SO WE'RE GOING TO GIVE SHOTS AND WE'RE GOING TO GIVE SUBCUTANEOUS INJECTIONS,
SO WE'RE NOT GIVING THE DEEP INNER MUSCULAR.
YOU'LL DO THOSE NEXT SEMESTER.
BUT YOU DO HAVE A LOT OF OPPORTUNITIES IN THE NURSING HOMES
TO GIVE INSULIN AND HEPARIN.
THEY WANTED YOU TO BE ABLE TO DO THAT WHILE YOU CAN
SO WE'RE GOING TO GET THAT TAKEN CARE OF.
WHAT WE'RE GOING TO DO IS GIVE TWO SHOTS.
WE HAVE A MAR, KIND OF HARD TO SEE, BUT YOU HAVE TWO SHOTS ORDERED FOR YOUR CLIENT,
AND I WANT YOU TO BE THINKING OF THEM
AS TWO SEPARATE TIME FRAMES, TWO SEPARATE SHOTS.
BECAUSE I WANT YOU TO GO THROUGH THE WHOLE ROUTINE OF GIVING ONE SHOT,
WALK AWAY FROM IT, DROP ANOTHER SHOT, GO AND GIVE ANOTHER SHOT.
JUST SO THAT YOU CAN, KIND OF, GET THROUGH THE STEPS THAT IT ENTAILS TO GIVE IT.
SO WE HAVE TWO SHOTS TO GIVE. WE HAVE INSULIN THAT WE'RE GOING TO GIVE SUBCUTANEOUS
AND WE HAVE HEPARIN THAT WE'RE GOING TO GIVE.
I'M GOING TO GO AHEAD AND START WITH THE HEPARIN,
JUST BECAUSE IT'S A SINGLE MEDICATION
AND THE HEP.. THE INSULIN IS MIXING OF TWO MEDICATIONS, SO WE'LL BUILD UP TO THAT.
ALRIGHT, WE TOOK OUR DOCTOR'S ORDER. WE HAVE OUR TWO SHOTS.
LET'S PRETEND IT'S 5 O'CLOCK IN THE EVENING AND AND WE'RE GOING TO GIVE OUR HEPARIN.
TYPICALLY, HEPARIN IS GIVEN IN THE EVENING
BECAUSE THEY NEED TO DRAW LAB AND CHECK CLOTTING TIMES IN THE MORNING.
SO WE GIVE IT AT FIVE AND THEY DROP LABS AT 8 IN THE MORNING
AND THEY GET A GOOD INDICATOR OF BLEEDING TIMES.
THERE'S TWO PARTICULAR TESTS THAT WE PUT INTO ACTION WHEN WE CHECK BLEEDING TIMES.
AND YOU NEED TO KNOW WHAT THESE ARE.
WHEN YOUR CLIENT IS ON HEPARIN, THEY'RE GOING TO CHECK HIS PTT OR APT.
HIS PARTIAL PROTHROMBIN TIME
OR HIS ACTIVATED PARTIAL PROTHROMBIN TIME.
AND THE IDEA IS THAT WE'RE GIVING ENOUGH BLOOD THINNER
THAT THE PATIENT THEN BECOMES..
HAS THINNER BLOOD, WHICH IS ONE AND HALF TO TWO AND A HALF TIMES
WHAT NORMAL BLOOD WOULD CLOT AT.
SO IT'S A LONGER CLOTTING TIME, THE BLOOD'S THINNER.
SO WHAT THEY SAY IS IT'S ONE AND HALF TO TWO AND HALF TIMES THE CONTROL.
THE CONTROL BEING WHAT NORMAL CLOTTING IS AND THEN...THINNER.
USUALLY, THE CONTROL IS ABOUT 30 TO 40 SECONDS,
MOST OF US CLOT, PUT A LITTLE PRESSURE ON THERE, 30 TO 40 SECONDS.
BUT WHAT THEY WANT IS TO HAVE AN EXTENDED CLOTTING TIME
OF 45 TO 90 SECONDS SO THAT THE BLOOD IS THINNER.
THAT WOULD BE KIND OF.. HIGHLIGHT YOUR THINKING TO GO,
"OH, BLOOD THINNERS WOULDN'T BE GOOD IF THEY'RE GOING TO SURGERY."
RIGHT? SO YOU WANT TO BE CAREFUL TO KNOW
WHAT KIND OF BLOOD THINNERS PEOPLE ARE ON.
HEPARIN IS SUBCUTANEOUS AND IT'S GIVEN OBVIOUSLY AS A SHOT,
BUT ANY TIME WE START SOMEONE ON A BLOOD THINNER THAT'S AN INJECTIBLE,
WE'RE GOING TO GET QUICK ACTION.
WE ALWAYS SIMULTANEOUSLY PUT THEM ON AN ORAL ANTl-COAGULANT,
WHICH IS USUALLY COUMADIN OR IT'S GENERIC WARFARIN.
ARE YOU WITH ME HERE?
WHAT HAPPENS IS THE WARFARIN ACTS A LITTLE DIFFERENTLY
THAN THE HEPARIN ON A LITTLE DIFFERENT CELL.
YOU'LL GET MORE OF THIS IN YOUR WILL PATHO-CRITICAL CARE.
WHAT YOU NEED TO APPRECIATE IS THAT THERE'S A LAB VALUE
THAT CHECKS FOR THE CLOTTING TIME ASSOCIATED WITH THE COUMADIN OR THE WARFARIN.
AND THAT'S A PT TIME.
NOW HOW DO I KEEP THESE STRAIGHT?
WELL, A PT BOAT GOES TO WAR,
WARFARIN, THAT HELPS ME BECAUSE I GET MIXED UP.
BUT, YOU KNOW, YOU WALK AWAY FROM THIS, IN TWO OR THREE MONTHS AND YOU ARE GOING,
"PT, PTT. OH, WHAT IN THE HECK? WHICH ONE GOES WITH WHICH? I CAN'T REMEMBER."
SO PTT GOES WITH HEPARIN
AND THE PT, PT BOATS GOES TO WAR, GOES WITH WARFARIN.
THE OTHER THING WITH HEPARIN, ONE OF THE CUES,
AND I WILL SHOW YOU A FUNNY LITTLE PICTURE I HAVE.
BUT ON THE H THERE'S TWO STEMS. SO IT TAKES TWO, SO TWO T'S.
THAT MAY HELP YOU REMEMBER THAT YOU NEED TO TWO T'S.
BECAUSE THE NEW TEST IS NOW TO ELIMINATE THE PT AND DO AN INR.
AND SO I DON'T WANT TO CONFUSE YOU HORRIBLY ON THAT,
BUT THEY'RE DOING A NEW TEST AND IT'S...A RATIO.
I FORGET WHAT IT MEANS.
INTERNATIONAL SOMETHING RATIO.
AND IT'S THE RATIO OF CLOTTING TO NOT CLOTTING TIME.
SO YOU'RE GOING TO BE LOOKING AT INRS WITH YOUR COUMADINS.
BUT YOU REALLY NEED TO KEEP IN MIND
THAT YOU NEED BOTH LAB VALUES AND THE APTT
OR THE PTT IS WHAT YOU'RE CHECKING FOR WITH YOUR HEPARIN.
