DO EVERYTHING YOU CAN WHILE YOU'VE GOT FACULTY SUPPORT,
WHILE YOU GOT PEOPLE THERE, YOU KNOW, TO COACH YOU THROUGH
BECAUSE YOU'LL FEEL THAT MUCH MORE CONFIDENT WHEN YOU REALLY DO IT.
- WHAT ABOUT IF AN OPPORTUNITY THAT COMES UP
TO DO SOMETHING THAT WE HAVEN'T DONE STILL?
- THAT DEPENDS ON YOUR COMFORT LEVEL WITH THAT AND IT DEPENDS ON WHAT IT IS.
FOR EXAMPLE, YOU CAN'T PASS IV PIGGYBACKS JUST BECAUSE SOMEONE WANTS TO COACH YOU THROUGH IT
BECAUSE YOU HAVE NOT PASSED MED MATH AND YOU SAY, "NO, I CANNOT UNTIL I PASS MY MED MATH."
AND THEY KNOW IT. CATHY DEFATTI IS YOUR WEEK TEACHER
AND SHE KNOWS THE RULES AND SHE'S GOING TO SUPPORT THAT.
BUT YOU HAVE LEARNT SOME STERILE TECHNIQUE
AND SO IF SOMEONE WANTS TO COACH YOU THROUGH A STERILE PROCEDURE
AND YOU FEEL COMFORTABLE ENOUGH TO HANDLE THE GLOVES AND THE KITS,
THEN FEEL FREE TO DO THAT.
I WOULD FEEL A LITTLE TENTATIVE MYSELF ABOUT
PUTTING A FOLEY CATHETER IN. I'VE HEARD STORIES OF PEOPLE COACHING THEM THROUGH.
I THINK THAT'S A BIT MUCH. I THINK YOU SHOULD WAIT ON THAT.
AND I WOULD BE A LITTLE TENTATIVE ABOUT DROPPING
NG TUBES OR TUBES THAT YOU HAVEN'T TALKED THROUGH THE ANATOMY OF.
JUST SAY, "OH, I AM SO UNCOMFORTABLE WITH THAT,
I'D REALLY LIKE TO SEE IT FIRST.
YOU SHOW ME AND TELL ME WHAT YOU ARE DOING." AND JUST, "NO."
AND THAT'S HOW I'D HANDLE IT. BUT MOST ANYTHING, IF --
IF YOU HAVE GOT A BASE OF INSTRUCTION AND YOU FEEL
LIKE YOU'RE COMFORTABLE WITH IT, GO FOR IT.
BUT WE WILL HIT MOST EVERYTHING BY THE END HERE.
YOU'LL BE GOOD TO GO.
ALRIGHT, NEW MODULE, IVS. YAY!
IT'S A GREAT MODULE, IT'S FULL, IT'S GOING TO BE LONG DEMOS,
A LOT OF STUFF TO ACCOMPLISH AND A LOT TO DO.
BUT IT'S REALLY FUN AND YOU'LL ENJOY IT.
IT'S A FOUR WEEK MODULE SO YOUR BLACKBOARD IS HUGE.
IT'S HUGE, JUST LIKE A 75-85 QUESTION BANK
AND IT'S A 25 QUESTION TEST OR QUIZ OR WHATEVER.
SO IT'S NOT THAT PAINFUL AS FAR AS TIMEFRAME
BUT IT HITS EVERY LITTLE THING FROM IV LOCKS TO PCAS
TO THINGS YOU ARE NOT REALLY GOING TO GET TO TILL WEEK FOUR.
INTERESTINGLY, THE CHAPTER IS FAIRLY SHORT AS A READ.
YOU WILL SEE THE READING ISN'T REALLY HUGE BECAUSE IT'S JUST,
IVS ARE REPETITIVE. IT'S THE SAME THING IN A DIFFERENT FORM.
SO BY THE END OF FOUR WEEKS YOU'RE, GOING TO KIND OF,
FEEL COMFORTABLE BECAUSE YOU'VE DONE IT IN ALL IN DIFFERENT FORMS, THE SAME THING.
BUT YOU DON'T KNOW WHAT ALL THOSE ARE YET UNTIL YOU GET FAMILIAR.
SO READ THROUGH YOUR BOOK, GET A GOOD OVERVIEW.
I'LL TRY TO HIGHLIGHT A LOT OF THINGS TODAY,
SO WHEN YOU READ THE WORDS YOU ARE NOT LIKE
TRYING TO CREATE THIS WRONG PICTURE IN YOUR MIND, AND WE'LL GET THAT DONE.
I AM NOT GOING TO GIVE YOU HOMEWORK IN YOUR MATH BOOK THIS WEEK
BUT I AM GOING TO GIVE YOU A COUPLE OF ASSIGNMENTS. THIS WEEK YOU'VE GOT A LOT TO DO.
YOU HAVE THIS HUGE BLACKBOARD TO CONQUER
AND YOU GOT TO GET THE CATHSIM DONE FOR NEXT WEEK
WHEN YOU COME AND I JUST WANT THAT STA --
YOUR TWO SUCCESSFUL ATTEMPTS STAPLED TO THE BACK OF YOUR CHECKLIST,
JUST LIKE WE DID WITH THE MATH THIS TIME.
AND A LOT OF READING AND A LOT OF JUST GETTING SOME CONCEPTS RIGHT.
WE ARE GOING TO TALK ABOUT DRIP FACTORS AND HOW TO GET IT DRIPPING.
AND THIS IS THE MAJORITY OF YOUR MED MATH TEST WILL BE INTRODUCED TODAY.
AND WE'LL BE WORKING WITH IT FOR THE NEXT FOUR WEEKS.
SO HOPEFULLY, YOU'LL FEEL VERY COMFORTABLE WITH IT BY THE TIME WE'RE DONE
BECAUSE WE ARE GOING TO QUIZ YOU TO DEATH ABOUT IT AS YOU COME TO TESTING STATIONS
SO THAT YOU GET A LOT OF FEEDBACK WITH THAT.
AS FAR AS TESTING, I'LL JUST TELL YOU THAT THE SKILLS ARE VERY QUICK.
YOU'RE GOING TO ADD A SOLUTION TO YOUR IV.
YOU'RE GOING TO START AN IV. THAT TAKES ABOUT WHAT? TWO MINUTES.
YOU ARE GOING TO DC AN IV, THAT TAKES ABOUT FIVE SECONDS.
AND THEN YOU ARE GOING TO CALCULATE A DRIP FACTOR
AND THAT SHOULD ONLY TAKE YOU ABOUT A MINUTE OR TWO.
SO TIME-WISE THE DRILLS ARE FAST.
CONCEPT WISE, THERE'S SO MUCH TO GET INTO YOUR HEAD
THAT IT'S A LOT OF WORK THIS WEEK JUST TO, KIND OF, GET YOUR FEET GROUNDED.
SO WE HAVE A LOT TO COVER. AND WE'LL START DOING IT.
WE ARE JUST GOING TO START FROM THE TOP AND INTRODUCE IV PRODUCTS
AND WHAT YOU NEED TO DO ALONG THE WAY.
SO FIRST THINGS FIRST, YOU'RE GOING TO CHECK YOUR DOCTOR'S ORDER.
YOU ARE GOING TO HAVE A DOCTOR'S ORDER AND YOUR ORDER IS BASICALLY IN YOUR SYLLABUS.
AND IT SAYS FOR YOUR ASSIGNMENT, THAT THE DOCTOR HAS ORDERED THAT YOU ADD 1 CC OF MULTIVITAMINS
TO 1000 CCS OF YOUR IV FLUID WHICH IS 0.9% NORMAL SALINE.
ALRIGHT, AND THAT'S IN YOUR SYLLABUS AT, I DON'T KNOW, WHEREVER IT SAYS ASSIGNMENTS.
OKAY. IN YOUR BAG.
I AM GATHERING UP EQUIPMENT NOW.
YOU HAVE 500 CC IV BAG OF 0.9% SODIUM CHLORIDE.
THIS AN ISOTONIC SOLUTION.
IT'S THE NORMAL SOLUTION OF THE BODY AND THERE YOU HAVE IT.
HERE'S THE 500 CC BAG.
YOU'LL SEE ME HANGING A LOT OF 1000 CC BAGS.
BUT I GAVE YOU A LITTLE MATH HERE, IT IS PRETTY BASIC.
IF I ORDERED 1 CC OF MULTIVITAMINS TO BE ADDED TO 1000 CCS,
HOW MUCH ARE YOU GOING TO ADD TO 500? - 25.
- THAT'S EASY. SO YOU ARE GOING TO BE DRAWING UP
YOUR HALF CC FROM NOW YOUR MULTIVITAMIN VIAL.
SO IT IS NOW MULTIVITAMINS, OKAY? M-V-I STANDS FOR MULTIVITAMINS.
AND SO JUST LABEL IT ACCORDINGLY SO YOU CAN GET THAT SET IN YOUR MIND.
I'VE GOT MY BAG. FIRST THING I WANT TO DO WHEN I GET MY BAG
IS I WANT TO LOOK AND I WANT TO CHECK THE EXPIRATION DATE
AND MINE SAYS 10/'03.
NO GOOD.
THAT'S WHY I GET THEM FREE.
SO, BUT CHECK YOUR EXPIRATION DATE
AND MAKE SURE YOU HAVE GOT A GOOD PRODUCT BEFORE YOU HANG IT.
AND IT SHOULD BE SEALED IN A PLASTIC COAT, A BAG.
OKAY. SO I HAVE THAT.
I NEED SOME IV TUBING TO CONNECT IT TO.
SO YOU'RE LOOKING IN YOUR BAG FOR PRIMARY TUBING.
PRIMARY TUBING IS A LONG TUBING USUALLY OVER A 105 INCHES.
THIS IS A 100 INCH TUBING. THEY COME IN PLAIN --
HI, CUTIE. - DO YOU HAVE A MAILBOX?
YOU CAN JUST THROW IT ON MY DESK, RIGHT THERE.
GO AROUND THAT ROOM RIGHT BY THE COMPUTER. THANK YOU. I APPRECIATE IT.
- THERE IS MANY THINGS IN THE ENVELOPE SO OPEN IT UP. - OKAY. THANKS.
YOUR TUBING WILL HAVE PORTS ON IT, I'LL TALK ABOUT THAT LATER.
WHAT WE ARE CONCERNED ABOUT RIGHT NOW
IS THAT IT'S PRIMARY TUBING, THAT IT'S LONG
AND IT'S THE TUBING THAT HAS TO BE LONG ENOUGH THAT WE CAN ACCESS IT
FOR OTHER LITTLE THINGS AND, LIKE, ATTACH SHORT TUBINGS
WHICH ARE OUR SECONDARY TUBINGS, WE'LL DO THAT NEXT WEEK.
BUT RIGHT NOW, PRIMARY TUBING.
THIS ONE SAYS PRIMARY IV SET
AND THERE IS ONE OTHER THING THAT'S REALLY KEY TO KNOW --
WELL, TWO ACTUALLY. YOU WANT TO KNOW IF YOU HAVE MEDIPORTS ON IT.
YOU DO, WE'LL TALK ABOUT THOSE LATER.
AND YOU WANT TO KNOW THE LITTLE DROP HERE.
ON THE PACKAGE, IT SHOULD TELL YOU A DROP FACTOR.
THIS IS VERY IMPORTANT TO KNOW...ON YOUR TUBING.
ALRIGHT, I WILL TALK ABOUT THAT IN A MINUTE, BUT DROP FACTOR.
ALRIGHT, I KNOW I NEED TO PUT MULTIVITAMINS IN. SO I HAVE MY MULTIVITAMINS.
I'M GOING TO CHECK MY EXPIRATION DATE, MAKE SURE I HAVE A GOOD PRODUCT.
I HAVE A SYRINGE TO DROP MY 1 CC, OR MY HALF CC HERE.
I HAVE TAPE BECAUSE I NEED TO LABEL MY BAG.
I HAVE A MEDICATION ADDED LABEL BECAUSE ANY TIME YOU ADD ANYTHING TO AN IV SOLUTION,
YOU HAVE TO LABEL YOUR BAG AND IT'S ALWAYS BRIGHT, BRIGHT RED.
SO I HAVE THAT, I'VE ALREADY FILLED IT OUT EXCEPT FOR THE TIME.
AND I WILL ADD THAT IN A MINUTE. SO MY MULTIVITAMINS.
AND I HAVE AN IV TUBING LABEL.
THERE'S A RULE ABOUT IV TUBING AND THAT IS THAT WHEN YOU HANG A PRIMARY LINE,
IF IT'S JUST SOLUTIONS WITHOUT MEDICATIONS GOING THROUGH,
YOU CAN HANG IT FOR 48 TO 72 HOURS DEPENDING ON YOUR HOSPITAL POLICY.
MOST OF THEM GO WITH THE 72.
WE GO WITH THE LONGEST JUST BECAUSE IT'S THE CHEAPEST. OKAY.
BUT THAT'S WHAT THEY HAVE DETERMINED AS A SAFE CRITERIA FOR THAT.
SO SINCE TODAY IS WEDNESDAY,
THURSDAY, FRIDAY, SATURDAY,
I HAVE A CHANGED SATURDAY LABEL FOR MY TUBING FOR IN A MINUTE.
OKAY.
I'LL TALK ABOUT MEDICATION CRITERIAS NEXT WEEK. THEY'RE DIFFERENT.
IF YOU ARE PUTTING MEDICATIONS THROUGH THE TUBINGS, IT CAN VARY DEPENDING ON THE MEDICATIONS
AND IT CAN AGAIN BE ANYWHERE FROM 24 TO 72 HOURS
DEPENDING ON THE MED AND THE HOSPITAL POLICY.
AND SO YOU HAVE TO FALL IN LINE WITH YOUR HOSPITAL.
AND MAY I SAY, THEY'RE ALL DIFFERENT.
FOR WHATEVER REASON, THEY JUST ARE.
SO YOU NEED TO FIND OUT WHAT YOUR HOSPITAL SAYS.
OKAY. I HAVE A MARKER.
I HAVE ALL MY SUPPLIES. I'VE WASHED MY HANDS.
AND THEN I AM GOING TO PREPARE MY SUPPLIES IN THE MED ROOM.
SO CONSIDER YOURSELF WHEN YOU COME TO ME THAT YOU ARE COMING
TO THE MED ROOM TO SHOW ME THAT YOU ARE PUTTING YOUR MEDICATION IN CORRECTLY
AND GETTING YOUR IV SET CORRECTLY.
ALRIGHT.
THERE'S OTHER THINGS I NEED TO DO, BUT I'LL PUT THAT ASIDE.
ALRIGHT. FIRST THINGS FIRST.
WHEN YOU OPEN UP YOUR BAG AND I WANT YOU OPEN UP ALL OF YOUR BAGS.
I WANT YOU TO PRACTICE WITH THEM, CONNECT YOUR TUBING TO THEM,
DO EVERYTHING TO PRACTICE WITH THEM.
YOU ARE GOING TO NEED THE EXTRA TIME, REMEMBER NEXT WEEK'S A HOLIDAY.
MONDAY, WE ARE CLOSED ON CAMPUS AND SO MONDAY THE LAB WILL NOT BE AVAILABLE.
THAT'S IMPORTANT FOR YOU TUESDAY PEOPLE BECAUSE I KNOW YOU DO A LOT OF PRACTICE
MONDAY AFTER CLASS AND SO YOU DON'T HAVE THAT TIME.
BUT YOU HAVE BAGS AT HOME TO DO A LOT OF STUFF AT HOME.
GET YOUR BAG. WHEN YOU FIND YOUR BAG, THERE SHOULD BE A LITTLE SEPARATION
AND YOU JUST RIP IT LIKE THIS TO GET IN.
IT'S JUST A PROTECTION.
ONCE YOU'VE OPENED YOUR BAG YOU WANT TO SQUEEZE IT
AND MAKE SURE THAT IT'S INTACT AND THAT THERE IS NO MANUFACTURING DEFECT
THAT WOULD CAUSE IT TO LEAK, SO I JUST ALWAYS GIVE IT A SQUEEZE.
AND THEN TAKE A GOOD LOOK AT IT, MAKE SURE YOUR SOLUTION
DOESN'T HAVE ANY PRECIPITANCE,
ANY PARTICLES AND ANY CLOUDINESS AND THAT IT LOOKS GOOD.
WE'VE ALREADY CHECKED EXPIRATION DATE, SO THIS IS GOOD.
YOU MAY SOMETIMES, WHEN YOU OPEN UP YOUR BAG, FEEL A LITTLE MOISTURE ON THE OUTSIDE
AND THAT'S BECAUSE THEY ARE PACKAGED WITH A LITTLE MOISTURE
SO THE PLASTIC DOESN'T STICK TO THE PLASTIC.
SO IT DOESN'T MEAN JUST BECAUSE YOU FEEL A LITTLE MOISTURE THAT IT'S LEAKY.
YOU WANT TO SQUEEZE AND SEE IF ANYTHING SHOOTS OUT OF IT. OKAY.
ALRIGHT.
ON YOUR BAG, IT TELLS YOU YOUR PRODUCT.
YOU HAVE MARKERS ON THE SIDE THAT ARE THE INDICATORS FOR THE FLUID LINES,
THE VOLUME THAT'S IN THE BAG.
EVEN THOUGH THAT SAYS ZERO,
THAT THE FLUID SHOULD BE TO THE ZERO LINE TO TELL ME I HAVE 500 CCS.
BUT BECAUSE OF THE WEIGHT OF THE SOLUTION,
YOU CAN SEE IT'S KIND OF FATTER HERE AND IT FALLS INTO THE BAG.
WE ARE JUST GOING TO ASSUME THAT AT HERE ZERO IS 500 CCS
AND WE'LL CALCULATE IT FROM THERE WITH A LITTLE TIME STRIP.
ON THE BAG YOU HAVE INDICATORS FOR YOUR FLUID AS IT DECREASES,
SO THAT YOU CAN KEEP TRACK OF WHAT'S LEFT IN THE BAG.
SO IF THE FLUID LINE COMES DOWN TO SAY RIGHT HERE, THIS THREE,
HOW MUCH IS LEFT IN THE BAG?
200. COUNT UP FROM THE BOTTOM.
1 -- 200 OR IN, 300 THEN HAS GONE IN TO THE CLIENT.
SO YOUR CREDIT FOR I&O LATER, LEFT IN THE BAG IS 200 CCS.
AND THAT'S HOW WE USE THOSE LITTLE MARKERS.
WE NEVER FIGURE IT TO THE 242 CC EXCEPT BY IV PUMP.
WHEN YOU VISUALLY LOOK THERE IS NO WAY YOU CAN TELL.
WE FIGURE TO THE NEAREST 25.
THEY'RE BROKE DOWN IN INCREMENTS OF 50, THE LINE.
AND SO YOU CAN, KIND OF, GUESSTIMATE WHEN IT'S BETWEEN THE LINE
BUT DON'T TRY TO THINK, "OH, IT'S 340."
YEAH, RIGHT, LIKE, YOU CAN REALLY TELL.
IT'S NOT EVEN ON RIGHT TO START WITH.
IT'S JUST AN ESTIMATE AS TO HOW IT'S GOING IN.
- I HAVE A QUICK QUESTION. YOU SAID INPUT/OUTPUT AND YOU SAID
IT WOULD BE 200 BECAUSE OF WHAT'S LEFT IN THE BAG?
