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.

- 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.