WE WANT TO KNOW THAT. SO I'VE GIVEN YOU ALL THAT INFORMATION.
NOW WHEN YOU GO AND MAKE YOUR MED CARDS, FIND IT YOURSELF.
OKAY. SO SEE WHERE THAT INFORMATION IS. WHERE DID I FIND THAT OUT?
DID I FIND IT IN NURSING IMPLICATIONS, LAB CONSIDERATIONS?
SO THAT YOUR EYE BEGINS TO PICK UP ON THE THINGS
THAT ARE REALLY CRITICAL TO THE ROUTINE MANAGEMENT OF MEDS. OKAY?
SO I'LL ASK YOU QUESTIONS RELATED TO THAT WHEN YOU COME TO GIVE YOUR SHOT.
OKAY, KEEPING ALL THAT IN MIND, I HAVE MY HEPARIN,
I KNOW LABS ARE GOING TO BE ORDERED AND SO FORTH.
SO NOW WHAT I WANT TO DO IS GATHER UP MY EQUIPMENT.
SO I GO TO MY MEDICATION DRAWER AND I WENT
AND I GOT OUT MY HEPARIN VIAL THAT PHARMACY SENT UP.
AND I NOTICED THAT I HAVE HEPARIN 20,000 UNITS PER MILLILITER.
HEPARIN COMES IN ALL KINDS OF DILUTIONS.
IT COMES IN 5,000 UNITS PER MIL, 10,000 UNITS PER MIL,
20,000 UNITS PER MIL, ALL SORTS OF THINGS.
WHAT YOU HAVE WILL BE 10,000 UNITS OR 20,000 UNITS,
I DON'T KNOW WHAT GOT THROWN INTO YOUR DRAWER.
WHAT YOU NEED TO DO IS FIGURE OUT THEN
HOW MANY CC WILL THAT BE? HOW MANY MILLILITERS TO GIVE THE CORRECT DOSE?
IN THE HOSPITALS, PHARMACY'S USUALLY NICE,
AND THEY PUT A LABEL ON IT, THEY TELL YOU.
THEY FIGURE IT OUT FOR YOU SO YOU DON'T HAVE TO FIGURE IT OUT.
BUT YOU ALWAYS WANT TO DOUBLE CHECK WITH YOUR HEPARINS TO BE SURE.
SO I CALCULATED, IF 20,000 UNITS EQUALS ONE MILILITER,
THEN 7,500 UNITS EQUALS X MILLILITERS.
GOT YOUR CALCULATORS?
OH, ALWAYS HAVE CALCULATORS.
IF YOU NEED CALCULATORS TO FIGURE OUT YOUR MATH FROM NOW ON,
PUT A CALCULATOR IN YOUR NURSING UNIFORM AND YOU JUST CARRY IT WITH YOU EVERYWHERE.
BECAUSE YOU NEVER KNOW WHEN YOU ARE GOING TO NEED TO USE IT.
AND I FIGURED IT OUT AND I KNOW AHEAD OF TIME.
I DON'T WANT TO SEE YOU DOING MATH. I DON'T WANT TO WATCH IT.
I WANT YOU TO COME PREPARED AND YOU HAVE IT WRITTEN DOWN ON YOUR MAR READY TO GO.
IT'S 0.38 MILLILITERS FOR YOUR DOSE
OR WHATEVER IT IS, DEPENDING ON WHAT YOUR DILUTION IS.
SO I CALCULATED OUT THE DOSE THAT I NEED.
I GOT MY HEPARIN. I ALSO KNOW THAT I NEED TO GET A SYRINGE.
WE NEED TO TALK ABOUT SYRINGES JUST A LITTLE BIT,
BECAUSE THAT'S PROBABLY THE HARDEST PART OF THIS WHOLE ACTIVITY,
IS, WHAT SYRINGE DO I GET?
WHEN YOU FIRST WALK INTO THE MED ROOM AND YOU ARE ON YOUR OWN,
THEY JUST HAVE BOXES AND BOXES AND DRAWERS AND BOXES
OF EVERY SIZE NEEDLE AND SYRINGE AVAILABLE
AND YOU GOT TO PICK ONE.
ALL RIGHT, LET ME HELP YOU HONE IN ON THIS, JUST A LITTLE BIT.
WHENEVER YOUR DOSE IS LESS THAN A MILLILITER,
YOU CAN USE A ONE MILLILITER SYRINGE.
THAT'S A GOOD PLACE TO START.
THE RULE OF THUMB IS WHENEVER YOUR DOSE IS BELOW 0.5 MILLILITERS
YOU HAVE TO USE A ONE CC SYRINGE BECAUSE IT'S THE MOST ACCURATE.
IT'S A DOSE THAT IS MARKED TO THE ONE HUNDREDTH VERSUS THE TEN.
ALRIGHT, THIS ONE'S PRE-PACKAGED.
AND THIS IS A SAFETY LOCK, ONE MILLILITER SYRINGE,
BUT IT ALSO HAS AN NEEDLE ATTACHED.
SO I KNOW MY DOSE IS WHAT?
0.38. SO IT'S LESS THAN THE 0.5 CRITERIA, RIGHT?
SO I'VE GOT MY ONE MILLILITER SYRINGE.
BUT I ALSO NEED TO KEEP IN MIND WHAT KIND OF NEEDLE
DO I WANT ATTACHED TO THIS SYRINGE OR DO I NEED TO ATTACH.
YOU CAN DO EITHER WAY. THEY CAN HAVE THE NEEDLE ON OR OFF,
AND YOU GET THE NEEDLE SEPARATELY.
THIS ONE HAS A PRE-ATTACHED SYRINGE TO IT, OR NEEDLE.
AND IT SAYS THAT IT'S A 25 GAUGE 5/8TH INCH NEEDLE.
WHAT DOES THAT MEAN?
TWO PIECES OF INFORMATION YOU GOT THERE. ONE IS THE GAUGE.
THE GAUGE IS THE WIDTH OF THE NEEDLE. IT'S THE THICKNESS OF THE NEEDLE.
THE HIGHER THE NUMBER THE SMALLER THE WIDTH.
IT'S BACKWARDS IN THINKING WHENEVER YOU'RE DEALING WITH GAUGES.
WHENEVER I GIVE A SUBCUTANEOUS INJECTION,
I DON'T USUALLY GO WITH ANYTHING LARGER THAN A 25 GAUGE.
USUALLY -- ESPECIALLY WHEN WE GO TO OUR INSULIN,
THEY GO 27, 28 AND 29. THIN, THIN LITTLE FINE THINGS.
BUT FOR YOUR AVERAGE SUBCUTANEOUS INJECTION,
WE'RE JUST GOING INTO THE FATTY LAYER OF THE BODY.
WE JUST NEED A 5/8THS INCH NEEDLE.
WE'RE GIVING A WATERY SOLUTION AND THE WATER WILL PASS THROUGH
PERFECTLY FINE WITH THAT THIN OF A NEEDLE.
THAT'S ANOTHER CONSIDERATION WE MAKE. HOW THICK OR HOW VISCOUS IS THE FLUID?
AND ITS NOT WATERY.
ALRIGHT, SO MY GAUGE IS 25
AND MY LENGTH IS 5/8THS INCH.