- 200 WAS LEFT IN THE BAG, THAT'S THE CREDIT FOR THE NEXT SHIFT.
I'M GOING OVER I&O AT THE END OF WHAT WE DO.
BUT WHAT WENT INTO THE CLIENT WAS 300.
SO 300 WENT IN AND THAT GOES INTO THE INTAKE. - OKAY.
- BUT YOU HAVE TO TELL THE NEXT SHIFT WHAT'S LEFT IN THE BAG,
L-I-B, SO THEY CAN CALCULATE WHAT WENT IN ON THEIR SHIFT.
SO YOU'RE KEEPING TRACK OF TWO NUMBERS,
WHAT WENT IN FOR YOU, WHAT'S LEFT FOR THEM.
SO THEY CAN KEEP TRACK.
SO L-I-B IS THE ABBREVIATION OF THE DAY,
LEFT IN BOTTLE, LEFT IN BAG.
THERE'S TWO OTHER FEATURES TO THIS BAG,
AND THAT IS THE PORTS AT THE BOTTOM. YOU HAVE TWO PORTS.
ONE IS THE SPIKING PORT THAT WE PUT THE SPIKE FROM THE TUBING INTO,
AND THE OTHER IS THE MEDICATION PORT.
AND IT ACTUALLY LOOKS JUST LIKE A VIAL TOP.
IT'S GOT A LITTLE BULL'S EYE ON THE RUBBER STOPPER
AND THAT'S WHERE WE ARE GOING TO INTRODUCE OUR SOLUTION,
OUR MEDICATION INTO THE BAG.
ALRIGHT. SO I'VE CHECKED THAT I HAVE THE RIGHT SOLUTION, 0.9% SODIUM CHLORIDE.
I AM GOING TO GO AHEAD AND PREPARE MY MEDICATION.
SO I'VE CHECKED MY VIAL, I'VE POPPED MY TOP OFF.
YOU CAN ALREADY HAVE YOUR MVI LABELED AND YOUR SYRINGE AND READY TO GO.
I TOLD YOU I'M NEVER GOING TO WATCH YOU DRAW OUT OF A VIAL AGAIN.
I DON'T CARE TO SEE IT.
ALRIGHT. I AM GOING TO GET MY HALF CC.
I AM NOT GOING TO LABEL ANYTHING BECAUSE I AM NOT GOING ANYWHERE.
HOWEVER, WHAT I AM GOING TO DO -- I'VE BEEN FUSSING WITH THIS A LITTLE BIT.
I AM GOING TO TAKE MY PORT BECAUSE I'VE MESSED WITH IT
AND I AM GOING TO CLEAN IT OFF JUST LIKE I WOULD A VIAL TOP.
THERE'S TWO WAYS TO HOLD THIS.
YOU CAN PUT IT IN LIKE THIS IF YOU ARE VERY CAREFUL
NOT TO POKE THE NEEDLE THROUGH THE BAG,
OR ONE OF THE RECOMMENDATIONS IS THAT WE HANG IT
BECAUSE THE BAG IS FULLEST WHEN IT'S BULGING.
AND THEN WHEN WE STICK, WE GO UP FROM HERE AND STICK
SO THERE IS MORE BULGE AND LESS RISK OF PUNCTURING THROUGH THE SIDES, EITHER WAY WORKS.
THEY'VE PUT THIS SHIELD ON THE BAG AND I DON'T KNOW IF YOU CAN REALLY SEE IT.
AND THAT ALSO PROTECTS US FROM PUNCTURING THROUGH THE BAG, THAT'S HARDER PLASTIC.
ALRIGHT. SO I AM GOING TO PULL DOWN AND POKE THROUGH HERE AND IT JUST GOES STRAIGHT UP IN.
I WOULD HAVE -- I DON'T HAVE MY MAR AND THAT'S TERRIBLE TECHNIQUE HERE,
BUT YOUR MEDICATION SHEET TO ADD YOUR 0.5.
I AM GOING TO ADD IT, MAKE SURE IT WENT IN AND THEN TAKE THIS OUT.
THAT'S REALLY ALL YOU DO.
I CAN LOCK THIS OUT RATHER THAN STICK MYSELF.
AND WHAT I WANT TO DO AT THIS POINT
IS I WANT TO JUST SHAKE IT A LITTLE --
OH, I FORGOT TO DO A VERY IMPORTANT THING
AND SAY THE WORDS AND IT'S OUT OF SEQUENCE, SO I WOULD LOSE AN ASTERISK.
AND THAT IS TO CHECK COMPATIBILITY.
THE NEW BUZZ WORD FOR IV THERAPY AND YOU MIGHT AS WELL GET USED TO SAYING IT JUST LIKE ALLERGIES
AND IT'S JUST THERE, COMPATIBILITY.
IS MULTIVITAMINS COMPATIBLE WITH SODIUM CHLORIDE?
YES. I KNOW THAT AND HOW WOULD I KNOW THAT?
WELL, TWO WAYS. LOOK AT THE DRUG BOOK AND SEE.
IN THE DRUG BOOK, IT LISTS SYRINGE INCOMPATIBILITIES AND TUBING INCOMPATIBILITIES.
AND IT WILL LIST THERE WHAT IT'S INCOMPATIBLE WITH.
SO IT'S ALSO COMPATIBILITY CHARTS LIKE THIS CHART OVER HERE ON THE CUPBOARD
AND THEY WILL BE POSTED IN MOST OF YOUR MED ROOMS.
AND SO YOU CAN LOOK UP THE SOLUTION ON THE TOP IN THE MULTIVITAMINS
AND GO DOWN AND SEE WHERE THEY BIFURCATE TOGETHER
AND SEE IF THERE IS ANY ISSUES RELATED TO SODIUM CHLORIDE AND MULTIVITAMINS.
AND THERE IS NOT.
SO YOU'VE GOT TO CHECK AND MAKE SURE.
EVEN THOUGH I KNOW THAT SAYS IN THE DRUG BOOK OR IT DOESN'T SAY IT'S NOT,
I AM GOING TO LOOK TO SEE THAT AFTER I'VE ADDED THE SOLUTION UP TO A DARK BACKGROUND
THERE IS NO PARTICLES OR PRECIPITATE
AND UP TO A LIGHTER BACKGROUND
LIKE MAYBE A SHEET OR A WALL OR SOMETHING
THAT I DON'T SEE ANY CLOUDINESS OR PRECIPITATE IN THIS BAG.
AS SOON AS I'VE CHECKED IT AND I THINK MY BAG LOOKS GOOD,
I WANT TO GO AHEAD AND GET MY LABEL ON HERE...
.. SO THAT SOMEONE WOULD KNOW THERE IS MEDICATION NOW IN THIS BAG.
SO I ADD AN MVI, A HALF CC.
AT 13:20.
EVERYTHING ELSE I ALREADY PUT ON HERE.
IT ASKS FOR THE NAME OF THE SOLUTION, THE MEDICATION,
MY INITIALS, THE DATE AND THE TIME.
AND THAT GOES ON THE BAG.
WHEN YOU PUT THE LABEL ON THE BAG,
MAKE SURE THAT YOU DON'T OBLITERATE WHAT THE SOLUTION IS,
OR YOUR SIDE MARKINGS FOR THE SOLUTION OR YOUR EXPIRATION DATE.
BUT IT NEEDS TO GO ON THE -- OH, IT'S UPSIDE DOWN.
IT NEEDS TO GO ON THE FRONT SO THAT YOU CAN SEE IT.
NEVER PUT A LABEL ON BEFORE YOU PUT THE SOLUTION IN.
YOU CAN'T PRE-LABEL.
AND THE REASON IS IF YOU LABELED
AND SAID, "OKAY I AM GOING TO PUT MY MULTIVITAMINS ON."
YOU STICK YOUR LABEL ON, THEY CALL A CODE BLUE.
YOU ARE ON THE CODE TEAM, YOU HAVE TO RUN.
AND SO YOU JUST DROP EVERYTHING AND YOU RUN.
WELL, YOUR PATIENT'S IV IS RUNNING OUT.
AND SO PEOPLE ARE GOOD ABOUT FOLLOWING UP ON EVERYONE ELSE'S STUFF.
AND SO THEY LOOK IN YOUR ROOM AND SAY,
"OH HER IV IS ABOUT TO RUN OUT, I AM GOING TO GO HANG THAT FOR HER."
OH, THEY SEE THE BAG, IT LOOKS GOOD TO GO.
BUT THERE'S REALLY NOTHING IN IT.
NO ONE WOULD KNOW. SO THE LABEL HAS TO GO ON AFTERWARDS.
SO WHEN YOU ARE PRACTICING RATHER THAN STICK THESE ON
AND THEN YOU GET ALL THAT PAPER STUCK TO THEM,
BECAUSE THESE ARE REAL LABELS THAT WE ARE GIVING YOU TO PRACTICE WITH.
I'D JUST PUT A LITTLE TAPE ON IT OR JUST LAY IT ON THERE.
DON'T STICK IT ON THE ADHESION UNTIL YOU COME TO TEST
BECAUSE WE WILL TAKE OFF THE POINTS IF YOU COME IN LIKE THIS AND THEN PUT YOUR ADDITIVE IN.
OKAY?
ALRIGHT.
SO I'M GOOD TO GO ON THAT.
WHAT I NEED TO DO NOW IS GO AHEAD AND GET MY TUBING HOOKED UP.
I DO WANT TO MENTION ONE OTHER THING ABOUT THE BAGS.
IV SOLUTIONS ARE ONLY GOOD 24 HOURS.
SO IF YOU HUNG THIS, LIKE, IN A TKO.
TO KEEP OPEN OR KEEP VEIN OPEN AT A VERY SLOW DRIP RATE.
JUST ENOUGH TO KEEP A VEIN FROM CLOTTING OFF,
YOU HAVE TO CHANGE THIS OUT WHETHER IT'S EMPTY OR NOT IN 24 HOURS.
THE BAG HAS TO BE CHANGED.
EVEN THOUGH THE TUBING IS GOOD FOR 72 HOURS.
ALRIGHT,
AND I'LL SHOW YOU HOW WE MARK THE BAG HERE IN A SECOND.
I'M GOING TO GO AHEAD NOW AND OPEN UP MY TUBING.
YOU SHOULD HAVE TUBING THAT LOOKS SIMILAR TO THIS.
TAKE IT OUT.
BOTH ENDS ARE CAPPED.
IT'S TO MAINTAIN A STERILE CLOSED SYSTEM.
YOU WANT TO BE VERY CAREFUL ABOUT THE ENDS,
TAKING CAPS OFF AND CONTAMINATING THEM.
BECAUSE WHAT WE ARE DOING NOW IS GOING INSIDE A CLIENT
AND WE DON'T WANT TO BE CAUSING INFECTION, PHLEBITIS FOR THAT CLIENT.
SO YOU GOT TO PROTECT YOUR ENDS.
THE TUBING IS FULL OF AIR AND WE NEED TO HOOK IT UP
AND PUT SOLUTIONS THROUGH IT FOR THE CLIENT.
SO AGAIN, THE SAME KIND OF SAFETY FEATURE.
YOU HANG THE BAG IS WHAT THEY RECOMMEND, YOU DON'T SPIKE THROUGH IT.
BUT STILL YOU'LL SEE PEOPLE DO IT...LIKE THIS
AND THEY'LL SPIKE IT.
AS LONG AS YOU ARE GOING STRAIGHT IT'S. --
EITHER WAY IT'S WRONG, OR RIGHT OR ANYTHING.
BUT I WANT YOU TO SEE THIS.
THIS PARTICULAR PORT IS A FINGER TAB
AND YOU JUST...PULL IT OFF.
IT DOESN'T LEAK YET BECAUSE THERE'S A DIAPHRAGM IN THERE THAT'S HOLDING IT.
IT WON'T LEAK UNTIL YOU SPIKE IT.
TAKE MY CAP OFF.
AND NOW I'M GOING TO SPIKE. AND THEY'RE PRETTY STIFF.
SO WHAT I DO IS, I PULL IT STRAIGHT DOWN
AND THEN PUT IT IN AND TWIST UP.
PULL AND TWIST BECAUSE YOU WANT TO GET AS MUCH OF SPIKE IN AS POSSIBLE,
COS THEY'RE REALLY STIFF.
OKAY. I KNOW I'M IN, WHICH -- IT'S DRIPPING AND I'M THINKING,
"OH, SHOOT, I FORGOT TO DO SOMETHING." PINCH OFF.
IT WOULD HAVE BEEN REALLY SMART OF ME TO TAKE MY ROLLER CLAMP AND ROLL IT SHUT FIRST.
I CAUGHT IT FAST ENOUGH -- IT'S NOT --
IT'S NOT ANYTHING IN THE SCHEME OF LIFE
BUT IT'S HELPFUL SO THAT YOU DON'T LOSE FLUID.
ALRIGHT. I WANT TO TALK A LITTLE BIT ABOUT THE TUBING
AND WHAT YOU ARE LOOKING FOR ON THE TUBING.
ON THE TUBING ARE SOME FEATURES THAT ARE IMPORTANT TO KNOW.
THIS LITTLE PIECE RIGHT HERE...
..RIGHT. YOU POP IT OFF, IS A VENT.
YOU ONLY NEED A VENT FOR A GLASS CONTAINER.
REMEMBER ON THE VIALS THAT WE PUT AIR IN
TO GIVE US A LITTLE PRESSURE AND MAINTAIN THE PRESSURE,
EQUALIZE IT FOR THE FLUID WE BRING OUT.
THE SAME THING HAPPENS WITH THESE BOTTLES,
BUT THIS IS MORE LIKE THE PLAYTEX NURSER KIND OF A THING.
AS THE FLUID COMES, OUT THE BOTTLE COLLAPSES AND IT MAINTAINS SAME PRESSURE.
SO WE DON'T NEED A VENT THAT WOULD REPLACE WITH AIR THE FLUID THAT COMES OUT.
IT'S ALREADY EQUALIZING ITSELF BECAUSE IT'S A COLLAPSING BAG.
WE DON'T NEED THE VENT.
BUT IF YOU HAVE A GLASS BOTTLE AND THEY STILL DO SOMETIMES
BECAUSE CERTAIN MEDICATIONS CAN'T BE MIXED WITH PLASTIC.
SO YOU'LL SEE GLASS RARELY, BUT YOU MAY SEE IT.
THEN YOU HAVE TO OPEN A VENT SO THAT AS THE FLUID COMES OUT
AIR REPLACES THAT SPACE, OTHERWISE THE FLUID WON'T COME OUT ANY MORE.
IT GETS STUCK BECAUSE YOU HAVE TO EQUALIZE PRESSURE.
SO YOU HAVE A VENT, I TALKED ABOUT SPIKE VENT.
THEN YOU HAVE YOUR DROP CHAMBER.
YOUR DROP CHAMBER ON THE INSIDE HAS A DROPPER.
AND THE DROPPERS ARE DIFFERENT SIZES
AND THAT'S WHAT IS INDICATED BY THE DROP FACTOR.
I WROTE UP FOUR DROP FACTORS FOR YOU AND THIS IS HOW THEY WORK.
THERE'S --THE DROP FACTOR MEANS, FOR EXAMPLE, OURS IS 15.
ON THIS BAG, 15. AND THAT MEANS IT TAKES 15 OF THIS SIZED DROP
TO EQUAL 1 MILLIMETER.
15 DROPS, 1 MILLIMETER.
THERE'S ONLY FOUR KINDS OF DROP FACTORS OUT THERE, PERIOD.
THERE ARE NO MORE.
THERE IS A DROP FACTOR THAT'S 10...
..THAT LOOKS LIKE THIS. I AM GOING TO PASS IT AROUND.
AND YOU CAN PULL OUT THE DROP CHAMBER AND SEE HOW MUCH BIGGER THE DROPPER IS.
SEE THE SIZE.
IT TAKES ONLY 10 DROPS TO EQUAL 1 MILLIMETER.
THIS ONE IS 15. I'LL PASS ONE AROUND.
VISUALLY SMALLER THAN THE 10, IT TAKES 15 DROPS TO EQUAL 1 MILLIMETER.
HERE'S A 20.
IT LOOKS SIMILAR IN SIZE TO THE 15,
BUT IF YOU LOOK UP THE HOLE, IT'S A LITTLE BIT SMALLER
EVEN THOUGH THAT SPIKE LOOKS THE SAME.
AND THEN FINALLY, THERE IS A 60 DROPS
TO EQUAL 1 MILLIMETER.
THE FIRST THREE, 10, 15 AND 20 ARE CALLED MACRO DROPS.
THEY'RE BIGGER DROPS THAN WHAT'S CALLED THE 60
WHICH IS THE MICRO DROP OR THE PEDIATRIC SET.
OKAY?
I WILL PASS THOSE AROUND.
I'LL START HERE AND JUST SO THAT YOU CAN LOOK AT THEM.
ALRIGHT, OUR DROP FACTOR IS 15.
SO 15 DROPS TO EQUAL 1 MILLIMETER.
WHEN YOU GET TO THIS POINT YOU GOT YOUR TUBING CLOSED OFF.
YOU WANT TO SQUEEZE YOUR DROP CHAMBER AND FILL IT TO THE LITTLE LINE
AND YOU CAN'T, I'M SURE YOU CAN'T EVEN SEE IT FROM THERE,
BUT THERE IS A LITTLE LINE ON YOUR DROP CHAMBER.
YOU NEED FLUID IN HERE SO THAT AS IT'S DRIPPING,
AIR DOESN'T KEEP COMING THROUGH YOUR TUBING.
SO THAT'S WHY WE PUT A LITTLE AIR.
BUT YOU DON'T WANT TO FILL IT ALL THE WAY UP
BECAUSE THEN YOU CAN'T SEE THE DROPS OR COUNT THEM
SO THAT YOU HAVE THE RIGHT RATE WHEN IT'S GOING INTO THE CLIENT.
WE HAVE THE BACK CHECK VALVE AND WHAT THAT DOES
IS IT KEEPS FLUID FROM BACKING UP INTO THIS BAG.
SOMETIMES WHEN YOU PUT IV SOLUTIONS INTO THESE MEDIPORTS,
YOU DON'T WANT IT GOING THE WRONG WAY
OR IT GETS DILUTED AND THEY DON'T GET THEIR MED
OR SOMETIMES WHEN IT'S IN A CLIENT,
BLOOD MAY BACK UP AND BACK SOLUTION OR BLOOD UP INTO THE BAG.
AND YOU DON'T WANT THAT TO GO UP EITHER.
SO BACK CHECK WON'T LET IT FLOW UP, ONLY LETS IT FLOW DOWN.
YOU HAVE A MEDIPORT. THIS IS CALLED SMARTSITE,
OR SAFESITE, I DON'T KNOW, ONE OF THE TWO.
SMART SITE, SAFE SITE, IT'S A DIAPHRAGM.
WE'LL WORK WITH THAT LATER, DON'T WORRY ABOUT IT NOW.
JUST DON'T STICK ANY NEEDLES IN THERE, YOU'LL BREAK THEM.
YOU HAVE TWO ROLLER CLAMPS OR TWO CLAMPS,
ONE'S A ROLLER CLAMP AND ONE'S A SLIDE CLAMP.
ON THE ROLLER CLAMP, WHEN IT'S IN THE DOWN POSITION,
IT'S OFF AND IT KEEPS IT FROM MOVING.
BUT WHEN IT'S IN THE UP POSITION, IT'S AN OPEN TUBING.
I HAVE A PINCH DOWN HERE SO IT WON'T RUN.
