YOU HUNG AND HOW MUCH WENT IN.
AND THAT'S WHAT WOULD HAPPEN ON YOUR SHIFT.
OKAY. THAT'S NICE.
THEN WE'RE GOING TO SAY TO YOU, "ALRIGHT, IT'S THE END OF YOUR SHIFT.
IT'S 9 O'CLOCK AT NIGHT, COMPLETE THE I&O."
ARE YOU WITH ME SO FAR?
OKAY, YOU'VE GOTTEN THE CREDIT FOR YOUR SHIFT AT 1 O'CLOCK.
DRIP TIME GOES BY FAST, AND NOW IT'S 9 O'CLOCK AT NIGHT.
WE'RE GOING TO COME TO THE BAG.
AND OUR 100 CC'S HAS ALREADY GONE IN, WE'VE TAKEN CREDIT FOR THAT.
BUT NOW, WHAT YOU NEED TO DO IS COME UP HERE,
AND LOOK AND SEE HOW MUCH IS LEFT IN THE BAG RIGHT NOW.
I ALWAYS START WITH WHAT'S LEFT IN THE BAG.
AND I START COUNTING FROM THE BOTTOM UP.
AND HOW MUCH IS LEFT IN MY BAG?
- THAT'S ABOUT -- - HARD TO SEE. YEAH. 1000 WILL BE UP HERE.
- NO, BUT I MEAN, IT IS 1000 BAG. - IT'S 1000 CC BAG.
IT'S ON THE 2 MARK, EACH MARK IS 100,
SO ABOUT 800 CC'S IS LEFT IN THE BAG.
THAT'S THE CREDIT FOR THE NEXT SHIFT.
THAT'S THE LIB IS WHAT I'M GIVING THEM.
OKAY. SO LOOK AND SEE WHAT'S IN THE BAG.
WHEN YOU'RE CALCULATING AND WHEN YOU'RE ESTIMATING,
I MEAN, HOW ACCURATE CAN YOU BE ON THESE THINGS?
GO TO THE NEAREST 25 CC'S AND JUST GUESS.
IF IT'S BETWEEN THE 50 MARK, THEN GUESS 25.
BUT DON'T GUESS 37 OR -- THERE'S JUST NO WAY. SO JUST GUESS 25.
BUT OURS LANDED PRETTY CLOSE TO A WHOLE NUMBER.
SO, I'M GOING TO COME DOWN HERE
AND AT 21:00, I HAVE 800 CC'S
LEFT IN THE BAG OF 0.9% SODIUM CHLORIDE...
..WITH 40 OF K. HOW MUCH WENT IN?
THAT'S THEIR PROBLEM, HOW MUCH WENT IN, IN MY SHIFT?
- 100 CC'S. - IF 900 WAS WHAT WAS MY CREDIT,
SUBTRACT WHAT I HAVE LEFT
AND YOU SHOULD HAVE 100 CC'S THAT WENT IN.
THE TOTAL THAT WENT IN FOR MY SHIFT, 200 CC'S.
FOR I&O.
AND THAT'S IT.
IT WOULD SEEM SO SIMPLE AS I DISCUSSED THIS WITH YOU.
THIS HAS TO BE THE WORST GRADE THAT EVERYONE GETS EVERY SEMESTER, EVERY SEMESTER.
I MEAN, WE'RE TALKING, LIKE, 20S, 40S.
EVERY STEP IS ASTERISKED ON THIS ONE.
BECAUSE I KNOW, IF YOU GET THE LEFT END BOTTLE WRONG,
IF YOU GET THE NUMBER WRONG,
IF YOU DON'T GET YOUR SOLUTIONS ON THE RIGHT LINE,
EVERYTHING'S MESSED UP.
IT'S DOCUMENTATION, EVERY SINGLE STEP OF THIS IS ASTERISKED.
SO YOU GOT TO APPRECIATE WHAT YOU'RE DOING, PRACTICE WITH A COUPLE.
YOU'LL HAVE THIS EXACT SAME SHEET, WE'LL HAVE DRIPPING IV'S.
NO ONE WILL HAVE THE SAME LIB,
AS THE DAY GOES ON, YOU KNOW,
THE 1 O'CLOCK PEOPLE WILL HAVE. LIKE, 850,
BUT BY THE TIME IT GETS TO 4:00 IN THE AFTERNOON,
THEY'LL HAVE 500 IN THE BAG, I DON'T KNOW,
BECAUSE IT'S GOING TO KEEP DRIPPING CONTINUOUSLY ALL AFTERNOON.
AND YOUR IV -- LEFT-IN BAGS WILL CHANGE AS THE DAY GOES ON.
SO YOU'RE GOING TO TAKE RESPONSIBILITY FOR YOUR PIGGYBACK,
YOU'VE GOT YOUR CREDIT FOR YOUR SHIFT, JUST ASSUME IT'S 2 O'CLOCK.
WHETHER YOU COME IN AT 1:00 OR 4:00, THAT'LL MAKE IT EASY.
AND THEN AFTER YOU'VE HUNG, YOU'VE DOCUMENTED YOUR PIGGYBACK,
THEN WE'LL SAY, "IT'S 9:00 AT NIGHT, COMPLETE THE I&O.
GIVE THE CREDIT TO THE NEXT SHIFT
AND TOTAL OUT HOW MUCH WENT IN FROM YOUR SHIFT."
YOUR CREDIT WILL BE 900.
OKAY.
- SO YOU STARTED OUT UP THERE, THAT'S 1200, RIGHT, WHERE YOU HAVE THE CIRCLE?
- THAT'S HOW MUCH WENT IN.
AND I ALWAYS CIRCLE THE TOTALS,
BECAUSE IF YOU DON'T, SOMETIMES THEY GET ADDED UP
INTO THE NEXT SHIFT'S AMOUNT.
SO, CIRCLE THE EIGHT-HOUR TOTALS,
BECAUSE AT THE END OF THE DAY, THEY HAVE TO TOTAL UP EVERYTHING.
AND SO, THEY'RE GOING TO TOTAL UP THE THREE EIGHT HOURS
TO COME UP WITH A 24 HOUR TOTAL OF WHAT WENT IN
BECAUSE WE'VE GOT TO START MATCHING IT NOW TO WHAT CAME OUT.
SO, YOU'RE GOING TO GET -- YOU'RE GOING TO HANG YOUR PIGGYBACK.
IT DOESN'T TAKE ANY TIME AT ALL,
YOU HOOK THE THING UP AND PUT IT IN, GET IT DRIPPING.
YOU DECIDE, IT'S YOUR DECISION HOW FAST YOU'RE GOING TO RUN IT
ACCORDING TO THE CRITERIA IN THE BOOK.
WE ALREADY TALKED ABOUT 30 TO 60 MINUTES, YOUR DROP FACTOR.
THE IV'S RUNNING AT TKO, MAKE IT HAPPEN.
THEN YOU'RE GOING TO CALCULATE I&O AT ANOTHER STATION.
YOU GO OVER THERE AND WORK OUT YOUR MATH.
AND, THAT'S IT, OKAY. SO, TWO STATIONS
THAT YOU'RE GOING TO HIT. ALRIGHT.