NOW HOW DID I KNOW THAT THAT WAS A GOOD LENGTH?
WELL, AGAIN I AM GOING INTO THE SUBCUTANEOUS LAYER
AND WHEN I STARTED NURSING, IT WAS JUST THE RULE.
YOU JUST DO 5/8THS INCH TO GO INTO SUBCUTANEOUS.
AND WE JUST MEMORIZED IT AND THAT'S ALL THERE WAS TO IT.
BUT NOW WHAT THEY'RE SAYING IS THAT WHEN YOU GIVE A SHOT,
YOU PINCH UP LIKE A ROLL OF FAT, SO YOU GRAB AND PINCH UP.
AND YOU WANT YOUR NEEDLE TO BE AT LEAST HALF OF THE ROLL.
SO SOME PEOPLE CAN HAVE A LITTLE LONGER NEEDLE
AND STILL BE IN THE FATTY LAYER.
BUT YOU'RE STILL GOING TO BE IN FATTY LAYER EVEN WITH THE 5/8THS INCH.
PEOPLE DON'T HAVE 5/8THS INCH WORTH OF SKIN.
WE'VE GOT TO PASS THROUGH SKIN AND GET TO FAT.
IF THEY'RE REALLY LEAN, THEN YOU MAY NEED TO GO TO A HALF INCH NEEDLE.
AND THAT WOULD BE REALLY THE ONLY EXCEPTION, WOULD BE LEAN PEOPLE.
BUT HEAVIER PEOPLE COULD STILL USE SHORT.
SO I'M HAPPY. I'VE GOT MY SYRINGE,
I'VE GOT MY NEEDLE. AND I'M GOOD TO GO.
LET'S TALK A LITTLE BIT ABOUT THE SYRINGE.
YOU HAVE A PEEL-BACK PACKAGE.
AND INSIDE THE PACKAGE EVERYTHING IS STERILE, UNLESS I TOUCH IT.
SO THAT'S NICE TO KNOW BECAUSE THEN I CAN USE THAT
TO SET MY CAP AND STUFF DOWN SO I DON'T CONTAMINATE.
ALRIGHT, LET'S TALK A LITTLE BIT ABOUT THE SYRINGE.
THE SYRINGE HERE HAS A LOT OF DIFFERENT PARTS.
THIS IS THE PLUNGER RIGHT HERE
AND YOU'RE GOING TO MEASURE YOUR DOSE BY THE BOTTOM OF THE PLUNGER.
THE BOTTOM OF THE BLACK, NOT THE TOP OF THE BLACK.
THEN YOU HAVE YOUR PHALANGES, I CALL THEM.
AND THAT'S THE PLACE I LIKE TO HOLD WHEN I'M PUSHING ON MY SYRINGE.
THIS IS THE BARREL OF THE SYRINGE
AND THIS IS WHAT HAS YOUR MARKINGS FOR THE DOSE AMOUNT.
OKAY, SO WHEN YOU'RE LOOKING AT IT, THE 0.1 IS 0.1 MILLILITERS
AND THEN THE LITTLE MARKS IN BETWEEN,
THERE'S 10 MARKS AND THAT'S YOUR 100.
SO IF I NEED 0.38, I'M GOING TO GO TO THE 0.3,
AND THEN UP 8, OF THE LITTLE MARKS.
THIS IS THE CAP OF MY NEEDLE
AND YOU OUGHT TO BE CAREFUL IN HANDLING THE SYRINGE
SO THAT YOU DON'T GET STUCK. THIS IS VERY IMPORTANT.
I THINK, ANYWAYS.
SO THIS IS HOW I WANT TO SEE YOU PULLING YOUR CAPS OFF.
SEE HOW MY HANDS ARE SEPARATE FROM EACH OTHER.
AND I GRAB ON TO THE CAP AND I GRAB ON TO THE PHALANGE
AND I PULL AWAY FROM ME LIKE THIS.
SO THE NEEDLES IS OUT HERE AND THE CAP'S OUT HERE.
AND THEN I JUST SET MY CAP IN THAT STERILE PACKAGING TO KEEP IT SAFE.
THIS IS WHAT I DON'T WANT TO SEE.
OKAY? BECAUSE WHAT HAPPENS WHEN YOU PULL THE NEEDLE OUT?
SLICE, YOU HAVE A SPAZ POKE.
SO YOU DON'T COME DOWN YOUR HAND.
SOME PEOPLE ARE STEADY AND MAYBE THEY'LL NEVER STICK THEMSELVES.
MAYBE?
YOU'RE JUST MUCH SAFER TO COME AWAY FROM YOURSELF AND PULL HARD, OKAY?
SO I HAVE MY NEEDLE.
WHAT YOU HAVE HERE IS THE HUB OF THE NEEDLE.
THEN YOU HAVE YOUR NEEDLE, WHICH IS THE 5/8THS INCH.
AND IT'S PROBABLY IMPOSSIBLE TO SEE FROM HERE,
BUT YOU HAVE A BEVEL OF THE NEEDLE AND THAT'S THE SLANT OF THE NEEDLE.
WE ALWAYS TALK ABOUT HAVING THE BEVEL A CERTAIN DIRECTION.
IF YOU GO IN AT A 45 DEGREE ANGLE YOU WANT THE BEVEL TO BE UP,
SO THAT THE POINT IS DOWN AND IT GOES IN SMOOTHLY.
BECAUSE IF THE BEVEL IS DOWN AND YOU GO IN,
YOU TEND TO DRAG DOWN AND THAT MAKES FOR A LITTLE MORE PAINFUL SHOT.
SO YOU WANT THE VERY TIP OF THE NEEDLE TO GO IN FIRST
AND THAT'S WHY WE SAY BEVEL UP.
WE'RE GOING TO GIVE OUR SHOT GOING AT A 90 DEGREE ANGLE,
SO IT REALLY DOESN'T MATTER WHERE THE BEVEL IS, RIGHT?
BECAUSE IT SHOULD GO STRAIGHT DOWN.
BUT THEY DID SOME RESEARCH ON HOW WE GIVE SHOTS
AND THEY FOUND THAT WHEN WE GIVE 90 DEGREE SHOTS, WE GIVE THEM AT 80..
..OKAY, OR 75, BECAUSE WE'RE NOT USUALLY SO STRAIGHT.
SO I STILL TRY TO GET MY BEVELS UP
IN CASE, I DO A LITTLE TWINK OF A LOW, YOU KNOW WHAT I MEAN?
SO BEVEL'S UP PRIMARILY.
ALRIGHT.
I'M GOING TO GO AHEAD AND RECAP.
THE OTHER RULE FOR INJECTIONS,
YOU CAN RECAP STERILE, YOU CANNOT RECAP CONTAMINATED.
RIGHT? BECAUSE IF I STICK MYSELF WITH A STERILE NEEDLE, IT JUST HURTS.
BUT IF I STICK MYSELF WITH A CONTAMINATED NEEDLE,
OH, MAN. YOU GOT A LOT OF STUFF TO DO FOR BOTH YOURS AND THEIR SAFETY AND SO FORTH.
ALRIGHT, WHEN I GO TO RECAP..
..I HAVE SHAKY HANDS. BECAUSE I JUST DO.