AND YOU CAN MOVE THE CLAMP UP AND DOWN ON THE TUBING
TO GET IT TO WHERE YOU WANT IT AND I ALWAYS SLIDE THEM UP
TO THE TOP WHERE THEY'RE WITHIN EASY REACH.
SO THERE'S YOUR ROLLER CLAMP.
I VERY RARELY USE A SLIDE CLAMP BECAUSE YOU DON'T SEE THEM VISUALLY
AND IT'S, LIKE, "IT'S NOT DRIPPING, WHAT'S WRONG? AH! WHO PUT THAT ON THERE?"
SO I JUST DON'T HARDLY MESS WITH THESE AT ALL.
BUT THEY'RE A QUICK CLAMP AS WELL TO STOP YOUR DRIPPING.
ALRIGHT. NOTICE THAT THIS MEDIPORT IS ABOVE THE ROLLER CLAMP,
THAT'S IMPORTANT FOR MEDICATION ADMINISTRATION.
AND THEN YOU HAVE ANOTHER MEDIPORT DOWN LOW,
NEXT TO THE SIDE THAT'S FOR DIRECT IV ADMINISTRATION
FOR IV PUSH MEDS VERSUS INTERMITTENT INFUSION
WHICH ARE LIKE PIGGYBACK TYPE MEDS.
AND THEN FINALLY YOU HAVE THE END OF THE TUBING.
WHAT WE WANT TO DO IS PRIME OUR TUBING.
SO YOU DO IT JUST LIKE WE DID WHEN WE DID THE NG TUBES.
YOU ARE JUST GOING TO OPEN IT UP.
YOU CAN TAKE YOUR LITTLE TAP OFF
AND THEN RUN THE SOLUTION THROUGH.
NOW JUST A COUPLE OF THINGS, AIR --
I AM OPENING THIS UP. AIR CAN GET TRAPPED IN THESE PORTS.
AND SO IF WE TURN THEM ABOUT SIDE DOWN, WHERE DOES THE AIR GO?
TO THE TOP, SO -- OH SHOOT. HERE.
AND IF YOU JUST, KIND OF, FLICK THEM,
THE AIR WILL POP OUT, CAN YOU SEE THAT?
AND ALL THE AIR WILL COME OUT AND THAT LOOKS GOOD.
[BEEPING]
SOMEONE'S BEEPING. TURN YOURSELF OFF.
- I THINK IT'S A WATCH.
- IS IT A WATCH? IS IT YOU, TOM? SOMETIMES IT'S YOU.
LIKE A LITTLE PAUSE EDIT HERE.
WE'RE ALL HERE AND YET IT'S SOMEWHERE OVER THERE.
- WE'LL CALL IT IN. - YEAH. IT'S A BOMB.
- YOU CAN'T SAY THAT AT AIRPORTS.
I KNOW BUT WE ARE NOT IN AN AIRPORT, SO. WE ARE NOT ON, ARE WE?
OH, WE'RE STILL ON THERE. - WE'RE STILL ON.
THANK YOU, WHOEVER IT WAS.
OKAY. ONCE I AM ALL PRIMED, IT LOOKS GOOD.
I HAVE A COUPLE OF LITTLE SPECKY BUBBLES IN HERE,
BUT I AM NOT GOING TO WORRY ABOUT IT, LET'S TALK ABOUT AIR.
AIR EMBOLI.
YOU CAN KILL SOMEONE WITH TOO MUCH AIR IN THE VEIN.
HOW MUCH AIR IS TOO MUCH AIR?
A TUBING FULL OF AIR IS TOO MUCH AIR.
BUT LITTLE BITS OF AIR THAT MIGHT COME THROUGH,
LITTLE SPECKS LIKE THIS ON A PERIPHERAL LINE JUST GET ABSORBED BY THE BODY.
NOTHING TO WORRY ABOUT. SOMETIMES THE PATIENTS FREAK OUT A LITTLE BIT ABOUT IT
BECAUSE THEY THINK IT WILL KILL THEM, BUT IT WILL NOT.
AND SO YOU JUST REASSURE THEM THAT THE BODY WILL ABSORB THAT, THAT'S OKAY.
ALRIGHT. ONCE IT'S PRIMED,
YOU WANT TO GO AHEAD AND LABEL YOUR TUBING
WITH YOUR CHANGE LABEL AND YOU CAN PUT THE DATE ON HERE.
CHANGED SATURDAY, WHICH WOULD BE
2/14, VALENTINE'S DAY AT 13:30.
- NOT ALL OF THEM HAVE LINES ON THEM...
- SOME -- MOST DO. BUT IF THEY DON'T, IT DOESN'T MATTER,
THE IDEA IS THAT YOU JUST FILL HALF WAY.
ALRIGHT, WHEN I PUT MY CHANGE LABEL ON,
I ALWAYS PUT IT UP HERE AT EYE LEVEL AND DOUBLE --
IT'S GOT STICKY ON BOTH SIDES,
AND YOU JUST TO DOUBLE BACK TO ITSELF AND THERE IT IS.
GOOD TO GO.
ALRIGHT. MY TUBING'S LABELED HOW MANY DAYS?
THREE, 72 HOURS. SO IF YOU ARE GOING TO BE CHANGING,
YOU ARE GOING TO HANG ON TUESDAY, WHAT DAY YOU WANT?
- FRIDAY.
- YEAH, FRIDAY.
SO PUT CHANGE, FRIDAY'S ON.
YOU COULD GO AHEAD AND STICK THOSE ON IF YOU WANT.
ALRIGHT. JUST HOUSEKEEPING HERE.
YOU CAN GO AHEAD AND SPIKE YOUR BAG,
YOU CAN GET IT ALL PRIMED AND EVERYTHING.
EVEN TO COME TEST, WE'LL JUST PRETEND THAT IT'S NOT ANY MORE
OR YOU WILL SAY I PRIMED IT. I MEAN, YOU KNOW.
BUT FOR SAVING IT IN YOUR BAGS AND STUFF,
WHAT YOU NEED TO DO IS ONCE LEAVE IT SPIKED.
IF YOU PULL THE SPIKE OUT AND THEN TRY TO RE-PLUG IT WITH THE END,
IT WILL JUST LEAK OUT ALL OVER INTO YOUR SUPPLIES.
SO JUST LEAVE IT SPIKED, TURN THE ROLLER CLAMP OFF
AND I WOULD SUGGEST THAT YOU PUT IT INTO ONE OF THOSE BIGGER BAGGIES
AND TO PROTECT YOUR STUFF. THEN JUST PULL IT OUT AND YOU ARE READY TO GO FOR TESTING.
AND WE ARE GOING TO BE USING THAT OFF AND ON FOR DIFFERENT THINGS
FOR THE NEXT FIVE WEEKS -- FOUR WEEKS.
OKAY.
SUPPLY-WISE, I HAVE MY SOLUTION AND IV READY TO GO.
WHAT I NEED TO DO NOW IS I NEED TO START AN IV ON MY CLIENT.
SO I HAVE GOT SOME CLEANING UP HERE IN MY AREA
AND I NEED TO GATHER UP SOME MORE SUPPLIES.
OH, I DO NEED TO DO ONE OTHER THING.
LET ME JUST GET RID OF SOME OF THIS TRASH.
I WILL SAVE THIS BAG SO YOU CAN SEE WHERE IT DROPS OUT.
OKAY. BEFORE I MOVE ON, I DO WANT TO TALK ABOUT SOME ADDITIVES.
WE ARE PUTTING MULTIVITAMINS IN AND WE ARE ALLOWED TO PUT MULTIVITAMINS IN.
WE USED TO, IN THE OLDEN DAYS, PUT POTASSIUM CHLORIDE IN.
BUT I JUST WANTED YOU TO SEE HOW POTASSIUM COMES.
DON'T THEY LOOK SIMILAR?
SOME SIGNIFICANT MED ERRORS HAVE BEEN MADE OVER THE YEARS
BY SOMEONE PUTTING IN THIS WHEN THEY THOUGHT IT WAS SALINE.
AND YOU CAN KILL PEOPLE. THIS IS SERIOUS.
I WANT YOU TO KNOW SERIOUS, UPFRONT.
YOU CAN KILL PEOPLE WITH SO -- WITH POTASSIUM.
BECAUSE OF THAT YOU WILL NEVER SEE IT IN THIS FORM EXCEPT IN THE PHARMACY.
YOU WILL ALWAYS SEE IT IN A DILUTED FORM LIKE THIS
SO THAT WE CAN PREVENT SOME OF THESE LIFE AND DEATH ERRORS.
SO WE WILL BE GIVING IT -- I AM SORRY I HAVE THAT BACKWARDS.
YOU'LL GIVE IT IN A PIGGYBACK FORM
OR YOU'LL GIVE IT AS AN ADDITIVE TO YOUR CONTINUOUS IV,
SO THE DOCTOR MIGHT ORDER -- WHAT IS THIS ONE?
THIS IS HALF NORMAL SALINE 0.45% SODIUM CHLORIDE
WITH 20 MIL EQUIVALENTS OF POTASSIUM.
AND YOU CAN SEE IT'S REALLY BIG ON THERE, YOU CAN'T MISS IT.
SO THEY ARE ALWAYS PRE-ADDED FOR YOUR CLIENT. AND IT'S A SAFETY FEATURE.
WE NEED ALL THE HELP WE CAN GET SO THAT WE DON'T MAKE ERRORS.
NOW THERE WE GO.
OKAY. SO IF YOU EVER SEE -- THAT'S POTASSIUM,
APPRECIATE THAT IT'S GOING TO BE DILUTED.
ALRIGHT.
I NEED TO DO ONE OTHER THING BEFORE I GATHER UP THE REST OF MY SUPPLIES
AND THAT IS, HOW WOULD YOU KNOW THAT THIS BAG IS 24 HOURS OLD?
I DIDN'T GIVE YOU ANY INDICATOR.
I SAID WHEN I PUT THE MULTIVITAMINS IN, BUT I DIDN'T SAY THE BAG.
SO WHAT YOU WANT TO DO IS PUT A TIME TAPE ON.
AND YOU WANT TO DO WITH PAPER TAPE.
AND GET A BIG OLD LONG STRIP, BE GENEROUS WITH YOURSELF
BECAUSE YOU WANT THE TAPE TO COME --
OH, THIS IS NOT A VERY BIG BAG.
I WANT IT TO GO FROM THE TOP ALL THE WAY TO THE BOTTOM
BECAUSE I NEED TO PUT SOME INFORMATION ON HERE.
SHARPIES WORK THE BEST.
I NEED TO SAY THE DATE WHICH IS 2/11.
I NEED TO SAY THE RATE THAT THIS IV IS GOING TO INFUSE AT.
THE DOCTOR HAS TO GIVE YOU A SOLUTION AND A RATE.
THE RATE WILL BE STATED IN ONE OF TWO FORMS.
THE DOCTOR WILL SAY, "1000 CCS OVER EIGHT HOURS."
IT'LL EITHER BE A ONE TIME BAG OR CONTINUOUS.
OR THE DOCTOR WILL SAY,
"INFUSE 0.9% SODIUM CHLORIDE AT 125 CCS PER HOUR."
YOU ALWAYS WANT TO GET THE RATE DOWN TO A CCS PER HOUR INCREMENT.
SO, IF THE DOCTOR ORDERED 1000 CCS OVER EIGHT HOURS,
HOW DO YOU KNOW HOW MANY CCS PER HOUR?
UP THERE. THE VERY FIRST ONE I WROTE IN BLUE.
IF YOU PUT 1000 MILLIMETERS OVER EIGHT HOURS
AND YOU DIVIDE 1000 BY 8,
IT TURNS OUT TO BE 125 MILLIMETERS PER HOUR.
I WROTE ME A LITTLE NOTE HERE.
JOINT COMMISSION HAS TAKEN ON A NEW CAUSE ABOUT ABBREVIATIONS.
I DON'T KNOW IF YOU'VE HEARD ABOUT THEM AS YOU'VE BEEN IN YOUR FACILITIES,
AND THEY'RE ASK -- THEY'RE REQUIRING NOW THAT WE DON'T WRITE ANYTHING ABBREVIATED CC.
IT GETS MISINTERPRETED AS 00,
SO THEY WANT EVERYTHING TO BE IN MILLIMETERS.
OH, THIS IS GOING TO BE HARD FOR ME.
MY IVS ARE CCS, I HAVE SET IT ALL MY LIFE, I'M OLD, 25 YEARS OF CCS.
I DON'T KNOW, I AM TRYING.
YOU CAN SAY IT. WE KNOW, IT'S THE SAME.
YOU JUST CAN'T WRITE IT ANY MORE BECAUSE OF MED ERRORS,
JUST AS WELL AS YOU CAN'T WRITE UNITS.
THEY DON'T WANT YOU TO USE THE EVERYDAY, EVERY HOURS ANY MORE.
THEY ARE TRYING TO STAY AWAY FROM DIVS.
THEY DON'T WANT YOU TO WRITE SC OR SQ ANY MORE.
YOU HAVE TO WRITE SUBCUTANEOUS, SUBC, SUBQ
BECAUSE OF ERRORS AND SO FORTH.
I WILL GIVE YOU THE SHEET LATER BUT ANYWAY FOR OUR PURPOSES TODAY.
ALRIGHT, WE ARE GOING TO GET INTO MILLIMETERS PER HOUR
BECAUSE WE'RE GOING TO ALWAYS BE THINKING
IN MILLILITERS PER HOUR FOR OUR RATE.
IT'S THE JARGON OF THE DAY.
THAT'S HOW YOU ARE GOING TO SET YOUR RATE AND THAT'S
HOW YOU ARE GOING TO SET IV PUMPS BASED ON CCS, MILLILITERS PER HOUR.
ALRIGHT, LET'S JUST PRETEND FOR TODAY
OUR RATE THAT'S ASSIGNED IS 125 CCS PER HOUR.
SO I HAVE GOT MY DATE.
I AM GOING TO WRITE THE RATE UP HERE, 125 PER HOUR.
AND I AM GOING TO PUT A MARK HERE AT ZERO.
AND THEN I AM GOING TO START MARKING
THE TIMES THAT I -- FROM WHEN I HUNG IT.
SO LET'S JUST SAY 13:30
IS WHEN I STARTED THIS BAG AT ZERO.
RIGHT?
IN ONE HOUR, IF THIS BAG RUNS ON TIME,
WHERE SHOULD THE WATER LEVEL BE?
A 125 DOWN.
AND AN HOUR FROM THAT IF IT'S RUNNING ON TIME,
I SHOULD HAVE 250 THAT WENT IN.
I'M GOING TO MAKE A HASH MARK.
IN ONE HOUR FROM 250, IT SHOULD BE AT 375. MAKE A LITTLE HASH MARK.
AND THE WATER LEVEL SHOULD BE FALLING TO THESE LINES.
BY THE END OF THE BAG, IT SHOULD BE OUT.
SO 13:30.
14:30.
15:30,
16:30.
AND THIS BAG SHOULD BE DONE AT 5:30 TONIGHT,
IF IT RUNS ON TIME.
SO, YOU HAVE TO HAVE THE TIME YOU STARTED.
SO IF I LOOK AT THIS BAG I KNOW THAT THIS BAG WAS SPIKED
2/11 AT 1:30.
AND I CAN'T LET THIS BAG GO UNTIL TOMORROW TO 2/12 PAST 1:30.
IT HAS TO BE THROWN OUT. THAT'S HOW I KNOW HOW OLD IT IS.
IT SHOULDN'T EVER. IF IT'S RUNNING ON TIME, IT SHOULD BE DONE IN FOUR HOURS.
AND I KNOW THAT BECAUSE I HAVE DONE ONE, TWO, THREE,
FOUR HOURS OF TIMEFRAME.
ALWAYS PUT WHERE IT SHOULD BE AT EACH HASH MARK
AND REMEMBER TO PUT WHERE IT WILL BE WHEN IT'S DONE.
THAT'S MAYBE AS IMPORTANT AS WHERE IT IS AS IT'S INFUSING
BECAUSE YOU WANT TO BE PREPARED TO CHANGE THIS BAG
AND PUT A NEW ONE ON BEFORE IT RUNS DRY.
SO YOU ARE GOING TO KNOW AROUND 5:00-5:15.
I AM GOING TO RUN IN THERE AND CHANGE MY BAG.
I AM NOT GOING TO LET IT RUN COMPLETELY DRY.
IT HELPS YOU KEEP ON SCHEDULING.
ALRIGHT.
I'M REALLY READY NOW TO GO IN MY CLIENT'S ROOM.
I HAVE GOT THE BAG.
I AM GATHERING UP SUPPLIES.
I NEED TO START AN IV.
YOU NEED YOUR IV KIT. I LEFT IT, SO JUST GRAB THE KITS. IT'S GOT EVERYTHING YOU NEED IN IT.
I HAVE EVEN CHECKED, IT'S GOT MY DRESSING, IT'S GOT TAPE,
IT'S GOT ALCOHOL, IT'S GOT A TOURNIQUET. BEAUTIFUL.
WHEN YOU REALLY GO TO START AN IV IN SOMEONE'S ROOM,
THEY USUALLY HAVE AN IV CARD OR AN IV TRAY.
IN THE TRAY ARE ALL DIFFERENT KINDS OF CATHETER SIZES
FOR YOU TO CHOOSE FROM ONCE YOU GET IN THE ROOM.
IT'S HARD TO KNOW WHAT SIZE THE VEIN IS WHEN YOU GO IN.
WITH OUR MANNEQUINS, WE USE THE SMALLEST
AND SO EVERYTHING IN THE MANNEQUINS WILL BE 22S
BECAUSE IT DOESN'T POKE THEM UP SO MUCH.
SO WE ARE GOING TO LOOK -- I GATHERED UP MY GAUGES, MY INTRA-CANS.
I HAVE A COUPLE OF BRANDS HERE THAT WE'RE GOING TO PRACTICE WITH.
ABBOCATH IS WHAT YOU WILL PRACTICE WITH
BECAUSE THEY DON'T HAVE ANY SAFETY LOCK FEATURES.
SO YOU CAN STICK THE MANNEQUINS TWO OR THREE TIMES WITH THE SAME CATHETER.
I AM GOING TO SHOW YOU WHAT THEY ARE USING IN MOST OF THE FACILITIES RIGHT NOW,
SAINT AGNES AND COMMUNITY AND MOST OF THEM ARE USING THE BRAUN
WHICH IS EXACTLY THE SAME AS THIS ONE.
IT'S JUST GOT A LITTLE SAFETY LOCK FEATURE IN THERE THAT'S SO COOL,
YOU'LL LOVE IT. ONCE YOU USE IT IT'S DONE.
ALRIGHT. SO I HAVE GOT A COUPLE OF CATHETERS.
I HAVE SOME EXTRA ALCOHOL, BAND AIDS AND A 2X2 FOR DC-ING THE IV
AND I HAVE A CHUX BECAUSE IF THIS COULD BE MESSY.
ALRIGHT. I HAVE ALL MY SUPPLIES, I HAVE MY MEDICINE, I HAVE EVERYTHING.
AT THIS POINT CONTINUING ON, HAVING CHECKED MY DOCTOR'S ORDERS
KNOWING THERE IS NO ALLERGIES TO ANY OF THIS MEDICATION.
IT'S AT THIS POINT I WANT TO REALLY BE COGNIZANT OF ALLERGY,
ESPECIALLY MEDICATION, BUT NOTHING TO MULTIVITAMINS OR TO THIS SOLUTION.