AND MOST OF YOU DO TOO AND IT JUST MAKES ME FEEL SO GOOD.
BECAUSE ALL OF MY NURSING LIFE, I THOUGHT I WAS THE ONLY PERSON TH-A-T SHO-O.
- AND I'M NOT. - OK.
SO, I PUT MY LITTLE SHAKY HANDS DOWN ON THE TABLE AND STEADY THEM UP.
AND IF YOU ARE REALLY JUST HAVING A TIME OF IT,
GET YOURSELVES STEADY AND GET THIS IN HERE,
AND THEN PRESS WITH THE PHALANGE.
OKAY, NOW I NEED TO SHOW YOU ONE OTHER THING.
AND THAT IS, THIS IS THE SAFETY LOCK SYRINGE.
I'VE TALKED TO YOU ABOUT THE BARREL,
BUT WE ALSO HAVE THIS SHIELD THAT SLIDES.
THAT'S WHY I HANDLE IT ALL THE TIME BY THE PHALANGE.
AND YOU GOT TO GET A REALLY GOOD VISUAL UNDERSTANDING OF THESE PHALANGES,
AND NOT MIX IT UP WITH YOUR PLUNGER.
IF YOU DO MOST OF YOUR STUFF BY THE PHALANGE,
YOU DON'T INADVERTENTLY SLIP THIS OFF.
THE POINT OF THE SAFETY FEATURE IS THAT WHEN WE GO TO GIVE AN INJECTION..
..YOU PUT THE NEEDLE IN, YOU GIVE YOUR INJECTION
AND THEN SO THAT YOU'RE NEVER EXPOSED TO A DIRTY NEEDLE,
YOU HOLD ON TO THAT OUTER BARREL AND PULL UP,
SO THAT YOU'RE NEVER EXPOSED
AND GET STUCK BY A DIRTY NEEDLE.
THEN THIS LOCKS INTO PLACE.
DO I HAVE ANY EXTRAS AROUND HERE?
DON'T KNOW WHAT I DID WITH MY EXTRAS.
SO, VOILA! STERILE AGAIN.
OKAY. THAT'S THE SYRINGE.
OKAY, KNOWING ALL OF THAT, I HAVE MY SYRINGE READY,
I'VE GOT MY STUFF PICKED. I'M STILL GATHERING UP SUPPLIES.
SO THERE IS A COUPLE OF OTHER THINGS YOU NEED TO HAVE. ALCOHOL SWABS.
ALL GOOD NURSES HAVE 20 ALCOHOL SWABS IN THEIR POCKETS.
ALL THE TIME. AND AT LEAST FIVE BAND AIDS, RIGHT?
SO GRAB A BUNCH WHEN YOU COME ON, STUFF THEM IN YOUR POCKET.
GRAB THREE OR FOUR BAND AIDS, STUFF THEM IN YOUR POCKET, YOU NEED THEM.
I'LL TELL YOU MORE SUPPLIES YOU NEED. YOU'RE GOING TO FEEL LIKE YOU NEED A UTILITY BELT.
YOU'LL SEE SOME NURSES THAT ARE CARRYING AROUND -- WEARING THESE LITTLE HIP PACKS ON.
AND MAN, BLESS THEM. YOU THEY WILL NEED ALL THAT STUFF.
THE OTHER THING YOU NEED IS A 2X2,
IT DOESN'T NECESSARILY HAVE TO BE STERILE. I HAVE A STERILE ONE TODAY. THIS IS FOR CONVENIENCE.
AND I HAVE A PIECE OF TAPE TO LABEL MY SYRINGE,
SO YOU NEED JUST A LITTLE PIECE OF PAPER TAPE
AND YOU CAN PUT A LABEL ON THAT SAYS WHAT WE'VE GOT IN OUR SYRINGE.
ALRIGHT, I HAVE ALL MY SUPPLIES.
I'VE WASHED MY HANDS AND NOW WHAT I WANT TO DO IS DRAW UP MY DOSE.
I'VE ALREADY CALCULATED IT. I ALREADY KNOW ITS HEPARIN.
AND I'VE ALREADY DONE ONE OTHER DOUBLE CHECK.
I'VE CHECKED THE EXPIRATION DATE OF THE VIAL.
VIALS HAVE A DATE ON THEM THAT YOU MUST CHECK
TO MAKE SURE THAT IT'S ACCEPTABLE.
ONCE I POP THE LID OFF OF THIS,
THEN IT IS CONSIDERED STERILE.
IF IT'S MORE -- IF IT'S A MULTI DOSE VIAL FOR 30 DAYS,
UNLESS THE MANUFACTURER SAYS DIFFERENTLY.
BUT THE RULE OF THUMB IS 30 DAYS, OKAY.
SO ONCE I POP THE LID OFF OF THIS,
THIS IS STERILE, UNLESS I GET IT CONTAMINATED.
ALRIGHT, SO AT THIS MOMENT I'M JUST GOING TO GO AHEAD AND WRITE ON HERE.
ONCE IT'S OPEN HOW WILL I KNOW 30 DAYS HAS PASSED, RIGHT?
SO I'M GOING TO WRITE ON HERE, 4/2/03, THE DATE,
THE TIME, 10:20, AND MY INITIALS DB.
SO WE KNOW AT THIS POINT
THIS IS ONLY GOOD NOW UNTIL MAY 2ND AT 8 O'CLOCK.
AND THEN IT GETS PITCHED NO MATTER HOW MUCH IS IN HERE, OKAY?
ALRIGHT, I AM GOING TO POP THE LITTLE CAP OFF. YOU JUST FLICK THEM OFF.
AND THEN WHAT YOU HAVE HERE IS A VIAL WITH A RUBBER STOPPER. OKAY, ITS STERILE AT THIS POINT
SO I CAN TAKE MY STERILE NEEDLE AND PUT IT INTO THIS VIAL AND NEVER THINK ABOUT IT AGAIN.
HOWEVER, IF I WERE TO SET IT AND LEAVE THE AREA
I DON'T KNOW WHAT'S HAPPENED TO IT.
ANY TIME IT LEAVES MY SIGHT, THEN IT IS NO LONGER STERILE.
BY THE SAME TOKEN, IF IT'S A MULTI DOSE VIAL
AND YOU'RE USING IT AND IT DOESN'T HAVE THAT PROTECTIVE CAP ON IT,
THEN YOU HAVE TO CLEAN THE VIAL WITH AN ALCOHOL SWAB PRIOR TO DRAWING UP.
OKAY, SO YOU WIPE OFF YOUR STOPPER TO GET IT CLEAN.
ALRIGHT, I NEED TO GET 0.38 MILLILITERS OUT OF THIS VIAL.
TO DO THAT, WHAT I NEED TO DO IS DRAW UP 0.38 CC OF AIR INTO MY SYRINGE
SO THAT I CAN PUT IT INTO THE VIAL.
THE REASON IS I COULD PROBABLY GET ONE OR TWO DOSES OUT OF HERE WITHOUT PUTTING AIR IN HERE.
BUT IF I KEEP TAKING FLUID OUT WITHOUT REPLACING
THAT VOLUME IN THIS CONTAINER, IT STARTS TO BE LIKE A VACUUM.
AND IT STARTS SUCKING MY PLUNGER BACK IN AND I CAN'T GET MY FLUID OUT.
SO YOU HAVE TO REPLACE THE VOLUME.
NOW THIS DOESN'T HAVE TO BE AN EXACT SCIENCE FOR AIR, OKAY?
I SEE SOMETIMES PEOPLE GOING, "OKAY, I GOT TO GET MY EXACT 0.38."
LIKE IT'S MAGIC. IT DOESN'T REALLY MATTER THAT MUCH.
IF YOU PUT 0.35 OR YOU PUT 0.4, WHO REALLY CARES?
WHAT DOES MATTER IS IF YOU PUT 2 CC AND ONLY TAKE OUT 0.2,
AND EVERYONE KEEPS PUTTING IN 2 CC OF AIR.
THEN THE PRESSURE GETS SO GREAT IN HERE
THAT WHEN YOU STICK A NEEDLE IT SPITS THE MEDICINE OUT.
BECAUSE THERE IS TOO MUCH PRESSURE IN THE VIAL.
SO YOU WANT TO BE SORT OF CLOSE. IT DOESN'T HAVE TO BE LIKE PERFECT TO PUT AIR IN.
ALRIGHT, SO I'VE CLEANED MY VIAL.
I'M TAKING MY LITTLE CAP OFF.
I DON'T LIKE TO SET MY CAPS ON THE TRAYS. THESE TRAYS ARE NASTY.
WHO KNOWS WHERE THEY'VE BEEN. SO I USUALLY LIKE TO SET THEM IN MY LITTLE STERILE CONTAINER.
I NEVER SET MY CAPS DOWN LIKE THIS. BECAUSE YOU WANT THEM TO BE STERILE.
SO EITHER TO THE SIDE OR IN YOUR LITTLE STERILE WRAPPER.
NOW, AGAIN SHAKY HANDS AND THE GOAL HERE IS
THAT I HAVE GOT TO GET INTO THE MIDDLE OF THIS STOPPER.
SO TWO WAYS TO DO IT. YOU CAN HOLD IT UP LIKE THIS AND STICK
OR YOU CAN COME DOWN HERE AND STEADY YOUR LITTLE HANDS DOWN
AND PUT YOUR NEEDLE IN TO THE STOPPER.
PUSH THE AIR IN AND NOW YOU HAVE TO TURN IT UPSIDE DOWN
SO THAT YOU CAN GET THE FLUID OUT.
SO YOU WANT TO MAKE SURE YOUR NEEDLE IS IN FLUID
AND THEN YOU JUST PULL BACK.
NOW, I DON'T KNOW IF YOU COULD SEE VERY WELL,
BUT THERE IS.. THE HUB OF THE NEEDLE HAS AIR IN IT.
AND SO YOU'RE ALWAYS GOING TO GET A DAB OF AIR
WHEN YOU FIRST PULL FLUID INTO THE SYRINGE.
SO WHAT I ALWAYS DO IS, I JUST DRAW UP A WHOLE BUNCH,
MORE THAN WHAT I NEED.
THEN I, KIND OF, TAP IT A COUPLE OF TIMES,
AND GET THE BUBBLES LOOSE FROM HERE.
KIND OF STABILIZE THIS AGAINST YOUR PALM
AND TAP AND GET THOSE BUBBLES OFF.
AND THEN HOLDING IT STRAIGHT UP,
YOU'RE GOING SQUIRT THE AIR AND THE SOLUTION BACK INTO THE VIAL.
AIR GOES TO THE TOP, IT'S LIGHTEST
AND FLUID IS HEAVIEST IT COMES TO THE BOTTOM.
AND SO THE ONLY WAY THAT YOU'RE GOING TO BE ABLE TO GET THE AIR OUT OF THE SYRINGE
IS GET THAT AIR BUBBLE CENTERED TOWARDS THE MIDDLE
AND GO STRAIGHT UP AND SQUIRT IT BACK INTO THE VIAL.
I.. YOU CAN GO BACK AND FORTH A GILLION TIMES UNTIL YOU GET IT SET RIGHT.
KEEP YOUR NEEDLE AND YOUR VIAL CONNECTED.
DON'T DRAW UP THE WHOLE BUNCH, TAKE YOUR NEEDLE OUT AND THEN SQUIRT MEDICATION INTO THE SINK.
ITS NOT LIKE LIFE OR DEATH OR REALLY USUALLY WRONG.
IT'S JUST THAT YOU WASTE A LOT OF MEDICINE.
AND THEN IF YOU NEED TO GET MORE YOU GOT TO STICK THE VIAL AGAIN AND OH.
IT JUST GETS, KIND OF, OUT OF CONTROL.
DO ALL OF YOUR ADJUSTING CONNECTED TO THE VIAL.
ALRIGHT, SO I'M LOOKING HERE AND I'M GOING TO SET IT AT MY 0.38
AND EACH LITTLE --
AND EACH LITTLE MARK IS 100 ON HERE.
I AM GOING TO DOUBLE CHECK THIS 0.38.
AND THEN WE HAVE THIS RULE IN NURSING.
THE TWO MOST COMMON MED ERRORS IN NURSING, THE RESEARCH STILL BEARS THIS OUT,
I JUST READ AN ARTICLE LAST MONTH ON THIS,
THAT HEPARIN AND INSULIN ARE STILL THE TWO MOST COMMON MED ERRORS THAT NURSES MAKE,
WHICH IS AMAZING TO ME. I DON'T SEE HOW THIS COULD BE
BECAUSE WE HAVE THIS RULE THAT WHEN YOU DRAW UP HEPARIN AND INSULIN,
YOU HAVE TO HAVE ANOTHER NURSE VERIFY IT.
IT'S AN UNWRITTEN RULE, BUT THAT'S THE DEAL.
SO, I'D COME OVER HERE TO JENNIFER AND SAY,
"JENNIFER, I'M SUPPOSED TO GIVE 0.38 OF HEPARIN, 75 UNITS
THAT'S WHAT I FIGURED WITH MY 20,000 UNITS."
I SHOW HER THE 20,000 UNITS
AND I SHOW HER THE SYRINGE, WHILE IT'S ALL CONNECTED.
OTHERWISE, SHE DOESN'T KNOW WHERE I TOOK THIS MEDICINE FROM,
IF SHE DOESN'T SEE THE VIAL.
AND SO SHE BLESSES IT AND THEN I GO ON.
AND WE DO THIS FOREVER.
I MEAN, RN TO RN.
STUDENTS, GET EVERYTHING BLESSED, YOU KNOW, BEFORE YOU GO,
BUT RN TO RN, INSULIN AND HEPARIN MUST BE VERIFIED BY ANOTHER NURSE.
NOT A NURSE AID, A NURSE FOR THIS.
OKAY, ONCE IT'S BEEN CHECKED, I AM GOING TO DOUBLE CHECK AGAIN
AND MAKE SURE I DIDN'T HIT MY PLUNGER INADVERTENTLY.
OH, AND SOMETIMES WE WRECK THESE DOSES.
SEE THAT LITTLE SQUIRT, NOW.
OKAY, THIS IS STILL STERILE SO I CAN RECAP.