COMPATIBILITIES HAS ALREADY BEEN DEALT WITH.
AND I AM GOING TO TAKE ALL MY STUFF IN WITH MY WASHED HANDS.
AND NOW VOILA, WE'RE IN THE THE PATIENT'S ROOM.
AND I AM GOING TO IDENTIFY MY CLIENT WHO IS AN IV ARM.
AND I DON'T HAVE IV VEINS ON IT BECAUSE WE NEED THE WHOLE ARM TO PRACTICE WITH,
IT WILL BE ON THE OTHER ARM AND PROVIDE PRIVACY.
ALRIGHT.
I NEED TO EXPLAIN BRIEFLY HOW THESE WORK.
WHEN YOU COME TO TEST,
THE INSTRUCTORS WILL WORK THE IV ON FOR YOU.
AND YOU REALLY NEED TO PRACTICE THIS IN BUDDIES, IT'S EASIER.
SO SOMEONE CAN MAKE IT WORK LIKE REAL OVER HERE
WHILE YOU ARE DOING YOUR THING OVER THERE.
YOU CAN DO IT ON YOUR OWN, JUST KIDDING.
WHEN YOU GO TO PUT AN IV IN, IF YOU HAVE BEEN ON THE CATHSIM,
YOU KNOW THAT YOU PUT THE IV IN AND THEN THE CATHETER IN
AND YOU HIT THE VEIN, AND BLOOD COMES BACK INTO THE FLASH CHAMBER.
THEN YOU TAKE --
PUT IT IN A LITTLE FURTHER, THREAD IT THROUGH AND SO FORTH.
TO MAKE THE BLOOD COME THROUGH,
WHAT YOU HAVE TO DO IS APPRECIATE THAT WE HAVE GOT TWO TUBINGS HERE.
WE HAVE GOT BLOOD. THIS IS ARTIFICIAL BLOOD.
WHAT IT IS A VEGETABLE DYE PRODUCT,
IT WILL COME OUT OF YOUR CLOTHES.
IF YOU CAN WASH THEM WITH HOT WATER AND SOAP.
IT COMES OFF OF YOUR SKIN WITH HOT WATER AND SOAP.
THIS IS NO TIME TO WEAR DRY-CLEAN AND BEST CLOTHES IN HERE.
JUST ANYTHING YOU CAN WASH.
I HAVE GOT THEM ON EVERYTHING AND IT COMES OUT FINE IN THE LAUNDRY.
WHAT YOU WANT TO DO IS OPEN UP --
ACTUALLY, I HAVE IT SET BACKWARDS NOW.
YOU WANT TO OPEN THIS UP AND MAKE SURE THAT YOU HAVE GOT SOME BLOOD IN THIS LINE.
THEN YOU WANT TO TURN THE BOTTOM RESERVOIR OFF
SO THAT YOU BUILT UP SOME PRESSURE IN THIS OTHER LINE, OKAY.
SO NOW THIS IS OPEN, BLOOD IS OPEN.
SO BLOOD IS READY TO COME OUT AND IT'S CUT OFF DOWN HERE.
THAT'S WHY YOU, KIND OF, NEED OPERATORS.
BECAUSE ONCE YOU STICK IT IN,
AND I AM GOING TO TEACH YOU ON HOW TO PUT PRESSURE,
THAT'S WHEN YOU WANT TO SWITCH THEM OUT AND I WILL SHOW YOU WHAT TO DO
BECAUSE YOUR IV TUBING -- THE FLUID FROM THIS SIDE, IT WON'T RUN UPHILL.
YOU HAVE GOT TO CLOSE THIS UP AND OPEN THAT UP SO YOUR IV WILL RUN.
AND THAT'S THE LITTLE DRAWBACK THERE BUT IT WORKS.
AND IT LOOKS JUST LIKE REAL.
ALRIGHT. SO I'M SET UP.
I HAVE IDENTIFIED MY CLIENT, THIS IS MY IV ARM,
PROVIDE PRIVACY AND I AM READY TO GO.
I AM GOING TO EXPLAIN TO MY CLIENT I NEED TO PUT AN IV IN.
IT'S A NEEDLE THAT GOES INTO YOUR VEIN.
I AM NOT GOING TO LEAVE A HARD NEEDLE IN, IT'S JUST YOU'LL FEEL A LITTLE POKE
AND THEN WE'RE GOING TO LEAVE A SOFT CATHETER IN YOUR VEIN
SO THAT WE CAN GIVE YOU FLUIDS AND MEDICATIONS TO HELP YOU GET BETTER.
IT MAY HURT A LITTLE BIT.
IF YOU JUST HOLD STILL, IT SHOULDN'T BE TOO PAINFUL.
THERE ARE SOME OTHER PRODUCTS, REMIND ME
AND I WILL TELL YOU SOME OTHER PRODUCTS YOU CAN USE TO AVOID PAIN
BUT SOMETIMES THEY MAKE THE VEINS BLANCHE OUT AND YOU CAN'T FIND THEM.
AND SO I HAVE USED THEM, BUT I DON'T LIKE TO A LOT.
ALRIGHT. SO I HAVE EXPLAINED I AM GOING TO START AN IV.
I NEED TO GO AHEAD AND GET MYSELF SET UP.
SO I WANT TO MAKE SURE FIRST I'VE GOT GOOD LIGHTING.
THIS IS REALLY KEY, YOU'VE GOT TO BE ABLE TO SEE THESE VEINS.
SO YOU MIGHT WANT TO TURN THE LIGHTS ON AND POINT THEM DOWN OR SOMETHING HERE FOR YOUR CLIENT.
I WANT TO PUT CHUX UNDERNEATH, AND I CALL IT MY GOOD LUCK.
IF I DON'T PUT A CHUX, I JUST GET BLOOD EVERYWHERE.
IS THAT LIFE OR DEATH? NO.
IT'S JUST MESSY. AND SO I'M TRYING TO AVOID A MESS.
I HAVE MY CHUX UNDER.
YOU ALSO WANT TO MAKE SURE AT THIS POINT
THAT YOUR CLIENT'S ARM IS DEPENDENT.
YOU WANT IT LOWER THAN THE HEART SO THAT BLOOD
COMES DOWN AND FILLS THOSE VESSELS UP.
OKAY. SO HE'S, KIND OF, HARD TO BE DEPENDENT
BUT I WANT TO MAKE SURE AT THIS POINT
THAT HIS HANDS ARE, KIND OF, FILLING WHILE I AM DOING MY SET UP OVER HERE.
I'M GOING TO GO AHEAD AND GET MY KIT READY
BECAUSE I KNOW I AM GOING TO USE IT.
AND THEN I WILL JUST SAVE ME A LITTLE TIME HERE.
SO OPEN UP YOUR KIT.
I HAVE A LITTLE...
..DRESSING.
I DON'T NEED MY 2X2 QUITE YET.
I NEED TAPE TO SET MY DRESSING
AND THIS IS HOW I DO THE IV DRESSING.
THERE'S A LITTLE VARIATION IN IT.
THE MOST WONDERFUL ARTICLE I HAVE EVER SEEN
ON HOW TO START AN IV I GAVE YOU, AND IT'S JUST BEAUTIFUL. IT'S GOT BEAUTIFUL PICTURES.
IT'S TALKED THROUGH EVERY TECHNIQUE POSSIBLE, AND IT'S BEAUTIFUL.
THEY CHEVRON A LITTLE DIFFERENTLY THAN I DO,
BUT YOU WANT TO SPLIT A TAPE
THAT'S ABOUT FOUR INCHES LONG
AND YOU DON'T WANT IT REALLY MORE THAN A QUARTER OF AN INCH WIDE.
IF IT'S TOO FAT, IT DOESN'T WRAP THE HUB OF THE IV VERY WELL.
SO I HAVE THAT SPLIT, THAT'S TO CHEVRON.
AND THEN I NEED TO STABILIZE MY TUBING
WITH AT LEAST TWO ONE-INCH TAPES.
AND AGAIN I LIKE THEM TO BE PRETTY GOOD LENGTH,
ABOUT FOUR INCHES BECAUSE OF HOW I DOUBLE BACK TUBING.
ALL GOOD NURSES CARRY THEIR PLASTIC TAPE IN HER POCKET AT ALL TIMES.
BECAUSE LOOK AT -- THIS TAPE IS ABOUT AN INCH AND A QUARTER, INCH AND A HALF
AND SOMETIMES THIS MAY GIVE YOU A LITTLE BETTER SECURITY
THAN WHAT YOU LIKE FROM YOUR KIT.
SO ALWAYS HAVE TAPE TO GO IN CASE YOU DON'T LIKE WHAT YOU HAVE.
ALRIGHT. IN THIS PARTICULAR KIT,
I HAVE BETADINE AND ALCOHOL JUST LIKE YOU SAW IN THE CATHSIM.
BUT YOU NEED TO APPRECIATE THAT THE NEW RECOMMENDATION
FROM THE CDC IS THAT WE USE CHLORHEXIDINE.
IT'S A NEW PRODUCT, IT'S A RECENT PRODUCT.
AND HONESTLY, THEY DON'T HAVE IT IN ALL THE HOSPITALS YET.
I HAVE BEEN TALKING TO THE NURSES THAT WORK
AND IT'S NOT APPEARING QUITE YET BUT IT WILL BE.
IT'S THE NEW RECOMMENDED PRODUCT BY THE INS
WHICH IS THE INTRAVENOUS NURSING SOCIETY AND THEY ARE PRETTY MUCH THE ONES
THAT SET THE STANDARD OR RECOMMENDATIONS FOR THE CDC
WHO'S GOVERNING OUR IV THERAPY.
- WHICH REPLACES BOTH OR JUST BETADINE?
- IT REPLACES EVERYTHING, CHLORHEXIDINE.
IF A CLIENT IS ALLERGIC TO BETADINE, CHLORHEXIDINE IS THE PRODUCT.
THEY'RE ALSO USING...PREVACARE
AS A PREP PRODUCT THAT'S VERY SIMILAR TO THE CHLORHEXIDINE
AND IT MAY INDEED BE A CHLORHEXIDINE. THEY JUST DIDN'T KNOW.
AND SO THEY WERE TALKING, THAT'S WHAT THEY ARE USING AS A PREP PRODUCT OUT THERE
BECAUSE IT HAS A LONGER BACTERIAL FIGHTING LIFE ON THE SKIN,
UP TO EIGHT HOURS -- SIX HOURS ON THE SKIN.
SO THAT MAKES A NEAT PRODUCT SO THAT BACTERIA DOESN'T GROW.
BUT WE HAVE THE OLD FASHIONED
SO WE WILL GET THAT OUT AND WE WILL USE THAT.
AND MY TOURNIQUET.
I THINK YOUR KITS ARE NON-LATEX TOURNIQUETS NOW.
SO THE INTERESTING FEATURE ABOUT THE NON-LATEX TOURNIQUETS
ARE THEY ARE, KIND OF, SPRINGY
AND THEY DON'T STICK AS GOOD AS THE LATEX DOES
BUT IT'S A LATEX-FREE ENVIRONMENT,
SO WHAT DO YOU DO.
ALRIGHT. I HAVE MY TOURNIQUET AND THEN I HAVE MY CATHETERS.
AND I'M READY TO GO HERE WITH THAT.
ALIGHT, THE FIRST THING I WANT TO DO IS HUNT FOR A VEIN.
SO THE CLIENT'S ARM IS BEEN DEPENDENT, GETTING SOME FLUID IN IT.
WHAT I WANT TO DO NOW IS ATTACH THE TOURNIQUET.
AND I KNOW THE GUIDELINE IS FOUR TO SIX INCHES ABOVE THE SITE
THAT YOU ARE GOING TO STICK, BUT I DON'T KNOW WHAT I AM GOING TO STICK YET.
SO I USUALLY PUT THE TOURNIQUET RIGHT BELOW THE ELBOW
AND THEN JUST START LOOKING ON THE ARM.
SO THIS IS HOW YOU PUT A TOURNIQUET ON.
SEE THAT MY HANDS RIGHT NOW ARE APART.
I AM GOING TO CRISS-CROSS MY HANDS
AND I AM GOING TO HOLD.
THIS HAS TO BE REALLY SNUG UNDER THE ARM.
I AM GOING TO HOLD WITH MY LEFT HAND
AND TUCK WITH MY RIGHT AND LEAVE.
THE LITTLE FLAPS ARE UP HERE AT THE TOP,
SO THEY ARE NOT DRAGGING DOWN HERE IN MY WAY WHERE I NEED TO SEE VEINS.
SO THAT AS SOON AS I GET THE VEIN AND I THREAD MY CATHETER,
I JUST POP IT OFF,
IT NEEDS TO JUST COME RIGHT OFF. SO NO TWISTY TIES OR ANYTHING.
OKAY. WATCH ONE MORE TIME.
CRISSCROSS, HOLD SNUG. LOOK HOW MUCH STRETCH I HAVE ON THERE.
TUCK AND HOLD, IT WILL HOLD.
YOU CAN SEE IT MOVING ALREADY BECAUSE LATEX DOESN'T WANT TO HOLD AS WELL.
ALRIGHT. IT NEEDS TO BE TIGHT ENOUGH
THAT YOU HAVE NOT CUT OFF THE ARTERIAL CIRCULATION, BUT YOU CUT OFF VIENOUS FLOW.
SO YOU SHOULD STILL BE ABLE TO PALPATE A PULSE ONCE THE TOURNIQUET'S ON.
SO TIGHT BUT NOT THAT TIGHT.
IF YOU WEREN'T GET ANY GOOD RESULTS FROM YOUR TOURNIQUET,
YOU CAN USE A BLOOD PRESSURE CUP.
AND YOU CAN PUMP IT UP TO ABOUT 10 OR 20 OR SO ABOVE DIASTOLIC.
AND THAT WILL GET THE JOB
BECAUSE THEN YOU WILL STILL BE HAVING A SYSTOLIC PULSE THROUGH,
BUT YOU PUMP IT UP TO ABOUT ABOVE RESTING. OKAY.
AND SOME PEOPLE LIKE THAT BECAUSE YOU GET A BETTER PRESSURE
THAN THIS LITTLE SKINNY BAND. THEY LIKE BLOOD PRESSURE CUPS BETTER.
ALRIGHT, ONCE YOU GOT THE CUP ON WE ARE ON A TIMEFRAME HERE, TWO MINUTES RIGHT?
SO YOU ARE GOING TO TAP THE VEIN
- OH, I SHOULD HAVE MENTIONED A COUPLE OF OTHER THINGS.
WHICH ARM WOULD I NOT PUT THIS TOURNIQUET ON?
YOU NEED TO CONSIDER THAT. YOU DON'T JUST SLAP THEM ON ANY ARM.
IF THEY HAVE A SHUNT FOR KIDNEY DIALYSIS FOR EXAMPLE,
YOU CAN'T USE THAT ARM, ABSOLUTELY FORBIDDEN.
IF THEY'VE HAD A RADICAL MASTECTOMY YOU CAN'T USE THAT ARM.
WE DON'T USE THE SAME IV ARM THAT THEY HAVE HAD BEFORE.
WE TRY TO AVOID THE DOMINANT ARM.
IF THEY'RE RIGHT-HANDED, WE WOULD TRY TO START LEFT HAND. IT GETS THEM A LITTLE MORE FREEDOM.
AND SO SOME CONSIDERATIONS THAT YOU WANT. INJURIES, AND THAT KIND OF THING.
ALRIGHT SO I HAVE GOT A GOOD ARM. NOW I WANT TO FIND A VEIN.
TO FIND A VEIN, YOU CAN STROKE THE VEIN DOWN, YOU CAN TAP ON IT.
YOU CAN PUT A WARM SOAK ON, BUT IF YOU DO YOU HAVE GOT TO TAKE THAT OFF.
MAKE A FIST AND SOMETIMES THAT WILL PUMP IT UP A LITTLE.
I DON'T HAVE THEM DO THAT AS MUCH.
THAT'S MORE FOR GIVING BLOOD, REALLY GET A BIG OLD FULL VEIN.
BUT SOMETIMES THAT WILL HELP, GETS YOU A LITTLE MORE CIRCULATION GOING IN THERE.
SO A FEW IDEAS TO GET A NICE, PUFFY VEIN.
ALRIGHT. ONCE YOU'VE LOCATED YOUR VEIN, THEN YOU CAN GO AHEAD AND STICK.
IF IT'S TAKING ME A LONG TIME I CAN RELEASE IT,
GATHER UP MY SUPPLIES AND CONTINUE FROM THERE.
ALRIGHT.
LET ME EXPLAIN HOW WE ARE GOING TO DO THIS.
I DID BRIEFLY WHEN WE DID THE CATHSIM,
BUT LET'S LOOK AT THE CATHETER HERE.
YOUR CATHETER COMES PACKAGED LIKE THIS. WHEN YOU PULL IT APART,
YOU WANT TO DO IT JUST LIKE YOU DID WITH YOUR SYRINGES.
PULL IT AWAY FROM YOU.
YOU SET THIS HERE.
IT'S REALLY DIFFICULT TO SEE, BUT WORK WITH ME HERE.
THIS IS YOUR FLASHBACK CHAMBER.
WHEN YOU HIT THE VEIN, BLOOD IS GOING TO COME INTO THIS PIECE RIGHT HERE.
SO THAT WHEN YOU'RE STICKING IT IN,
YOU WANT TO MAKE SURE YOU'RE HOLDING FROM THE FLASHBACK CHAMBER
SO THAT YOU CAN SEE WHEN THE BLOOD COMES BACK.
IF YOU COME DOWN AND HOLD IT LIKE THIS YOU HAVE BLOCKED OFF YOUR VIEW
AND YOU COULD GROW THROUGH THE VEIN BECAUSE YOU DIDN'T SEE THE CUEING THAT YOU HIT THE VEIN.
THIS IS THE CATHETER HUB.
AND THIS WHITE PIECE RIGHT HERE
IS THE OVER THE NEEDLE CATHETER, THE ONC
WHERE ACTUALLY THE CATHETER IS OVER THE STYLET.
THIS IS STYLET OR THE NEEDLE THAT'S HELPING US GET INTO THE VEIN.
ONCE WE GET INTO THE VEIN, WE'LL PULL THE STYLET OUT
AND WE LEAVE THIS SOFT LITTLE RUBBER CATHETER IN THE VEIN
SO IT'S NOT GOING TO POKE THROUGH THEIR VEIN.
THIS IS WHAT YOU DON'T WANT TO DO, IT'S CALLED RE-CANNULATION.
IT'S PULL IT OUT AND RE-STICK IT IN
BECAUSE YOU CAN SLICE THE CATHETER WITH THE STYLET
AND YOU CAN THEORETICALLY CAUSE A PLASTIC EMBOLI.
A LITTLE PIECE OF PLASTIC GETS SLICED AND DICED OFF
THEN IT GOES THROUGH THEIR VEINS AND THERE'S PLASTIC IN.
SO THAT'S WHY MAYBE YOU RE-CANNULATED
A COUPLE OF TIMES ON THE CATHSIM, I DIDN'T LIKE IT
BECAUSE WE CAN'T TAKE THAT RISK OF PULLING IN AND OUT. NO.
WHAT I WANT YOU TO APPRECIATE IS THE CATHETER OVER THE NEEDLE --
I KNOW IT'S REALLY HARD TO SEE BUT LOOK FOR THIS.
IT ONLY GOES TO THE TOP OF THE BEVEL.
THE BEVEL OF THE STYLET IS WHAT'S SHOWING.
SO THAT WHEN WE GO INTO A VEIN,
WE'RE GOING TO GO INTO THE VEIN, DOUBLE UP
AND AS SOON AS YOU HIT BLOOD,
BLOOD IS GOING TO COME BACK HERE.
BUT YOU MAY ONLY HAVE THE BEVEL IN THE VEIN SO FAR, RIGHT?
YOU NEED TO GET THE CATHETER IN THE VEIN.
SO YOU'VE GOT TO GO A LITTLE BIT FURTHER IN THE VEIN
TO MAKE SURE CATHETER IS IN VEIN.
BECAUSE ONCE YOU'RE IN VEIN, YOU'RE GOING TO STOP.
YOU'RE NOT GOING TO TRY TO GET THIS WHOLE CATHETER IN BY PUSHING IT IN.
YOU'RE GOING TO STOP.
YOU'RE GOING TO THEN TAKE YOUR FINGER, HAND, HOWEVER,
THERE'S THREE WAYS TO DO IT, YOU'LL SEE ON THIS PAPER.
YOU'RE GOING TO SLIDE THIS INTO THE VEIN
AND LET THE STYLET BE YOUR GUIDE.
AND SO IT SLIDES UP IN, NEVER MOVING THIS.
STABLE, STABLE AND THEN POP THE TOURNIQUET
SO THE BLOOD DOESN'T GO POOPH.
PUT PRESSURE, HOLD, TAKE THIS OFF, CONNECT TUBING.
IF--LET ME EXPLAIN ONE MORE THING
SO YOU CAN A GOOD VISUAL IN YOUR MIND.
IF YOU PUT THIS IN AND YOU HIT THE VEIN AND YOU STOP,
YOU GET JUST THE BEVEL IN.
AND THEN YOU TRY TO FLICK THIS OFF INTO THE VEIN AND LET IT THREAD THROUGH.
IT'S NOT IN THE VEIN YET AND IT WILL GO OFF TO THE SIDE AND INTO THE TISSUE
AND IT'S WHAT WE CALL, "YOU BLEW THE VEIN."
SO IT'S IMPORTANT THAT THE CATHETER BE IN VEIN.
SO THAT'S WHY ON YOUR SHEET IT SAYS,
SAW BLOOD RETURN, THEN ADVANCED ABOUT A QUARTER OF AN INCH FURTHER.
THAT'S TO GET THE CATHETER IN THE VEIN.
AND YOU WILL SEE A LITTLE BETTER WHEN I GO TO DO THIS.
ALRIGHT. I HAVE EXPLAINED.
THERE IS ONE THING I WANT TO DO TO BE REALLY PREPARED
AND THAT IS YOU'VE GOT TO HAVE YOUR TUBING READY TO GO.
I BURNT MYSELF ON THIS. WHEN I GO, I FOR--
I GET SO SET TO GO WHEN I FIRST STARTED
THAT I DIDN'T HAVE MY TUBING SET READY TO HANDLE.
YOUR HANDS ARE ALL BUSY AND YOU'VE ONLY HAVE TWO HANDS.
SO YOU'VE GOT THIS ONE THAT'S STUCK, THIS ONE THAT'S HOLDING, THIS ONE THAT'S PULLING.
WHERE IS THE TUBING? YOU KNOW?
YOU DON'T HAVE -- YOU'RE OUT OF REACH.
SO YOU GOT TO HAVE IT RIGHT HERE READY TO GO, TO CONNECT.
NOW THE OTHER PLACE THAT I HAVE GOTTEN A LITTLE BURNED IS,
THIS SOMETIMES IS ON SO TIGHT
THAT I COULDN'T GET IT OFF AND I'M OUT OF HANDS.
SO MAKE SURE IT'S ON EASY-- SO YOU CAN GET IT OFF EASILY.
BUT YOU CAN'T JUST LAY IT ON HERE OR IT'S CONTAMINATED.
YOU HAVE TO PROTECT THIS END,
IT HAS TO BE STERILE TO GO TO CLIENT, ALRIGHT.
EVERYTHING'S WITHIN REACH. I HAVE A NICE BEAUTIFUL VEIN.
GO AHEAD AND GET THIS ON, CRISS-CROSS TIGHT STUFF.
IF THEY WERE HAIRY, YOU CAN CLIP THE HAIR.
BUT THE RECOMMENDATION BY THE INS IS THAT YOU DO NOT SHAVE
BECAUSE YOU CAN GET LITTLE MICRO ABRASIONS THAT CAN CAUSE INFECTION.
SO, ALRIGHT.
THIS IS WHERE YOU NEED GLOVES.
REALLY.
OKAY, PUT SOME GLOVES ON HERE.
YOU ARE GOING TO TAP, TAP, TAP. STROKE, STROKE, STROKE, LOOKING GOOD.
SOMETIMES TO SEE THE VEIN,
ALCOHOL OR SOMETHING SHINY ON THE VEIN
WILL MAKE IT LOOK REALLY GOOD.
THE NEW RECOMMENDATION BY THE INS IS THAT WE DON'T JUST
DO A LITTLE CIRCLE FROM INSIDE TO OUT AND BE DONE,
THEY WANT VIGOROUS RUBBING UP AND DOWN
BECAUSE THE FRICTION GETS RID OF THE BACTERIA.
MOST OF YOUR HOSPITAL'S ALCOHOL IS ADEQUATE, SOME MAY REQUIRE BETADINE.
WE CAN JUST USE ALCOHOL, AND I WOULD PREFER
ON THE MANNEQUINS, THAT YOU JUST USE ALCOHOL
BECAUSE IT STAINS THEM ALL UP.
ALRIGHT, I'VE CLEANED,
I AM GOING TO GET MY CATHETER READY.
IN REAL LIFE, THIS IS WHAT I WOULD HAVE TO DO HERE IF I DIDN'T SEE WELL, OKAY.
DO WHAT YOU GOT TO DO TO SEE. NOW JUST LIKE WE DID
WHEN YOU WERE DOING YOUR INTRADERMAL,
YOU'RE GOING TO PULL TO STRETCH THE SKIN TAUT
AND YOU ARE GOING TO HAVE THE SAME GRIP ON HERE THAT YOU DID
WHEN YOU DID THE INTRADERMAL. YOU'VE GOT TO HOLD IT FROM THE TOP
BECAUSE YOU DON'T WANT YOUR FINGERS INCREASING THE ANGLE TOO MUCH.
SO HOLD FROM THE TOP, YOU'RE GOING TO GO IN AT ABOUT 15 TO 25 DEGREE ANGLE.
YOU ACTUALLY GOT TO GO IN A LITTLE BIT STEEP TO PUNCTURE THE SKIN AND HIT THE VEIN.
YOU CAN GO RIGHT IN HERE AND THEN ONCE YOU HIT, YOU SEE THE FLASHBACK.
I AM GOING TO FLATTEN OUT A LITTLE AND GO AN EXTRA QUARTER OF AN INCH.
I KNOW I'M IN. I AM GOING TO RELEASE THE TOURNIQUET.
IF YOU TAKE YOUR FINGERS AND YOU PUT PRESSURE --
NO, I HAVE TO DO ONE MORE THING.
OH, I DID THAT WRONG. BUT THAT'S ALRIGHT.
I AM GOING TO GO AHEAD AND THREAD THIS OFF.
NOTICE, I HELD THIS STILL. THREAD IT IN.
I AM GOING TO PUT MY FINGERS DOWN HERE ON THE VEIN,
SO BLOOD DOESN'T KEEP COMING BACK.
OH, I HAVE A HUGE PROBLEM.
HUGE, HUGE PROBLEM.
I THINK I'M OKAY. I THINK IT WILL STAY.
MY CAP CAME OFF AND I CANNOT HOOK THAT DIRTY LIKE THAT,
SO I WOULD TAKE THIS AND WIPE IT CLEAN WITH ALCOHOL,
NOT GREAT, BUT ALL I CAN DO RIGHT NOW.
PULL THAT OUT, CONNECT THAT IN
AS SOON AS YOU CONNECT YOU HAVE GOT TO TURN YOUR IV ON SO THAT IT'S DRIPPING.
OKAY. AND THIS IS WHERE TECHNICALLY SPEAKING SOMEBODY'S GOT TO TURN THIS OFF...
..AND OPEN THIS UP, SO NOW YOU'LL DRIP.
OKAY, I AM DRIPPING, BUT YOU DON'T LEAVE IT WIDE OPEN FULL BLAST.
YOU TURN IT DOWN TO WHAT WE CALL TKO
WHICH IS ABOUT A DROP EVERY FIVE TO 10 SECONDS.
OKAY, SLOW IT DOWN.
AND THEN -- OH I MADE A BLOODY MESS BECAUSE OF MY LITTLE DELAY.
LIFE HAPPENS, WHAT ARE YOU GOING TO DO? ADJUST.
OKAY, YOU ARE GOING TO CLEAN UP THE AREA AND GET ALL THE BLOOD OFF
BECAUSE YOU GOT TO PUT A DRESSING ON HERE,
AND YOU DON'T WANT IT ALL BLOODY.
SO CLEAN OFF THE BLOOD...
..AND IT WOULD NEED TO DRY. AND THEN, MY HANDS PROBABLY HAVE BLOOD
AND I DON'T WANT THAT ALL OVER THE TAPE.
I'M GOING TO SCOOP THIS AND PUT IT IN THERE FOR NOW SO I DON'T STICK MYSELF.
AND NOW I AM GOING TO GRAB ONE SKINNY TAPE
AND DO WHAT WE CALL A CHEVRON.
I AM GOING TO TAKE IT DOWN TO THE HUB OF THE BLUE.
AND I AM GOING TO CRISSCROSS IT ON THE BLUE CUP,
NOT ON THE TUBING.
NOW I KNOW IT'S HARD FOR YOU TO SEE AND APPRECIATE THIS.
BUT I NEED YOU TO APPRECIATE
THAT THAT CATHETER PIECE RIGHT NEXT TO THE HUB
IS YOUR MOST VULNERABLE PLACE ON THIS IV.
IF YOU CRIMP THAT OFF OR BEND IT,
YOUR IV WON'T DRIP.
YOU'VE GOT TO KEEP THAT STRAIGHT AND YOU'VE GOT TO KEEP THE TUBING
IN A STRAIGHT LINE WITH THE VEIN.
SO STABILIZE THAT AND THEN LOOK AND MAKE SURE
THAT YOU HAVE GOT THAT CATHETER STRAIGHT AND NOT KINKED.
ONCE YOU HAVE YOUR CHEVRON ON, THEN YOU CAN TAKE YOUR TEGADERM,
YOUR TRANSPARENT DRESSING
AND YOU ARE GOING TO LAY YOUR TRANSPARENT DRESSING RIGHT TO THE TOP OF THE BLUE HUB.
YOU ARE NOT GOING TO TAPE ON TO THE TUBING.
YOU MAY NEED TO CHANGE TUBING AND NOT CHANGE THE IV SITE,
DON'T JUNK IT ALL UP WITH TAPE,
IT'S THE HUB YOU WANT TO STABILIZE. GET THIS ON NICE AND STRAIGHT.
AND THEN YOU KNOW HOW TO PEEL THESE OFF,
WE HAVE ALREADY PRACTICED WITH THESE, SO GET THIS ON.
I LIKE THESE LITTLE IV TUBINGS
BECAUSE THEY HAVE A LITTLE LABEL THAT'S ALREADY ON IT.
SO YOU CAN GET YOUR LABEL AND WE NEED SOME INFORMATION ON THIS LABEL.
WE NEED THE DATE,
02/11/'04.
WE NEED THE TIME, 14:00.
AND WE NEED THE SIZE OF THE CATHETER I JUST PUT IN.
SO I NEED TO SAY ON HERE, NUMBER 22.
AND MY INITIALS OVER HERE.
AND THEN THIS DRESSING LABEL...
..GOES ON THE SIDE OF THE DRESSING.
DO NOT PUT YOUR LABEL ACROSS HERE
BECAUSE IT BLOCKS THE SIDE OF THE VEIN.
WE HAVE GOT TO BE ASSESSING RIGHT HERE
BECAUSE THAT WAS ABOUT AN INCH AND A QUARTER, INCH AND A HALF,
THE CATHETER, IF IT'S GOING TO BLOW,
IF IT'S GOING TO INFILTRATE,
IT'S GOING TO HAPPEN AT THE END OF THE CATHETER, RIGHT.
SO YOU ARE GOING TO BE LOOKING FOR SWELLING HERE,
COLDNESS, PAIN. HERE.
SO DON'T BLOCK YOUR VIEW, SO DON'T TAPE ACROSS HERE OR TAPE HERE.
ALRIGHT, I STILL NEED A COUPLE OF OTHER PIECES OF TAPE
AND THAT IS I NEED TO STABILIZE THIS TUBING.
AND WELL, WHEN YOU'RE THAT CLOSE TO THE HUB,
I DON'T LIKE HANDLING THAT WITHOUT GLOVES, SO.
YOU HAVE THIS LITTLE ATTACHMENT HERE ON YOUR TUBING
AND THAT'S SO THAT YOU CAN SCREW THE TUBING ON TO THE HUB
SO THAT STABILIZES IT AND THE TUBING WON'T COME OUT OF THE HUB.
BUT WHEN YOU DO THAT, YOU'VE GOT TO HOLD YOUR HUB STILL
SO THAT YOU'RE NOT TWISTING IT ALL UP WHEN YOU'RE TURNING IT ON.
BECAUSE THEN YOU WILL TWEAK OUT THAT LITTLE CATHETER AGAIN
AND IT WILL BEND AND THEN IT WILL QUIT DRIPPING.
ALL THE TIME THAT YOU'RE DOING ALL THIS TAPING, TWISTING, WHATEVER
KEEP LOOKING UP AT YOUR TUBING AND MAKE SURE YOU'RE DRIPPING.
YOU MAY BE IN THE VEIN BUT YOU ARE TAPING IT IN SOME COCK-EYED WAY
AND THEN IT WON'T DRIP BECAUSE IT'S TWEAKED, BENT OR IN THE WRONG POSITION.
SO KEEP LOOKING AND MAKE SURE YOU'RE NOT STOPPING IT
WHEN IT'S REALLY IN A GOOD PLACE.
ALRIGHT, ONCE YOU HAVE GOT THAT SCREWED ON TO THE HUB,
YOU WANT TO TAKE YOUR TUBING AND MAKE A LOOP ABOUT THIS SIZE.
YOU'RE GOING TO TAKE THE TAPE
PUT IT ON TO THE TUBING AND THEN DOUBLE STICK IT UNDERNEATH
AND LAY IT DOWN ON THERE AND BRING IT AROUND.
AND DOUBLE STICK IT AGAIN ON THIS END OF THE TUBING,
SO THAT IF THE TUBING GETS TUGGED, ALL THAT'S TUGGED IS THE TAPE.
YOU WILL SEE NURSES THAT WILL JUST TAPE IT FLUSH INTO THE SKIN,
AND BUT WHAT HAPPENS IS IT BURIES THE TUBING INTO THE SKIN
AND THEY HAVE A TUBING IMPRINT IN THEIR SKIN.
IT'S NOT WRONG, IT'S JUST NOT BEST TECHNIQUE.
I WANT YOU GUYS TO BE BEST.
OKAY. - AND ON THAT NOTE.
- OH, SEE THIS CRISSCROSS, IT'S BELOW
AND THEN THE TRANSPARENT IS ON THE BLUE HUB.
BUT THIS PIECE OF TAPE IS STABILIZING TUBING.
THIS PIECE OF TAPE IS GOING TO GO UP HERE.
YOU'RE GOING TO DO THE SAME THING, YOU'RE GOING TO DOUBLE BACK IT UNDERNEATH
AND THEN TAPE IT UP HERE.
BUT MAKE SURE THAT THIS PIECE OF TAPE AS WELL
IS NOT CROSSING YOUR VEIN PATH.
BECAUSE YOU HAVE GOT TO OBSERVE THIS FOR SIGNS AND SYMPTOMS
OF INFILTRATION AND PHLEBITIS.
PHLEBITIS, ITIS, INFECTION
AND IT'S GOING TO BE RED,
FEVER, HOT, KIND OF THING HAPPENING IF YOU'RE STREAKING.
ALRIGHT. ONCE IT'S ALL SET,
WE NEED TO SET OUR IV NOW AT THE CORRECT RATE.
OKAY, THIS IS ANOTHER PLACE.
WE WILL CLEAN UP IN A MINUTE. BUT THE FIRST THING YOU WANT TO DO
EVEN BEFORE YOU CLEAN UP IS WHAT DO WE TAKE CARE OF FIRST?
PATIENT BEFORE TRASH.
SO FIRST THING WE WANT TO DO IS SET OUR IV.
YOU KNOW THAT OUR DROP FACTOR IS?
15 DROPS PER MILLILITER.
SO IF 15 DROPS EQUAL ONE MILLILITER,
HOW DO I GET 125 MILLILITERS TO INFUSE IN ONE HOUR?
I'VE GOT TO FIGURE OUT HOW MANY DROPS PER MINUTE
I SHOULD COUNT TO GET TO A CCS OR DROPS
OR MILLILITERS PER HOUR?
DOES THAT JUST MAKE YOUR BRAIN GO, "WHAT IN THE HECK DID SHE SAY?"
UH-HUH, I KNOW. IT'S JUST SCARY. YOU WILL GET IT.
YOU GOT TO START SOMETIME SO THAT YOU CAN GET IT.
SO IT'S NEW INFORMATION. COME TO THE BOARD WITH ME.
TOM, CAN YOU GET THAT FRONT LIGHT?
ON. ALL OF THEM. LIGHTS. THERE WE GO.
OKAY, LET'S TALK ABOUT RATE A MINUTE.
I TOLD YOU THAT YOU CAN DO 1000 CCS OVER EIGHT HOURS
EQUALS 125 CCS PER HOUR.
THIS WOULD BE A GOOD TIME TO SAY
ALL GOOD NURSES CARRY A LITTLE CALCULATOR IN THEIR POCKET.
YOU CAN HAVE CALCULATORS. I'M GOING TO QUIZ YOU ALL THE TIME.
ALL THE INSTRUCTORS AT EVERY STAGE ARE GOING TO QUIZ YOU.
GET YOUR CALCULATOR OUT, OKAY. YOU CAN DO THAT. YOU WOULD, IN REAL LIFE.
ALRIGHT. SO WE HAVE AN HOURLY RATE HERE.
NOW WE NEED TO FIGURE HOW MANY DROPS PER MINUTE
TO ACCOMPLISH OUR 125 CC PER HOUR.
I PUT THE FORMULA IN YOUR BOOK. IT'S IN YOUR MATH BOOKS,
BUT LET'S WORK IT OUT DIMENSIONAL
SO THAT YOU CAN APPRECIATE WHERE THE FORMULA COMES FROM.
AND THE SHORTCUT I AM GOING TO TEACH YOU BEYOND THIS.
IF YOU UNDERSTAND THE ROOT
OF WHERE IT CAME FROM, THE SHORTCUTS ARE SO EASY.
ALRIGHT, WE KNOW THAT WE NEED 125 MILLILITERS PER HOUR.
WE KNOW THAT ONE HOUR EQUALS 60 MINUTES.
WE KNOW THAT OUR DROP FACTOR IS...
WHAT?