I STEADY MY HANDS DOWN AND TOUCH ON THERE
AND THEN HOLD IT WITH THE PHALANGES.
OTHERWISE, YOU TEND TO SHIFT THAT BARREL OFF TILL IT LOCKS.
AND THEN CLEAN UP YOUR MESS.
I AM SO PARTICULAR ABOUT MESSES.
THERE'S JUST NO REASON FOR NURSES TO LEAVE ALL THE SLOP THEY LEAVE AROUND.
PICK UP YOUR PAPERS.
ALRIGHT, I KNOW THIS IS HEPARIN BECAUSE I JUST DREW IT UP,
BUT I WANT TO MAKE SURE THAT IT'S LABELLED CORRECTLY
SO THAT I'M VERIFYING IT IN THE ROOM.
SO I GO AHEAD AND I PUT A PIECE OF TAPE.. ON MY CAP.
AND IT JUST SAYS HEPARIN 75,000 UNITS ON HERE.
I DON'T WRITE THE 0.38, I CAN SEE THE 0.38.
AND I HAVE IT WRITTEN ON MY MAR, WHICH I'M GOING TO TAKE IN THE ROOM.
SO IT JUST VERIFIES WHAT I'VE GOT IN HERE..
..FOR MY DOSE.
ALRIGHT, I DID WANT TO MENTION ONE THING BEFORE I FORGET ABOUT IT.
ONE OF THE THINGS YOU'LL READ ABOUT,
I THINK IT'S IN YOUR TEXT IS ABOUT SCOOPING YOUR CAP
IN CASE YOU HAVE TO RECAP, BECAUSE THEY DON'T WANT US TO RECAP ANYTHING.
BUT HERE'S THE DEAL, WHEN YOU SCOOP,
THE POINT IS THAT YOU'RE DOING IT SO THAT YOU NEVER STICK YOURSELF.
BUT IF YOUR NEEDLE IS STERILE AND YOU SCOOP,
YOU COULD INADVERTENTLY HIT THE TABLE AND CONTAMINATE YOUR NEEDLE.
AND SO WE DON'T WANT YOU TO SCOOP STERILE.
I ONLY WANT YOU TO SCOOP CONTAMINATED,
IF YOU HAD TO RECAP FOR SOME REASON.
ALRIGHT, SO, WE'RE NOT SCOOPING AND I'M GOING TO RECAP.
ALRIGHT, I HAVE MY LITTLE TRAY. I HAVE MY HEPARIN. I'M STILL GATHERING UP MY EQUIPMENT.
I'M DOUBLE CHECKING 0.38. I HAVE GOT A COUPLE OF ALCOHOL SWABS. I HAVE GOT MY 2X2.
OKAY.
I THINK I'M READY TO GO.
SO I HAVE MY MAR. I HAVE ME. I'VE WASHED MY HANDS.
I AM PROVIDING SOME PRIVACY.
I'M GOING TO GO IN THE ROOM AND I'M GOING TO GREET MY CLIENT.
TELL ME YOUR NAME.
OKAY, I HAVE SALLY SMITH HERE. DR. FEELGOOD. 777889999.
OH, SALLY, I SEE YOU'RE ALLERGIC TO PENICILLIN,
BUT THAT SHOULDN'T BE A PROBLEM
BECAUSE HEPARIN ISN'T A PROBLEM WITH PENICILLIN.
SO, I'VE CHECKED MY ALLERGIES.
I THINK I HAVE JUST ABOUT DONE EVERYTHING I NEED TO.
ALRIGHT, I NEED TO GIVE YOU YOUR HEPARIN INJECTION AND
YOU KNOW, HEPARIN GOES IN YOUR STOMACH.
SO, I'M GOING TO RAISE THE BED HERE A LITTLE BIT AND GIVE YOU YOUR INJECTION.
AND IT IS WHERE HEPARIN GOES. HEPARIN GOES IN THE ABDOMINAL PATH.
SO WE'RE GOING TO GIVE ALL OUR INJECTIONS THIS WEEK IN THE ABDOMEN,
JUST SO I CAN DESENSITIZE YOU TO ABDOMEN SHOTS.
DOESN'T THAT SEEM WIRED? TO GIVE A SHOT IN THE ABDOMEN,
BUT IT ACTUALLY IS THE MOST STABLE AREA FOR THE BODY AS FAR AS ABSORPTION GOES.
IF YOU GIVE SHOTS IN THE ARMS AND LEGS, DEPENDING ON THEIR EXERCISE AND ACTIVITY LEVEL,
IT AFFECTS THE RATE OF ABSORPTION.
BUT IF YOU'RE GOING TO BE ACTIVE,
IT'S GOING TO ABSORB THE SAME FROM THE STOMACH.
THE STOMACH IS THE FASTEST ACTING OR FASTEST ABSORBING PART OF THE BODY,
BUT AT LEAST IT'S THE MOST CONSISTENTLY ABSORBING PART OF THE BODY,
WHERE THESE CAN CHANGE.
SO, WHAT WE WANT TO DO, IS WE WANT TO COME ABOVE THE ILIAC CRESS.
YOU'RE NOT GOING TO GIVE THE SHOT DOWN HERE IN THE PUBIS AREA.
SO, WE'RE GOING TO COME ABOVE THE UMBILI -- THE ILIAC CRESS,
AND WE'RE GOING TO GO WITHIN TWO INCHES OF THE UMBILICUS.
IT HAS TO BE IN SUBCUTANEOUS TISSUE. IT HAS TO BE IN FAT.
WE DON'T WANT TO BE IN THE UMBILICUS AREA
BECAUSE THERE'S NOT FAT AS IT CAVES IN HERE.
SO, WE'RE GOING TO GO TO THESE OUTER EDGES.
THE OTHER THING WE WANT TO KEEP IN MIND IS THAT WE WANT TO ROTATE IN THE ABDOMEN.
SO IF GIVE IT ON THE RIGHT SIDE, THEN THE NEXT ONE WE GIVE ON THE LEFT AND SO FORTH.
SO MOVE IT AROUND, SO YOU'RE NOT JUST, YOU KNOW,
KEEPING -- PUTTING THAT THING, THAT SHOT IN THE SAME PLACE.
WHAT ARE SOME OF THE SIDE-EFFECTS
YOU MIGHT EXPECT FROM HEPARIN BEING A BLOOD THINNER?
- BLEEDING. - BLEEDING. BRUISING. OKAY.
SO, WHAT WE WANT TO DO IS BE VERY CAREFUL
WHEN WE'RE LOOKING AT THE ABDOMEN, TO NOT KEEP PUTTING IT INTO BRUISED PLACES
AND BY THE SAME TOKEN NOT TO BE CAUSING BRUISES.
THAT'S ANOTHER REASON FOR GOING WITH THE SHORTER AND THE THINNER NEEDLES,
BECAUSE BIGGER NEEDLES ARE GOING TO CAUSE MORE TRAUMA TO THE TISSUE AND CAUSE BRUISING.
AND WE'RE WANTING TO AVOID AS MUCH TRAUMA AND NEEDLE STICKS AS POSSIBLE.
SO, CERTAINLY WE'RE GOING TO.. AFTER HAVING CHECKED OUR LABS
TO MAKE SURE THAT THEIR BLEEDING TIME...IS GREATER THAN THE CONTROL?