15 DROPS PER MILLILITER.
THAT'S THE FORMULA TO GET US DROPS PER MINUTE,
RIGHT? BECAUSE MILLILITERS CANCEL, HOURS CANCEL
AND WE ARE LEFT WITH DROPS PER MINUTE.
ALRIGHT. YOU KNOW THAT YOU CAN REDUCE NUMBERS, CORRECT?
YOUR DROP FACTOR IS ALWAYS GOING TO BE ABLE TO BE REDUCED
INTO A WHOLE NUMBER INTO YOUR MINUTES.
RIGHT? BECAUSE OUR DROPS ARE ONLY 10, 15, 20 AND 60.
SO 15 WILL GO INTO 60.
WELL, WE'VE ALREADY CANCELED THESE.
RIGHT? MILLILITERS TO MILLILITERS.
15 WILL GO INTO 60 HOW MANY TIMES?
- 4. - 4.
SO WE ARE GOING TO DIVIDE 125 BY 4 TO GET...
I DON'T EVEN TRUST MY MEMORY.
31.25 DROPS PER MINUTE.
WHO COULD HAVE 31.25 DROPS PER MINUTE? NOBODY.
BUT THAT'S THE NUMBER THAT WE NEED.
WE NEED ABOUT 31 DROPS IN A MINUTE
TO GET 125 CCS PER HOUR.
SO WHAT WE ARE GOING TO DO NOW
IS THERE'S A COUPLE OF WAYS TO MAKE THIS A MANAGEABLE ACTIVITY.
IT'S TOO HARD TO COUNT 31 DROPS IN ONE MINUTE.
SO WE CAN BREAK IT DOWN INTO A 15 SECOND INTERVAL
OR WE CAN BREAK IT DOWN INTO A FIVE SECOND INTERVAL.
HOW MANY FIVE SECONDS ARE IN 60?
60 DIVIDED BY 5? - 12.
SO IF WE DIVIDE 31 BY 12,
WE GET TWO TO THREE DROPS PER FIVE SECONDS.
HOW MANY 15 SECONDS ARE IN 60?
4. SO IF YOU DIVIDE 31 BY 4,
LET'S SEE, 7 IS 28 AND 8 IS 32,
SO 7 TO 8 DROPS
PER 15 SECONDS.
IT'S JUST EASIER TO COUNT TWO OR THREE DROPS
IN A FIVE SECOND INTERVAL...
..TO GET 31 PER MINUTE
WHICH WILL THEN RESULT IN 125 IN AN HOUR.
125 CCS. OKAY.
I WANT TO EMPHASIZE THAT WHEN WE TALK ABOUT RATES
THIS WILL HAPPEN MORE NEXT WEEK.
I'LL SAY, WHAT'S THE RATE OF YOUR IV AND YOU WILL GO,
"OH, TWO TO THREE IN FIVE."
NOW WHAT IN THE HECK ARE YOU TALKING ABOUT?
NOBODY IN THE WORKING MEDICAL WORLD
TALKS IN DROPS PER MINUTE. NOBODY.
YOUR RATE IS CCS PER HOUR.
THAT IS WHAT THE DOCTOR ORDERS.
THAT'S WHAT IS GOING TO BE ON YOUR PUMPS.
EVERYTHING IS CCS PER HOUR.
HOW ARE WE GOING TO ACCOMPLISH THE CCS PER HOUR?
BY FIGURING OUT DROPS PER MINUTE.
DON'T TALK TO PEOPLE IN DROPS PER MINUTE.
THEY'LL GO, "STUDENT."
NO KIDDING, OKAY?
YOU KNOW THAT'S HOW YOU'RE GOING TO ACCOMPLISH IT,
BUT IT'S TO ACCOMPLISH THIS.
THIS IS HOW WE ARE GOING TO GET TO THIS. OKAY.
I WILL TELL YOU SOME MORE THINGS HERE,
BUT LET'S JUST KEEP WORKING THROUGH OUR CLIENT HERE.
WE KNOW THAT WE NEED, 31 TO 32 DROPS PER MINUTE.
THAT'S THE QUESTION ON THE MATH TEST,
HOW MANY DROPS PER MINUTE? 31 TO 32.
WE ARE GOING TO COME OVER HERE AND WE ARE GOING TO LOOK AT OUR WATCH.
PUT YOUR WATCH RIGHT HERE BEHIND THE DROP CHAMBER
AND LOOK AT FIVE SECONDS AND THEN YOU ARE GOING TO REGULATE.
ONE, TWO, THREE.
ONE TWO, THREE.
ONE TWO. I COUNTED THREE SETS OF FIVE.
I TOOK ME TO SEVEN TO EIGHT, CLOSER TO EIGHT.
I DID TWO TO THREE FOR FIVE SECONDS.
I'M DRIPPING NOW AT 125 CCS PER HOUR WHICH IS MY ORDERED RATE.
- SO YOU TOOK -- - FIVE
- FIVE SECONDS AND -- -UH-HUH.
SO I DIVIDED MY DROPS PER MINUTE BY 12.
- AND YOU MADE SURE THAT THERE'S TWO OR THREE GOING THROUGH IN FIVE SECONDS.
- TWO OR THREE DROPS IN FIVE SECONDS.
AND I REGULATE IT BY THE ROLLER CLAMP.
NOW THAT IT'S RUNNING PERFECTLY,
MY TIME TAPE'S REALLY OFF BECAUSE IF YOU'RE IN A TEACHING MODE,
YOU KNOW, IT'S TAKEN US A WHILE
BUT NEVERTHELESS I'LL CHECK MY TIME TAPES.
I COULD PUT THE TIMES ON NOW, MAYBE JUST PUT THE HASH MARKS
AND THEN PUT THE TIMES WHEN I ACTUALLY GOT IT DRIPPING.
NOW I AM GOING TO CLEAN UP MY MESS,
GOING TO GET RID MY SHARPS IN THE SHARP'S CONTAINER.
I DIDN'T NEED ALL OF THIS.
THESE SHOULD BE THROWN AWAY PER PATIENT USE.
I'VE PUT A NICE LITTLE ARTICLE, IT'S JUST A PARAGRAPH.
THESE SHOULDN'T BE SAVED FROM PERSON TO PERSON TO PERSON.
THERE WAS A NURSE THAT DECIDED TO CULTURE THEM ONE TIME
BECAUSE WE SAVED THEM AND PUT THEM --
YOU'LL SEE THEM IN THE IV TRAYS AND THE PHLEBOTOMY TRAYS
AND THEY USE THEM OVER AND OVER AND OVER.
SHE THOUGHT SHE MIGHT CULTURE THEM.
OH, UGLY THINGS WERE GROWING ON THESE.
THEY NEED TO BE THROWN AWAY. AND IF THEY ARE COMING AT YOU WITH A DIRTY LOOKING THING,
YOU SAY, "HEY, I WANT A NEW ONE. THAT'S DIRTY."
SERIOUS.
- COULD I ASK A QUESTION, DIANE?
SAY, YOU'RE ENROLLED IN A FACILITY
AND YOU'RE WONDERING ABOUT DIRTY INSTRUMENTS THAT THEY REUSE, LIKE --
- STERILIZING. - PULSE OX CABLES.
WITH LITTLE KIDS THAT HAVE RSV,
SHOULD THEY BE REPLACING THOSE PULSE OX CABLES?
- MOST OF THEM COME LIKE THAT BUT IT DEPENDS ON THE BRAND
AND I WOULD HAVE TO KNOW. WE HAVE A PULSE OX.
AND OURS, WHEN WE REPLACE, IT'S A DISPOSABLE CABLE
WITH THE FINGER PIECE THAT COMES ON.
SOME OF THEM ARE REUSABLE CLIPS AND THOSE NEED TO BE CLEANED,
WIPED OFF WITH A DISINFECTANT BETWEEN USES.
SO IT JUST DEPENDS ON WHAT THE BRAND IS
AND SO I WOULD -- I'D HAVE TO KNOW WHAT IT IS.
BUT SOME CABLES ARE DISPOSABLE AND SOME AREN'T.
MOST OF THE TIME IF IT'S THOSE LITTLE BANDAGE LOOKING LIKE PIECES,
THOSE ARE ALL DISPOSABLE AND YOU'RE GETTING A NEW SET EVERY TIME.
THEY ONLY WORK THAT WAY.
- CAN WE USE OUR ENTIRE IV KIT? - YES.
PRACTICE WITH IT. NO, YOU GOING TO BRING IT BACK BECAUSE IT'S JUST MANNEQUINS.
SOYEAH, BRING EVERY THING BACK.
I THINK YOU SHOULD -- I DON'T KNOW IF I GAVE YOU TWO LITTLE IV DRESSINGS OR NOT.
IF I DIDN'T, I HAVE MORE. SO IF WANT TO PRACTICE A DRESSING, PLEASE DO.
GO AHEAD AND BE COMFORTABLE WITH ALL OF YOUR STUFF.
ALRIGHT. ONCE THAT I HAVE DONE THIS
I AM GOING TO WASH MY HANDS AND I NEED TO DOCUMENT WHAT I DID.
DOCUMENTATION IS REALLY CRITICAL HERE.
IT WILL BE ON YOUR I&O FORM...
..AS WELL AS IT CAN BE, A NARRATIVE NOTE.
BUT YOU'RE DOCUMENTING THE SITE OF YOUR INSERTION,
THE ELBOW CATH OR THE ANGIO CATH SIZE THAT YOU USED.
WE USED A NUMBER 22.
YOU'RE GOING TO SAY THE NUMBER OF TIMES THAT YOU STUCK THE CLIENT.
DID YOU KNOW YOU JUST CAN'T STICK THEM AND STICK THEM
AND STICK THEM TILL YOU FINALLY GET IT IN?
HOSPITALS VARY. I DON'T KNOW ANY THAT LET YOU DO MORE THAN THREE.
MOST SAY IF YOU HAVEN'T GOT IT WITHIN TWO STICKS
ANOTHER NURSE HAS TO TRY.
SO IT VARIES, BUT CHECK. YOU JUST CAN'T STICK FOREVER.
SOMEONE ELSE NEEDS TO GIVE IT A GO.
SO THE NUMBER OF ATTEMPTS, THE IV SOLUTION THAT'S HANGING,
THE RATE IT'S GOING AT, THE KIND OF DRESSING,
HOW THE CLIENT TOLERATED IT, WHICH ARM IT'S IN...
IF THERE IS ANYTHING ELSE I FORGOT, IT'S IN THAT LITTLE LIST ON YOUR CHECKLIST.
BUT THAT'S THE GIST OF IT AS WELL AS THE I&O SHEET.
SO LET'S GO TO I&O.
WHAT YOU HUNG.
THAT'S ALL I WANT YOU TO DO. JUST BE FAMILIAR WITH,
YOU HAVE TO GIVE A CREDIT FOR WHAT'S HANGING
AT THE TIME YOU STARTED AN IV.
THE NEXT THREE WEEKS WE'LL BE DOING I&O CALCULATIONS FOR IV.
BUT FOR NOW THIS WILL DO. KEVIN, YOU ARE BACK ON DUTY.
COULD YOU TURN OFF THIS LIGHT WHICH IS THE ONE CLOSEST TO ME?
THANK YOU.
THE HAZARDS OF SITTING IN THAT CHAIR.
OKAY. I THINK I GAVE YOU A COUPLE OF FORMS FOR I&O.
THIS IS JUST ONE OF THEM, THEY'RE ALL PRETTY MUCH THE SAME.
WE ARE NOW TO THE OTHER SIDE.
YOU CAN'T SEE IT VERY WELL, IT'S A LITTLE BLURRY AT THE TOP
BUT WHAT IT SAYS RIGHT HERE IS THE TIME YOU HUNG YOUR SOLUTION.
SO YOU CAN PUT THE ACTUAL TIME THAT YOU HUNG.
THIS I&O FORM HAPPENS TO BE COMMUNITIES
AND THEIR SHIFT STARTS AT 1 O'CLOCK,
THEIR I&O CALCULATIONS. SO THAT MAKES IT NICE,
OUR SHIFT STARTS AT 1 O'CLOCK IN THE AFTERNOON AS WELL.
SO EVERYTHING WILL BE IN THIS MIDDLE SECTION.
SO LET'S SAY...
..14:00...
..IS WHEN --
HOW'S THAT? BETTER A LITTLE?
WHEN WE HUNG OUR IV. IT'S NOT GREAT.
THIS IS THE BOTTLE NUMBER AND SOME HOSPITALS ARE BETTER
ABOUT COUNTING ALL THE BOTTLES. LET'S NOT WORRY ABOUT THAT RIGHT NOW.
IT WILL BE LABELED ON THE BOTTLE.
MILLILITERS IN THE BOTTLE. HOW MANY DID WE HAVE?
500, THAT'S WHAT WE HUNG, 500.
IT COULD BE 1000, IT COULD BE 250, WHATEVER THE BAG IS.
THEN IT SAYS UP HERE, TYPE OF FLUID AND MEDICATION.
WHAT IS OUR TYPE OF FLUID?
0.9% SODIUM CHLORIDE WITH...
..MVI.
THAT'S OUR MEDICATION.
IT COULD BE POTASSIUM LIKE KCL 40 MIL EQUIVALENTS
OR POTASSIUM 20 MIL EQUIVALENTS WITH MVI.
YOU CAN SEE IT CAN GET A LITTLE CROWDED IN THAT LITTLE BOX RIGHT THERE.
BUT WHAT'S HANGING NOW TO YOUR KNOWLEDGE IN THAT BAG.
THEN IT SAYS AMOUNT RECEIVED IN MILLILITERS,
HOW MUCH HAS BEEN RECEIVED?
DOESN'T MATTER. IT'S NOT EMPTY YET, IT'S NOT THE END OF MY SHIFT.
I'M NOT GOING TO WORRY ABOUT THAT YET.
I'M GOING TO CALCULATE THAT WHEN THE BAG IS EMPTY OR AT THE END OF MY SHIFT.
AND PUT DOWN THE AMOUNT THEY RECEIVED,
AND THEN THE LIB FOR THE NEXT SHIFT. WE'LL TALK ABOUT THAT NEXT WEEK.
SO RIGHT NOW, JUST APPRECIATE WHAT YOU HUNG, YOU HAVE TO TAKE CREDIT FOR.
THEN -- OH, THIS ISN'T THE GOOD FORM.
I THINK YOUR FORM -- CAN I BORROW YOUR SHEET?
AT THE BOTTOM OF THIS PARTICULAR I&O SHEET,
AND THIS IS ALSO -- THIS IS AS VAS.
AT THE BOTTOM, IT HAS THE IV START,
THE DRESSING AND THE IV CATHETER.
SO YOU CAN DOCUMENT YOUR WHOLE IV START HERE AT THE BOTTOM.
AND I'M NOT GOING TO MARK ON HIS SHEET, BUT YOU CAN SEE PLASTIC DRESSING, TIME.
THAT'S THEIR WAY OF SAYING TRANSPARENT DRESSING.
THE DATE. TUBING CHANGE, IF YOU JUST CHANGED TUBING,
IV OR WHATEVER, THEN YOU PUT THE DATE,
THE SITE WAS CHANGED, TODAY.
SO 2/11 IV STARTED, TIME, TYPE, NUMBER 22,
RIGHT FOREARM, RIGHT HAND, RIGHT DORSAL HAND
WHEREVER YOU PUT THE IV, LEFT AND SO FORTH.
NUMBER OF CATHETERS, NEEDLES USED?
ONE.
AND WE'RE GOOD TO GO.
SO, IT IS ALL DOCUMENTED ON THEIR I&O SHEET.
OTHERWISE YOU HAVE TO FIND WHERE IT IS ON SOME OF THOSE,
YOU KNOW, THOSE FOLDING SHEETS. YOU GUYS HAVE SEEN THE SHEETS,
THEY'RE JUST EVERYWHERE. FIND IT OR YOU HAVE TO WRITE IT IN A NARRATIVE NOTE.
- IS THERE AN EXPIRATION FOR THOSE CATHETERS?
- THE SAME, YES. AND THAT'S A VERY GOOD QUESTION.
IT'S THE SAME AS THE TUBING, IT'S THREE DAYS.
I THINK.
THAT'S WHERE YOU RUN INTO SOME INTERESTING COMBINATIONS
BECAUSE LET'S SAY THE IV SITE GOES BAD,
INFILTRATES IN ONE DAY,
AND LEAKS INTO THE TISSUE,
YOU SEE INFECTION STARTING OR SOMETHING.
AND YOU HAVE TO PULL THE IV OUT AND START ANOTHER ONE.
WELL, IF THE TUBING IS GOOD UNTIL SATURDAY,
YOU'RE GOING TO HOOK UP THE SAME TUBING,
YOU'RE JUST GOING TO PUT A NEW CATHETER IN.
SO THE CATHETERS CAN BE ON A DIFFERENT TIMETABLE THAN THE TUBING CAN BE ON
DEPENDING ON WHAT'S HAPPENING WITH EVERYTHING.
THAT'S WHY YOU'VE GOT TO CHECK THE DRESSING DATES,
THE TUBING DATES AND THE BAG DATES,
BECAUSE EVERYTHING IS DIFFERENT.
YOU MAY HAVE SOLUTIONS THAT GOT CHANGED.
THE DOCTOR COMES IN AND SAYS, "OH, 20 MIL EQUIVALENTS OF POTASSIUM IS NOT ENOUGH,
WE NEED 40 MIL EQUIVALENTS, HANG A NEW BAG."
SO YOU DUMP THAT BAG WITH 800 CCS STILL IN IT,
IT DOESN'T MATTER. TO GET THE NEW THING UP, SO --
EVERYTHING'S ON A DIFFERENT TIMETABLE.
SO WHEN YOU'RE CHECKING TIMES AND DATES,
YOU'RE CHECKING A WHOLE SYSTEM OF THINGS
TO MAKE SURE EVERYTHING IS WITHIN THE PARAMETERS GIVEN.
WE'LL TALK A LITTLE MORE ABOUT THAT.
I WANT TO COME BACK TO DROP FACTORS HERE.
BECAUSE WHAT WE ARE GOING TO DO TO YOU AND FOR YOU,
FOR YOU IS WHEN YOU COME TO THE STATION,
YOU'RE GOING TO HAVE -- PUT YOUR ADDITIVE IN, YOU ARE GOING TO START YOUR IV,
YOU ARE GOING TO DO THE TKO DEAL. THANKS, KEVIN.
AND THEN YOU'RE GOING TO -- AND AT THE END,
YOU ARE GOING TO SAY, "I'M GOING TO SET MY RATE."
AT THAT POINT, WE ARE GOING TO GIVE YOU A RATE TO SET.
IT'S NOT GOING TO BE 125 CCS PER HOUR.
I'M GOING TO GIVE YOU ONE OF TWO SCENARIOS.
I AM GOING TO SAY, "OKAY, THE DOCTOR WOULD LIKE YOU TO INFUSE 1000 CCS OVER SIX HOURS.
1000 CCS OVER FIVE HOURS, 1000 CCS OVER --" WHATEVER I FEEL LIKE SAYING.
AND YOU ARE GOING TO FIGURE OUT THE CCS PER HOUR.
EASY, YOU GOT YOUR CALCULATOR, BRING A PIECE OF PAPER.
THIS IS NOT A TRICK, JUST WE WANT YOU TO GET IT RIGHT.
THEN YOU'VE GOT TO CALCULATE PER THAT CC PER HOUR RATE THAT YOU'VE GOT,
HOW MANY DROPS PER MINUTE.