BECAUSE I'D CALL THE PHYSICIAN IF WE'RE OUT OF THAT CONTROL PARAMETERS.
WE'RE GOING TO BE LOOKING FOR SIGNS AND SYMPTOMS OF BLEEDING.
SO, LOOK THROUGH WHEN YOU'RE LOOKING AT YOUR DRUGS,
THINGS RELATING TO BLEEDING PRECAUTIONS.
AND WE'LL GO OVER THOSE HERE IN A MINUTE.
ALRIGHT, BEFORE I PLUNGE ALONG.. OH, I ALREADY DID THAT. I FORGOT.
OKAY, I DID CHECK YOU NAME BAND, DIDN'T I, SALLY? YES.
OKAY, I THOUGHT SO.
ALRIGHT, I'M GOING TO GET SOME GLOVES.
AND I WANT TO CHECK ON MY MAR TO SEE WHERE THE LAST SHOT WAS GIVEN
OR I CAN JUST ASK THE CLIENT, "DO YOU REMEMBER WHERE THE LAST SHOT WAS."
AND WHEN I COME TO THE STOMACH,
I CAN LOOK HERE AND SEE HOW THE STOMACH'S LOOKING.
AND I WANT TO AVOID PLACES. I WANT TO AVOID SCARS.
IT'S NOT GOING TO ABSORB WELL IN SCAR TISSUE,
I WANT TO AVOID BRUISES, RASHES, HAIRY AREAS
AND SO FORTH ON THE STOMACH,
SO THAT I CAN PUT IT IN A NICE PLACE.
ALRIGHT, ONCE I'VE IDENTIFIED THE PLACE THAT I'M GOING TO PUT THIS IN,
I'M WANT TO COME OVER HERE AND I JUST WANT TO CLEAN IT
EVER SO GENTLY IN A CIRCULAR MOTION WITH ALCOHOL.
DON'T SCRUB UP THAT STOMACH HARD
BECAUSE IF THEY'RE ALREADY BRUISING EASILY AND IF YOU GO..
YOU'RE GOING TO CAUSE BRUISES.
I'VE GONE INTO PUT SHOTS INTO PEOPLES STOMACHS
AND THEY HAVE THE BIGGEST OR UGLIEST BRUISES I'VE EVER SEEN ON THOSE POOR STOMACHS
AND I THOUGHT, "DID I DO THAT?"
SO, ONE OF MY MISSIONS THROUGHOUT MY CAREER WAS,
I'D GIVE A SHOT ONE DAY AND I'D GO BACK, WHETHER THAT WAS MY PATIENT OR NOT
AND LOOK AND SEE HOW THAT STOMACH LOOKED THE NEXT DAY, TO SEE IF MY TECHNIQUE
WAS CAUSING THOSE BRUISES TO HAPPEN. I'LL HAVE YOU KNOW, IT'S NOT.
WE JUST NEED TO BE MORE GENTLE WITH THEIR SKIN AND NOT BE TRAUMATIZING IT.
ALRIGHT, I'M GOING TO PUT THIS INJECTION IN, AND I'M GOING TO GIVE MY INJECTION,
BUT I'M NOT GOING TO MASSAGE OR WIPE OR ANY THING AFTERWARDS.
IF THEY OOZE A LITTLE, I'M JUST GOING TO DAB IT WITH THIS 2X2.
SO, I HAVE MY 2X2 READY AND I'M GOOD HERE.
ALRIGHT, I'M GOING TO TAKE MY CAP OFF.
THIS IS MY THIRD, FIFTH, 8H CHECK, WHATEVER, OF HEPARIN AND I'M GOOD.
I'M GOING TO TAKE ONE MORE LOOK AND MAKE SURE
THERE'S NO GROSS AIR BUBBLES OR THAT I'VE HIT THE PLUNGER OR ANYTHING BEFORE I GIVE THE SHOT.
ALRIGHT, HOW DO YOU GIVE A SHOT?
YOU NEED TO HOLD THIS THING LIKE A PENCIL OR LIKE A DART TO GO IN.
AND IT'S MOSTLY WRIST ACTION TO JUST GET IT IN.
ALRIGHT. NOW, IT'S A LITTLE SHORT NEEDLE AND IT'S GOING TO GO IN SOFT TISSUE,
WE'RE NOT HAVING TO GO INTO HARD MUSCLE. IT'S JUST GOING INTO THE FAT.
SO, WE CAN BE PRETTY GENTLE WITH IT AND WE CAN BE SLOW OR FAST,
OR WHATEVER WE WANT TO DO TO GET IT IN. JUST GET IT IN.
ALRIGHT, I'M GOING TO TAKE THE SKIN AND I'M GOING TO VERY GENTLY
PINCH UP SOME SKIN AND I MEAN, EVER SO GENTLY.
I'VE SEEN NURSES, I'VE GONE IN TO GIVE MY SHOTS
AND I COULD SEE THEIR FINGER MARKS ON THEIR STOMACH.
THEY DIDN'T GET BRUISED FROM THE SHOT,
THEY GOT BRUISED FROM THE NURSE PINCHING UP SKIN.
EVER SO GENTLY, I'LL JUST USE TWO FINGERS.
I WANT MY BEVEL UP, MY GOAL IS TO GO IN AT 90 DEGREE ANGLE.
AND I'M JUST GOING TO DART A LITTLE. I'M A DARTER, I'M NOT A PUSHER.
OKAY, SO, I DART. THAT'S ALL THERE IS TO IT.
NOW, WE DON'T ASPIRATE ON INSULIN -- OR ON HEPARIN.
AND WE DO ASPIRATE ON OTHER SHOTS.
NOW, I WANT YOU TO NOTICE ONE OTHER THING I DO.
I HAVE SHAKY HANDS.
SO I ALWAYS STEADY IT, THE SYRINGE WITH MY OTHER HAND.
I RELEASE THE PINCH. I DON'T NEED IT ANY MORE AND THEN I HOLD.
WE DON'T ASPIRATE. WE PUT THE MEDICINE STRAIGHT IN SLOWLY.
AND THEN WE SIT THERE FOR 10 SECONDS,
SO THEN IT'LL ABSORB AND NOT TRACK UP THE NEEDLE.
SO, YOU HOLD IT IN YOUR 10 SECONDS.
THEN AFTER THE TEN SECONDS, PLUNGER.
NOW WHAT HAPPENS IF YOU PULL THE PLUNGER UP?
YOU JUST SUCK UP EVERYTHING YOU JUST TRIED TO AVOID
AND YOU TRAUMATIZE THAT SKIN.
SO YOU WANT TO BE SURE AND HOLD STEADY ONTO THIS OUTER BARREL
AND THEN PULL IT UP BY THE PHALANGE AND LOCK IT TILL IT CLICKS.
SO, ONCE IT'S SET LIKE THIS I CAN SET IT DOWN.
THERE'S NO RISK OF ANYONE GETTING EXPOSED TO BLOOD.
THEN IF I NEED TO, I TAKE MY 2X2
AND I JUST EVER SO GENTLY DAB, IF THERE'S ANY OOZE.