THE ONLY CONSTANT IN THIS FORMULA NEXT WEEK WILL BE YOUR DROP FACTOR.
WE WILL LET YOU KEEP THE 15 DROP PER MIL
BECAUSE THAT'S WHAT YOU REALLY HAVE.
BUT FOR THE FOLLOWING WEEKS WE'RE GOING TO GIVE YOU
DIFFERENT DROP FACTORS AND DIFFERENT RATES
SO THAT YOU CAN START PRACTICING WITH IT,
BECAUSE THAT'S ALL THE MATH TEST IS ABOUT.
CAN YOU FIGURE OUT A CORRECT RATE, TO GET YOUR IV DRIPPING OUT?
SO LET'S TALK ABOUT THAT FOR A MINUTE.
LET'S SAY --
GET RID OF ALL THIS.
LET'S SAY THAT YOUR IV HAD A DROP FACTOR OF 20,
BUT THE RATE IS 125 CCS PER HOUR.
IF YOUR DROP FACTOR IS 20,
HOW MANY DROPS PER MINUTE WILL YOU DRIP IT AT?
20 GOES INTO 60 HOW MANY TIMES?
THREE. SO 125 DIVIDED BY 3 EQUALS...
THAT ONE'S A LITTLE EASIER TO COME UP WITH.
JUST WANT TO BE SURE.
41.6 DROPS PER MINUTE.
SO IF YOU DIVIDE THAT BY 12...
..THREE TO FOUR DROPS PER MINUTE, IT'S 3.47222.
WELL, NO ONE CAN DO A 3.4 DROP, THAT'S RIDICULOUS.
SO THE ANSWER IS THREE TO FOUR DROPS PER MINUTE
OR DROPS PER FIVE SECONDS TO GET THIS 41.6 DROPS PER MINUTE,
125 CCS PER HOUR RATE BASED ON A DROP FACTOR OF 20.
WHAT IF YOUR DROP FACTOR IS 10?
AND YOUR RATE IS 125 CCS PER HOUR?
- DIVIDE THAT BY 6.
- GOES INTO 60, 6 TIMES.
SO 125 DIVIDED BY 6.
DID I DO THAT? YEAH.
20.8,
SO, 20 TO 21 DROPS PER MINUTE
DIVIDED BY 12, ONE TO TWO DROPS PER FIVE SECONDS...
..TO GET 125 CCS PER HOUR.
MY FAVORITE...
..WHAT IF YOUR DROP FACTOR IS 60?
IF YOUR DROP FACTOR IS 60,
YOUR RATE AND YOUR DROPS PER MINUTE IS ALWAYS THE SAME.
I LOVE IT.
SO 125 DROPS PER MINUTE.
THAT'S ALL YOU HAVE TO DO.
LITTLE TINY DROPS, TIC, TIC, TIC.
THEY COME THROUGH WHEN YOU COUNT.
WE USUALLY DON'T USE THE PDF OR DROPPER FOR RATES OVER 100.
SO, IT'S USUALLY RATES BELOW 100 THAT WE CAN COUNT
BECAUSE YOU CAN SEE IF YOUR RATE LOOKS LIKE 250 OR 185 OR SOMETHING.
OH, GIVE ME A BREAK.
ALRIGHT. LET'S LOOK AT WHAT THIS MEANS IN ENGLISH HERE.
WHERE DID ALL THIS STUFF COME FROM?
SHORTCUTS.
LET'S THINK MATHEMATICALLY HERE.
YOU KNOW HOW THE FORMULA WORKS NOW, LET'S SHORT CUT IT.
YOU KNOW THAT 10 DROPS TIMES WHAT IS GOING TO EQUAL TO 60,
6, 15, 4, 20,
3, 60, 1.
WHEN I HAVE THIS RATE, ALL I DO THEN IS DIVIDE IT OUT BY THAT NUMBER.
IT'S JUST QUICK.
MULTIPLY IT TOWARDS THIS, THAT'S YOUR DIVISOR.
DIVIDE OUT YOUR RATE BY THAT NUMBER
AND YOU ARE ALWAYS GOING TO GET YOUR DROPS PER MINUTE.
IT'S THE SHORT CUT.
THEY EXPLAINED IT VERY WELL IN YOUR BOOK IN A LITTLE BOX,
BUT THAT'S HOW THEY CAME UP WITH THAT IDEA.
YOU'LL SEE FORMULAS THAT HAVE OMITTED THIS, THIS AND THIS.
SO IT'S MILLILITERS TIMES DROP FACTOR OVER 60 MINUTES.
IT'S BECAUSE THEY ELIMINATED ALL THE 1S.
AND THAT'S HOW THEY GOT THE FORMULA.
YOU CAN DO THE SAME THING BY UNDERSTANDING
THAT ALL YOU HAVE TO DO IS REDUCE AND DIVIDE BY THAT NUMBER
TO GET YOUR DROPS PER MINUTE, BASED ON YOUR RATE.
LET'S JUST TAKE ONE RATE HERE THAT'S TOTALLY DIFFERENT.
LET'S DO 1000 CCS OVER SIX HOURS. WHAT'S THE RATE?
START BRINGING YOUR CALCULATORS. WE ARE GOING TO QUIZ YOU TO DEATH
THE RATE IS NOW 166.6.
SO IT'S 166 OR 167 CCS PER HOUR.
THAT'S OUR NEW RATE.
OKAY?
SO IF OUR RATE IS 166 CCS PER HOUR
AND OUR DROP FACTOR IS 15,
HOW MANY DROPS PER MINUTE
TO ACCOMPLISH THE RATE THAT WE NEED?
WHAT DO WE DO?
DIVIDE BY? - 4.
- 4, 106, HE SAYS. SO WHY WOULD YOU WANT US TO LOOK AT THE ROOM?
166 DIVIDED BY FOUR.
WE NEED 41.5 DROPS TO GET --
PER MINUTE, TO GET OUR RATE.
DIVIDE IT BY 12 SO THAT YOU CAN CALCULATE IT IN THAT LITTLE FIVE SECOND INTERVAL.
AND THAT'S ALL YOU DO. WE ARE JUST BREAKING IT DOWN INTO MANAGEABLE INCREMENTS.
YOU CAN DIVIDE IT BY 12, OR YOU CAN DIVIDE IT BY FOUR,
AND WORK IN A FIVE SECOND INTERVAL OR A 15 SECOND INTERVAL.
I DON'T KNOW WHAT I SAID ON YOUR PAPER, BUT ONE OF THE TWO IS JUST PERFECTLY ACCEPTABLE.
ALRIGHT, THERE IS NOTHING I SAID
THAT'S NOT IN YOUR MATH WORKBOOK OR THAT'S NOT IN YOUR SYLLABUS.
SO REVIEW IT UNTIL IT'S, KIND OF, CLEAR
BECAUSE WE ARE GOING TO KEEP WORKING WITH IT.
WHY ARE WE COUNTING --
PUMPS, RIGHT, WHAT IS THE POINT?
NOT EVERYBODY USES PUMPS.
AND THERE REALLY ARE SOME AREAS WHERE THERE ARE NO PUMPS
AND SO YOU NEED TO KNOW HOW TO DO IT.
AND WHAT ARE SOME OF THOSE AREAS.
THE EMERGENCY ROOM MAY NOT USE A PUMP.
SAME DAY SURGERIES DON'T ALWAYS USE PUMPS.
OUTPATIENT TREATMENTS DON'T ALWAYS USE PUMPS.
THERE'S A LOT OF VENUES. WHAT IF THEY ARE OUT OF PUMPS?
YOU SHOULD BE ABLE TO REGULATE ANYTHING BY GRAVITY.
IF THERE WAS A TERRORIST ATTACK AND EVERYBODY WAS IN THE HOSPITAL,
YOU COULD HAVE EVERYBODY RUNNING BY GRAVITY.
THIRD WORLD COUNTRIES DON'T HAVE PUMPS WHEN YOU GO TO HELP OUT.
SO THERE'S A LOT OF REASONS TO DO THIS.
YOU NEED TO KNOW HOW TO WORK IT BY GRAVITY.
ONCE YOU CAN APPRECIATE GRAVITY, THE PUMPS ARE A BREEZE.
SO WE ARE GOING TO START AND THEN BUILD UPON THAT PRINCIPLE.
ALRIGHT, ONCE YOU'VE GOT YOUR IV IN, WE NEED TO DC THE IV,
SO THAT'S YOUR LAST...
..LITTLE THING. YOU'RE GOING TO DO YOUR HIGH FIVE.
JUST TO BE QUICK HERE SO I WANT TO START AN IV FOR YOU.
YOU CAN DO YOU HIGH FIVE. I THINK I PUT ON THIS ONE, DID I NOT?
ON THE FIRST STEP, IDENTIFY SIX THINGS TO TROUBLESHOOT AN IV.
A NON-DRIPPING IV.
THERE'S DIFFERENT REASONS WHY WE STOP AN IV.
YOU STOP AN IV BECAUSE THE DOCTOR DISCONTINUED THE IV.
OKAY, THAT'S EASY ENOUGH, SO YOU DISCONTINUE.
BUT THE OTHER REASON IS USUALLY BASED ON INFILTRATION OR PHLEBITIS.
SIGNS AND SYMPTOMS OF INFILTRATIONS
ARE, COLD, SWOLLEN,
PAINFUL, NON-DRIPPING.
IT QUIT DRIPPING, IT'S LEAKING INTO THE TISSUE FOR SOME REASON.
IT'S INFILTRATED.
SO, FOR ONE OF THE THINGS TO CHECK FOR A NON-DRIPPING IV,
IS IT INFILTRATED?
SECOND, IS THERE PHLEBITIS?
PHLEBITIS IS THE INFLAMMATION OR INFECTION.
YOU ARE LOOKING FOR RED STREAKING AND PAIN AND FEVER.
ARE THERE SIGNS OF PHLEBITIS THAT MIGHT KEEP IT FROM NOT DRIPPING
OR THAT'S THE REASON TO STOP IT EVEN IF IT'S DRIPPING.
THERE'S INFECTION IN THAT SITE.
WE GOT TO GET IT OUT OF THERE.
SOME OTHER THINGS HAPPEN THAT KEEP IT FROM DRIPPING
THAT YOU CAN MAYBE SOLVE BEFORE YOU PULL IT OUT
BECAUSE WHO WANTS TO GET STUCK AGAIN?
SO WHAT CAN YOU DO? FIRST OFF, REMEMBER TO BE SYSTEMATIC,
EITHER START FROM THE BOTTOM AND WORK UP
OR START FROM THE TOP AND WORK DOWN TO PROBLEM SOLVE.
THE FIRST THING YOU MIGHT WANT TO DO IS PUT THIS UP HIGHER
SO THAT GRAVITY IS ABLE TO HELP IT TO COME OUT.
YOU MIGHT CHECK TO SEE IF THERE'S ANYTHING IN YOUR BAG.
SOUNDS SILLY BUT YOU'RE LOOKING AND IT'S NOT DRIPPING.
IT'S EMPTY.
YOU WANT TO MAKE SURE THAT YOUR ROLLER CLAMP IS OPEN SO THAT IT CAN DRIP.
YOU WANT TO MAKE SURE THAT THERE IS NO KINKS IN THE TUBING
THAT THEY ARE NOT LAYING ON IT, THAT IT'S NOT BENT AND SO FORTH.
YOU WANT TO MAKE SURE THAT WHEN YOU COME AROUND
THAT THAT AT RISK PLACE THAT I TALKED ABOUT OF THE CATHETER.
[BEEPING]
OKAY, WHO IS BEEPING AGAIN?
INFAMOUS TIMER.
I DON'T KNOW, WE ARE GOING TO HAVE TO HUNT IT DOWN.
CHECK THAT THIS CATHETER AT THE HUB IS NOT KINKED,
OKAY, SO THAT YOU'VE GOT GOOD FLOW.
DRESSING, GRAVITY, YOU MIGHT CHECK THAT IT'S NOT POSITIONAL.
WE TALK ABOUT POSITIONS A LOT. FOR EXAMPLE,
IF I PUT THE CATHETER IN THE HAND,
REMEMBER IT'S ONE AND A QUARTER INCHES LONG.
IT WOULD COME RIGHT TO WHERE THE BEND OF THAT WRIST IS.
AND SO JUST BECAUSE OF THEIR POSITION,
THEY CAUSE IT TO NOT DRIP, IT'S POSITIONAL.
THEY MAY BE LEANING, THEY MAY BE LAYING ON IT, THEY -- YOU KNOW.
SO YOU'RE LOOKING FOR POSITION AS WELL.
THEY MAY HAVE IT -- LIKE THEY'RE WATCHING TV AND THEY HAVE THEIR ARMS UP
OR THEY ARE COMBING THEIR HAIR OR SOMETHING.
AND SEE, LOOK WHAT HAPPENS WHEN YOU GET UP HIGH LIKE THAT AND COMBING,
SOMETIMES THAT CAUSES IT NOT TO DRIP LIKE IT SHOULD.
SO LOCATION, GRAVITY AND SO FORTH.
AND THOSE ARE GOOD THINGS YOU LOOK FOR TO MAKE IT DRIP.
WE'LL TALK MORE THINGS ON INFILTRATIONS NEXT WEEK,
BUT READ THROUGH THOSE TWO ARTICLES. THEY'RE WONDERFUL AND THAT OUGHT TO GET YOU GOING.
ALRIGHT, WHATEVER THE CASE IS WE ARE GOING TO GO AHEAD AND DC.
I NEED A CHUX, JUST TO BE SAFE.
USUALLY, IT'S NOT MESSY TO DC, BUT IT NEVER HURTS.
ALRIGHT. YOU WANT TO GO AHEAD AND TURN YOUR IV OFF.
YOU ARE GOING TO UNTAPE EVERYTHING.
I TURNED IT OFF FIRST THING SO IT CAN START CLOTTING.
ESPECIALLY IF IT'S RUNNING FINE AND THE DOCTOR JUST SAID, YOU KNOW,
"DISCONTINUE THE IV SO THEY CAN GO HOME."
TAKE THE TAPE OFF THE TUBING.
AND STABILIZE, YOU ARE NOT JUST YANKING IT OUT OF THEM.
PULL THIS TOWARDS THEM.
YOU CAN GO AHEAD AND GET YOUR BANDAGE READY JUST LIKE YOU DID.
YOU DON'T HAVE TO BANDAGE UP MY MANNEQUINS, BUT GET YOUR BANDAGE READY.
GET A -- SOMETHING DRY, A 2X2, EVEN KLEENEX BUT SOMETHING DRY
BECAUSE THE ALCOHOL IS SO WET AND IT BURNS AT THAT HOLE.
YOU WANT TO PUT IT OVER THE CATHETER.
AGAIN MAKE SURE IT'S OFF, OTHERWISE IT SPURTS AT YOU WHEN YOU PULL IT OUT.
PUT PRESSURE AT THE SITE AND THEN SLIDE IT OUT.
MAKE SURE THAT THE CATHETER IS INTACT.
GREAT. CATHETER'S INTACT THAT YOU HAVE IT ALL.
IF FOR SOME REASON IT WASN'T, YOU HAVE A CATHETER EMBOLI AGAIN,
YOU HAVE TO PUT A LITTLE TOURNIQUET ON THERE AND CALL THE DOCTOR STAT.
BUT I'VE NEVER HAD ONE ON, THIS IS JUST FOR MY SAFETY.
OKAY, PUT PRESSURE ON THERE,
ESPECIALLY IF IT'S A GOOD DRIPPING IV,
YOU WANT TO PUT THAT PRESSURE ON GOOD FOR AT LEAST TWO MINUTES,
OTHERWISE YOU CAN GIVE THEM A HAEMATOMA.
YOU'LL RELEASE AND IT WILL BLEED IN AND CAUSE A BIG OLD BRUISE.
IT DOESN'T KILL THEM. BUT OH, MAN, BRUISE, BAD.
ALRIGHT, TWO MINUTES, PUT THE BAND AID ON.
YOU CAN LEAVE THIS LITTLE WAD LIKE THIS AND PUT TAPE ON SNUGLY.
AND THAT PUTS A LITTLE MORE PRESSURE ON THE SITE
TO KEEP IT FROM BRUISING. AND HAVE THEM HOLD IT.
SAY, "HERE HOLD THIS FOR TWO OF THREE MINUTES TO HELP PREVENT BRUISING."
IT MAY ANYWAYS, BUT GIVE IT YOUR BEST SHOT.
AND THEN TELL THEM THEY CAN TAKE IT OFF IN A HOUR OR SO
AFTER YOU KNOW IT'S REALLY GOOD AND CLOTTED.
ALRIGHT, YOU ARE GOING TO CLEAN UP YOUR MESS,
TAKE YOUR GLOVES OFF, WASH YOUR HANDS AND DOCUMENT.
THE IV WAS DCED, YOU'LL FINISH UP YOUR I&O
AND THEN THE STATUS OF THAT CATHETER
THAT IT WAS INTACT WHEN YOU REMOVED IT.
ALL OF THIS THEN GETS DUMPED INTO THE BIO HAZARD AND..
..THAT'S IT, YOU'RE DONE.
SO YOU ARE GOING TO DO THREE THINGS, FOUR THINGS ACTUALLY.
ADDITIVE TO YOUR IV, START AN IV,
CALCULATE A DRIP RATE, DC THE IV,
NONE OF WHICH TAKE VERY LONG.
ALL OF WHICH ARE VERY HARD IF YOU LOOK AT THE CLOCK
TO EXPLAIN IT AND JUST CONCEPTUALIZE IT.
BUT ONCE YOU GET THE BASICS OF IT, OH, MAN. THE REST IS A BREEZE.
AND WE ARE GOING TO BUILD UPON THOSE SAME PRINCIPLES FOR THE NEXT THREE WEEKS.
OKAY, A LOT OF INFORMATION, BUT YOU CAN DO IT.
ANY QUESTIONS?
ALRIGHT.
WE ARE GOING TO GO AHEAD AND START AN IV FOR YOU, A REAL ONE,
SO YOU CAN SEE HOW IT'S DONE.
I NEED TO REALLY WASH MY HANDS
AND JUST CLEAR OFF THIS AREA FOR JUST A SECOND, SO.
WE ALSO WANT YOU TO, KIND OF, COME AROUND.
I AM GOING TO USE INSTEAD OF THE CATHETER YOU'RE PRACTICING WITH.
I ALSO DIDN'T MENTION THAT IV THERAPY,
THE INS HAS CHANGED THEIR THINKING ABOUT IV THERAPY
AND THE SIZE PICKING OF YOUR CATHETER.
YOU'RE WONDERING, HOW DO I KNOW WHAT SIZE TO PICK?
THE RECOMMENDATION IS YOU'D USE THE SMALLEST CATHETER POSSIBLE
BECAUSE IT IS NOT AS IRRITATING TO THE VEIN AND IT WILL LAST.
SO 22S WHENEVER POSSIBLE. ANY LIQUIDY TYPE SOLUTION WOULD BE A 22.
A 20 IS OKAY IF YOU'RE GOING TO BE DOING SOME OTHER KINDS OF THERAPIES...
EVEN BLOOD PRODUCTS THEY'RE SAYING CAN GO THROUGH 20
AND WE USED TO ALWAYS DO AN 18 FOR BLOOD PRODUCTS.
SO THAT YOU DIDN'T THE CELLS.
SO IF YOU HAVE SOMEONE THAT'S IN A TRAUMA UNIT
THEN THEY ARE GOING TO USE A BIGGER SIZE CATHETER LIKE 18 OR 16
BECAUSE THEY NEED TO GET LOTS OF FLUIDS IN FAST
WHEREAS A SMALL CATHETER LIKE THIS DOESN'T ALLOW THE VOLUME TO GO IN.
SO YOU'RE THINKING VOLUME AS WELL AS VISCOSITY.
FOR AN AVERAGE DRIPPING IV THAT'S 100 TO 150 CCS PER HOUR.
YOUR 22 CATHETER IS ABSOLUTELY FINE.
AND IT'S THE NICEST FOR VEINS AND PRACTICING.
ALRIGHT. THIS IS BY BRAUN.
IT LOOKS ALMOST EXACTLY LIKE THE CATHETER THAT I USED, CORRECT?
THE ONLY DIFFERENCE IS THAT OVER THE NEEDLE CATHETER IS CLEAR.
YOU CAN'T EVEN SEE IT ON HERE AT ALL, SO IT'S CLEAR.
AND THE DIFFERENCE IS THAT INSIDE AND YOU CAN'T REALLY SEE IT,
BUT INSIDE THIS HUB IS A LITTLE BUTTERFLY CLIP,
SO THAT WHEN YOU START THE IV AND PUT IT IN
AND THEN YOU'RE IN THE VEIN AND YOU THREAD IT OFF,
IT'S GOT THIS NICE LITTLE LEDGE
SO THAT YOU CAN SLIDE IT OFF LIKE THAT.
THEN YOU RELEASE THE TOURNIQUET, PULL IT OUT
AND THIS LITTLE CLIP LANDS ON THE END SO THAT YOU HAVE NO NEEDLE.
IT'S TUCKED AWAY INSIDE THE HUB.
SO IT FEELS JUST LIKE THE LITTLE CATHETER THAT YOU'RE PRACTICING WITH.
THE ONLY DIFFERENCE IS YOU WON'T HAVE THE LITTLE CLIPPIE COMING OFF
SO THAT YOU CAN DO IT IN THE MANNEQUIN A COUPLE OF TIMES, PULL IT OUT, RETHREAD
AND PRACTICE AGAIN WITH THE SAME ONES.
BUT IF YOU HAVE THIS TO PRACTICE WITH, IT'S DONE IN ONE PULL.
SO THAT'S WHAT WE'LL USE TODAY TO DO THIS IV.
ALRIGHT.
I HAVE ALL MY SUPPLIES GATHERED, ALL CLEANED, FRESH, NEW.
NOW THE ONLY THING I AM GOING TO DO DIFFERENT IS I'M GOING TO CREATE
WHAT'S CALLED AN IV LOCK FOR HER.
I'M GOING TO PUT THE CATHETER IN AND RATHER THAN CONNECT IT TO TUBING,
I'M GOING TO CONNECT IT TO THIS LITTLE LOCK
SO THAT I CAN CLOSE OFF THE END.
IT WILL ALLOW ME TO HAVE ACCESS TO HER VEIN
BUT SHE DOESN'T HAVE TO HAVE FLUID GOING IN ALL THE TIME
AND WE USE THOSE FOR MEDICATION ADMINISTRATION.
LIKE, THEY NEED THE MEDICINE EVERY EIGHT HOURS, BUT THEY DON'T NEED THE FLUID.
OR HEART ATTACK CLIENTS, WE KEEP AN IV IN THEIR VEIN IN CASE THEY HAVE A HEART ATTACK,
SO THAT WE CAN ADMINISTER EMERGENCY MEDICATIONS WITHOUT HAVING TO ACCESS A VEIN.
THAT WOULD BE NOT EFFICIENT BECAUSE SOMETIMES THEIR VEINS COLLAPSE IN CRISIS.
SO THAT'S WHERE YOU'LL SEE IV LOCKS.
WE'LL WORK WITH THEM THE THIRD WEEK OF THIS MODULE.
ALRIGHT. I NEED TO GET MY EQUIPMENT READY.
KELLY IS SO PATIENTLY WAITING BUT THAT'S PART OF THE PROCESS
IS JUST THE GETTING READY.
IF I CAN FIND AN OPENING IN HERE...
AND NOT TO MENTION I DO HAVE A A LITTLE BIT OF A SHAKY HAND,
HAVE YOU NOTICED?
AND I JUST WANT YOU TO APPRECIATE
THAT YOU CAN DO THIS NERVOUS OR NORMAL SHAKY.
YOU CAN. JUST YOU CAN.
ALRIGHT. I MIGHT --
YOU DON'T HAVE TOO HAIRY ARMS, SO I'M GOING TO GO AHEAD AND DRESS IT,
SO THAT YOU CAN SEE HOW TO HOLD IT AND THE DIFFERENCE.
SO WE'LL PUT A LITTLE DRESSING ON YOU, JUST FOR PRACTICE PURPOSES.
GET RID OF THESE LITTLE TABS.
AND I'LL SHOW YOU HOW I STABILIZE.
I HAVE MY CHUX TO PROTECT HER NICE WHITE PANTS
BUT I WOULD ANYWAYS ON PLAIN CLOTHES.
AND BECAUSE SHE IS SITTING -- I AM NOT GOING TO HAVE YOU PUT YOUR HAND ON THE TABLE,
I WANT YOU YOU HANGING LOW, SO THAT'S WHY WE ARE DOING IT LIKE THIS.
I HAVE MY CATHETER, I HAVE MY TOURNIQUET, I HAVE MY CLEANER.
I HAVE A 2X2 AND WE WILL USE THAT LATER WHEN WE PULL IT OUT.
AND I DO WANT TO GET YOU BAND AID...
..FOR PULLING IT OUT.
LOOK AT HER SHE IS PUMPING UP FOR ME. OH, GO GIRL.
THANK YOU.
BECAUSE THAT HELPS, IT HELPS TONS. OKAY.
I THINK I HAVE EVERYTHING I NEED.
I HAVE MY CATHETER, LET ME GET MY TOURNIQUET.
I AM JUST GOING TO USE ALCOHOL. DO YOU WANT BETADINE?
- NO, I DON'T CARE.
I JUST HAVE ALWAYS USED JUST ALCOHOL
UNLESS SOMEONE REALLY WANTS BETADINE, THAT'S ADEQUATE ENOUGH.
ALRIGHT. IS ONE SIDE BETTER THAN THE OTHER?
YOU CAN RELOCATE YOURSELF.
- WELL,THE RIGHT SIDE'S BETTER.
- I DON'T KNOW KELLY AT ALL SO I'M GOING TO LOOK AND INSPECT HER VEINS FIRST.
SO, AGAIN THIS IS HOW I SET THE TOURNIQUET. SEE HOW SNUG IT IS.
I AM INDENTING HER SKIN,
IT'S GOT TO BE SNUG OR IT DOESN'T DO ANY GOOD.
PULSE. ALRIGHT.
YOU'RE GOING TO MAKE IT DEPENDENT, GET YOUR LEGS FLAT.
AND YOU CAN STROKE DOWN, YOU CAN TAP --
OH, BABY. - I KNOW.
- YOU KNOW, AND THAT'S THE KIND THAT YOU WANT.
WHEN YOU'RE OUT IN THE FIELD AND ONCE YOU HAVE GOTTEN CLEARED OF IVS,
YOU SEE A VEIN LIKE THAT, YOU GO, "I'LL TRY."
YOU MAY BE SCARED BUT THAT'S WHAT TO PRACTICE ON,
HAT YOU CAN SEE ACROSS THE ROOM.
THIS IS A VERY GOOD VEIN, IT'S A DORSAL CEPHALIC VEIN.
AND...
..WHY YOU NEED TO KNOW THE NAMES IS BEYOND ME.
WE NEVER KNEW THE NAMES WHEN WE LEARNT, YOU JUST GOT TO KNOW WHERE THEY ARE.
SO HAND VEINS ARE NICE AND DISTAL.
WRIST VEINS ARE MY FAVORITE, THIS VEIN RIGHT HERE.
AND I CAN FEEL HERS BETTER THAN I CAN REALLY SEE IT.
I DON'T KNOW IF YOU CAN SEE IT RIGHT HERE.
BUT THIS VEIN IS REALLY STURDY AND YOU HAVE A NATURAL ARM BOARD,.
IT HOLDS STILL, WHEREAS IN THE HAND
IF I PUT IT HERE AND SHE BENDS, IT'S GOING TO QUIT RUNNING.
I WILL HAVE TO PUT A BOARD ON HER HAND TO STABILIZE HER WRIST.
BUT HERE, IT'S JUST NATURALLY BLOCKED OFF.
WE AVOID THE WRIST, I DIDN'T MENTION ON THE CHECKLIST.
WE AVOID THE WRIST, YOU DON'T PUT ANYTHING IN HERE
BECAUSE THERE'S TOO MANY NERVES AND TOO MANY CARTILAGES TO HIT
SO ALL OF THIS IS OFF LIMIT AS WELL AS THIS BONE.
YOU WANT TO BE TWO FINGERS OFF OF THIS BONE BEFORE YOU START STICKING.
HER BEST IS THIS HAND, OBVIOUSLY.
THERE'S A GOOD VEIN THAT RUNS THIS BACKSIDE OF THE ARM WHEN YOU ARE PICKING.
SO I'VE WASTED A GOOD MINUTE IN JUST EXPLAINING.
SO TAKE IT OFF, GIVE HER A BREAK AND THEN I'LL RESET ALL OF MY STUFF, EXCUSE ME.
NOW BEFORE I GET GOING I KNOW --
OH, I AM SO RIGHT-HANDED. I'M GOING TO SWITCH THIS AROUND.
I'M THE NURSE. I'M IN CHARGE.
I SET UP THE ENVIRONMENT THAT MAKES ME MOST EFFECTIVE.
SO CAN YOU SCOOT JUST A TOUCH THIS WAY.
BECAUSE I AM GOING TO NEED TO GRAB MY STUFF FROM THIS SIDE.
YOU NEED TO HAVE YOUR TUBING READY.
REMEMBER, I TOLD YOU I'VE BEEN BURNED ON THAT ONE.
SO WHAT I WANT TO DO IS GRAB THIS,
PEEL THIS BACK AND GET THIS BLUE PIECE OFF OF THERE
SO THAT I CAN CONNECT TO HER.
AND I'M GOING TO LAY IT IN THAT NICE STERILE PACKAGE.
OK, I GOT MY ALCOHOL, I GOT ME, I GOT EVERYTHING, NOW I NEED YOU BACK HERE.
SO YOU COULD SEE IT WAS SNUG.
I PUT A LOW INDENTATION BUT --
BOY, IT MADE THAT VEIN GOOD.
ALRIGHT. SO ONE MORE TIME...
..ON.
IF YOU COULD MAKE A FIST, I'M GOING TO AVOID -- THAT'S BEAUTIFUL.
I LOST MY GLOVES HERE.
AND I LIKE THAT THING FILLING UP FOR ME.
- THANK YOU, I KNOW. - OH, THAT'S A GOOD ONE.
OKAY. WE ARE GOING TO CLEAN.
AND AGAIN IT'S THE SCRUBBING MOTION SO THAT YOU GET GOOD FRICTION.
AND THEN YOU LET IT DRY.
AND SO THAT GIVES ME PLENTY OF TIME TO OPEN MY PACKAGES
AND GET LITTLE SELF ORGANIZED HERE.
MY TAPE IS, KIND OF, NOT CLOSE ENOUGH, BUT I'M HAPPY NOW.
REMEMBER, YOU'RE IN CONTROL OF YOURSELF.
ALRIGHT. I'M NOT COMFORTABLE DOWN HERE.
BEVEL UP. WHEN YOU GRAB THE HAND,
I GRAB LIKE THIS AND I STRETCH TOWARDS ME.
AND THEN I LIKE TO GO RIGHT ON TO THE VEIN.
YOU CAN ACTUALLY GO ON FROM THE SIDE AND CATCH IT IF IT'S A ROLLING VEIN.
BUT I LIKE TO BE RIGHT ON TOP.
OKAY, WARN THEM, A LITTLE STICK. I AM GOING TO SET DOWN
AND I'M GOING TO GO DIRECTLY TO THE VEIN.
I FELT THE LITTLE POP. I'M GOING TO GO IN JUST A LITTLE BIT MORE.
I KNOW I AM STILL IN BECAUSE LOOK AT THE BLOOD STILL COMING BACK.
MY SHAKY LITTLE HANDS ARE GOING TO THREAD THAT OFF.
SEE THE BLOOD.
I'M THREADING STEADILY, BUT NOTICE I DIDN'T PUSH THAT IN.
TAKE THIS OFF. YOU'RE THREADING WHILE THE VEIN IS MOST FULL.
THIS IS WHERE I DON'T WANT TO HAVE A SPAZ AND SEND MY LITTLE CAP OFF.
NOW I'M GOING TO SET HER HAND HERE.
I AM GOING TO PUT PRESSURE RIGHT HERE, NOT CONTAMINATING MY SITE,
BUT SO THE BLOOD DOESN'T COME ALL BACK OUT.
I'M GOING TO PULL THIS OUT AND THROW IT UP HERE
AND THEN SECURE THIS ON HERE JUST LIKE THAT.
- AND THEN TWISTED ON.
TWISTED IT ON LIKE A SCREW TOP, IT'S GOT THREADS, LUER LOCK.
I STABILIZED THIS, I TWISTED SO THAT THIS PIECE,
LOOK AT HOW PERFECT IT IS THAT LITTLE CONNECTION PIECE.
IT'S NOT TWEAKED OR BENT IN ANY WAY.
ALRIGHT, IT'S NOT GOING TO JUST FALL OUT OF HER HAND,
BUT YOU DON'T WANT HER TO MOVE AROUND A LOT TILL YOU STABILIZE.
SO I'M GOING TO GET MY LITTLE CHEVRON.
THIS IS MAYBE THE HARDEST PART OF ALL IS HANDLING YOUR TAPE.
SO I'M GOING TO SLIDE IT UNDER EVER SO CAREFULLY
BECAUSE YOU DON'T WANT TO STICK YOURSELF AND PULL IT OUT.
CHEVRON.
THEN YOUR TRANSPARENT DRESSING.
NOTICE I'M JUST ON THE BLUE HUB.
GOES TO THE TOP OF THE BLUE HUB.
NOT ONTO THE BUFFALO CAP OR THE IV LOCK.
GET ALL YOUR EDGES DOWN SO IT'S NICE AND FLAT AND THEN PEEL OFF.
AND I PRESS DOWN ALL THE WAY SO ALL MY ENDS ARE ON NICE.
AND YOU WOULD PUT ALL YOUR INFORMATION ON HERE, THE DATE,
NUMBER 22, TIME, INITIALS.
AND THEN THE LABEL
DOES NOT GO RIGHT HERE, RIGHT?
IT'S GOING TO GO OFF TO THE SIDE SO THAT THE DRESSING IS LABELED.
NOT ON HER SKIN, NOT ON THE TUBING BUT THERE.
THIS IS AN IV LOCK AND IT WON'T STAY --
IT WILL CLOT OFF, IF I DON'T FLUSH IT IMMEDIATELY
WITH SALINE TO GET THE BLOOD OUT OF THERE.
AND SO YOU WILL READ ABOUT THAT AND THAT'S WHAT KEEPS THE LINE PATENT.
SO SALINE, FOR IT TO MAINTAIN THE LOCK AS PATENT
AND THEN IT WILL STAY THAT WAY FOR A GOOD 8 TO 12 HOURS
TILL YOU DO A MEDICATION.
UH-HUH. JUST A SYRINGE. AND WE WILL DO THAT LIKE IN A COUPLE OF WEEKS
BUT THAT'S WHAT IT LOOKS LIKE.
- TA-DA. THAT WAS BEAUTIFUL. - DO YOU KNOW WHAT?
- DID IT HURT? - THAT WAS ONE OF THE MOST PAINLESS IVS I'VE EVER HAD.
- YAY! - I JUST WANTED YOU TO KNOW.
WE NEED TO DC SO LOOK HOW TO DC.
OKAY, TO DC, THIS IS A GOOD VEIN.
AND IF IT IS A GOOD VEIN THAT MEANS IT'S GOING TO BLEED WHERE I STUCK IT.
SO I WANT TO BE VERY CAREFUL
WHEN I PEEL TO KEEP GOOD PRESSURE.
AND I'M GOING TO TELL KELLY, THIS CAN CAUSE A BRUISE.
SO I WANT YOU TO PUT GOOD PRESSURE HERE
AFTER I PULL IT OUT FOR A GOOD THREE TO FIVE MINUTES.
SO YOU WILL HAVE THIS BIG OLD BRUISE ON YOUR HAND AND I'LL FEEL SO BAD.
- THAT'S OK, I'VE HAD IT BEFORE.
- I DON'T CARE. I DON'T WANT ANY MARKINGS FROM ME.
OKAY.
ALRIGHT. SO I AM GOING TO GET THIS ON HERE
AND I'M GOING TO BE THE ONE TO HOLD IT ON MYSELF.
I AM GOING TO PUT A FIRM, FIRM --
SHE CAN TELL IT'S FIRM, FIRM PRESSURE.
I AM GOING TO SLIDE THIS OUT, IT ALMOST ALWAYS BLEEDS A LITTLE,
DAB, DAB AND HOLD, HOLD.
- I'M JUST GOING TO REALLY HOLD --
- NO, I'LL HOLD IT A MINUTE. I DON'T WANT IT TO --
- DON'T WANT IT TO BRUISE. - I GAVE ONE A COUPLE OF YEARS AGO.
THAT POOR STUDENT COMES BACK AND SAYS, "LOOK AT MY HAND."
WE DIDN'T HOLD LONG ENOUGH.
- WHEN I HAD SURGERY, MY WHOLE HAND, BUT SHE BLEW THAT VEIN.
- YEAH. AND IF YOU BLOW THEM, IF YOU POKE THROUGH ON THEY GO POOF.
- IT WAS JUST THE WHOLE HAND. - THE WHOLE THING, IT WILL BLEED.
AND YOU GOT TO GET PRESSURE ON THAT THING STRAIGHTAWAY. SO ALRIGHT.
- SO IT DOESN'T HURT THEM WHEN YOU ARE PRESSING DOWN?
- THERE'S JUST NO ABSOLUTE ANSWER TO THAT.
PAIN IS, WHATEVER THE PERSON SAYS IT IS.
- I FELT IT WHEN SHE TOOK IT OUT.
WHEN SHE WAS PRESSING AND AS SHE PULLS OUT,
THAT, I FELT IT COMING OUT BUT IT WASN'T LIKE -- YOU FEEL IT.
- IT'S A SENSATION, BUT NOT PAIN LIKE -- SCREAM OR...
- NO. I THINK I, KIND OF, HAVE A HIGHER TOLERANCE FOR PAIN.
- I AM GOING TO LET YOU TAKE OVER NOW. - OKAY.
IT'S HER BLOOD AND IT'S HER HAND SO I AM GOING TO LET HER TAKE OVER
SO THAT I CAN PUT A PIECE OF TAPE ON THIS.
AND YOU CAN KEEP PRESSURE ON THERE FOR A COUPLE MORE MINUTES.
OKAY, THAT ALLOWS ME TO CLEAN UP MY AREA.
SHE CAN SIT THERE AND HOLD FOR A WHILE. HOLD, HOLD, HOLD. - OKAY.
- THE THING GOES IN THE TRASH AND WE ARE DONE AND GOOD TO GO.