BEAUTIFUL. I DO NOT PUT BAND AIDS ON HEPARIN INJECTIONS
BECAUSE THEN RIPPING OFF THE BAND AID BRUISES THEM.
SO, I JUST DON'T DO IT.
SIDE RAILS UP, GLOVES OFF, BED BACK.
WASH OUR HANDS AND GET RID OF ALL OUR STUFF.
OKAY? ALL OF THIS GOES INTO THE TRASH.
AND THEN THIS GOES INTO A SHARPS CONTAINER.
WHEN YOU PUT YOU SYRINGES INTO A SHARPS CONTAINER,
THE NEEDLE NEEDS TO GO DOWN.
DON'T PUT A NEEDLE UP BECAUSE IF SOMEONE INADVERTENTLY STICKS OR FLIPS IT,
THEY CAN GET STUCK JUST GOING INTO THE SHARPS CONTAINER.
SO, THESE JUST GO IN AND SO FORTH.
IF YOU FORGOT TO DO YOUR LITTLE SAFETY LOCK THING,
AND YOU JUST PULLED IT OUT,
THEN JUST TAKE THAT NEEDLE AND PUT IT IN HERE.
BUT YOU CAN'T SET THAT BARE, BLOODY NEEDLE DOWN ON THE TRAY OR THE TABLE
BECAUSE THAT'S JUST PUTTING SOMEONE ELSE AT RISK
AND YOURSELF FOR GETTING STUCK WITH THAT NEEDLE.
ANOTHER THING I NEED YOU GUYS TO PAY REAL CAREFUL ATTENTION TO
IS NEEDLES DO NOT GO INTO THE TRASH.
REALLY.
WE FIND - EVERY SEMESTER WE DO THIS, AT LEAST 8 NEEDLES.
WE'VE BEEN KEEPING TRACK, IN THE TRASH.
IT MAKES ME SO MAD. BECAUSE, ONE, I'M GOING TO GET STUCK TAKING OUT THE TRASH.
AND LET ME TELL YOU THAT WON'T BE A PRETTY THING.
THE HOUSEKEEPERS GET STUCK.
NOW OURS, GRANTED, USUALLY DON'T HAVE BLOOD ON THEM,
WE DO GIVE EACH OTHER SHOTS SECOND SEMESTER,
BUT STILL, NO ONE WANTS TO GET STUCK.
THEY DO NOT GO. IT'S A VIOLATION OF OSHA STANDARDS,
HOSPITALS CAN GET FINED REALLY BIG FOR NEEDLES AND TRASH.
ABSOLUTELY DO NOT PUT NEEDLES IN THE TRASH. ABSOLUTELY.
ALRIGHT.
WHAT WOULD HAPPEN..
SECOND SEMESTER, WHEN WE DO OUR INTRAMUSCULAR INJECTIONS,
WE ALWAYS ASPIRATE TO MAKE SURE WE'RE NOT IN A BLOOD VESSEL.
BECAUSE YOU DON'T MAINLINE DRUGS.
THEY'RE INTENDED TO GO INTO MUSCLES AND SUBCUTANEOUS TISSUE FOR ABSORPTION.
SO I ALWAYS ASPIRATE. IT'S JUST A HABIT I'VE BEEN IN ALL MY LIFE.
SO I KNOW I'M NOT SUPPOSED WITH HEPARIN BECAUSE IT COULD TRAUMATIZE THE SKIN.
WHAT WOULD HAPPEN IF I INADVERTENTLY DID IT?
AND I JUST FLICKED THAT PLUNGER UP.
NOTHING. IT'S NOT THAT HUGE OF A DEAL ON THE SCHEME OF LIFE.
IT JUST CAN CAUSE A LITTLE TRAUMA AND IT CAN CAUSE SOME BRUISING.
SO YOU TRY NOT TO DO IT. THAT'S THE ONLY REASON.
THEY FOUND THAT WE JUST NEVER HIT BLOOD VESSELS
WHEN WE GO INTO THE SUBCUTANEOUS TISSUE.
SO, IT'S JUST NOT WORTH THE CHECK AND THE TRAUMA
AND THAT'S THE ONLY REASON WE DON'T DO IT. IT'S NOT WRONG TO DO IT.
SO, I'D RATHER HAVE THE HABIT OF CHECKING THAN NEVER CHECKING.
SO MY THUMB JUST AUTOMATICALLY FLICKS THAT PLUNGER UP
IF I'M NOT REALLY FOCUSED AND THINKING ABOUT IT.
ON THAT. ALRIGHT, NEEDLE STICKS.
WHAT HAPPENS IF YOU DO STICK YOURSELF?
FIRST, THINGS FIRST. WASH YOUR HANDS.
GIVE YOURSELF A GOOD BETADINE SCRUB AND WASH YOUR HANDS.
THEY USED TO TELL US THAT WE SHOULD MILK IT
AND TRY TO SQUEEZE THE BLOOD OUT.
THEY FOUND THAT DIDN'T MAKE ANY DIFFERENCE WHATSOEVER
SO THERE IS NO REASON TO MILK AND SQUEEZE AND ALL THE STUFF WE USED TO DO.
WASH YOUR HANDS REALLY GOOD, DO A TWO-THREE MINUTE SCRUB WITH BETADINE.
AND THEN YOU'RE GOING TO HAVE TO DO FOLLOW UP WITH YOUR HEALTH SERVICES,
WHATEVER THAT IS IN QUALITY ASSURANCE.
YOU NEED TO FILL OUT INCIDENT REPORT, THAT'S THE LAST THING I DO.
MY FIRST THING I DO IS GO GET MYSELF FOLLOWED UP WITH THE NURSE.
THEY'RE GOING TO WANT TO FOLLOW UP WITH THE CLIENT TO SEE
IF THE CLIENT HAS HIV OR HEPATITIS AND THEN THEY'RE GOING TO..
IF THEY CAN'T GET THE INFORMATION FROM THE CLIENT,
THEN THEY WILL FOLLOW UP WITH YOU AND THEY'LL DO FOLLOW UP BLOOD.
IF THEY DON'T KNOW ABOUT THE CLIENT, THEY DO HAVE MEDICATION
THAT THEY PUT YOU ON THAT DAY, JUST TO PREVENT HIV.
SO YOU WANT TO MAKE SURE AND TAKE CARE OF YOURSELF.
DON'T PIDDLE AROUND WITH IT.
AS FAR AS THE RULES GO FOR WORKMEN'S COMP,
YOU NEED TO REPORT WITHIN THREE DAYS OF ANY INJURY.
SO DON'T MESS AROUND WITH IT, SAY, "OH, I'M TOO BUSY. I'LL GET AROUND TO IT.
OH, I HURT MY BACK TODAY, I'LL GET AROUND TO IT."
DO IT THAT DAY. YOU GOT TO DO IT THAT DAY TO MAKE SURE
THAT YOU GET THE APPROPRIATE COVERAGE AND FOLLOW UP, OKAY?
IF IT'S A STERILE NEEDLE, LIKE I SAID,
YOU DON'T REALLY NEED TO WORRY ABOUT IT, JUST WASH YOUR HANDS GOOD.
YOU CAN FILL OUT AN INCIDENT REPORT AND THEY CAN FOLLOW UP AS FAR AS THAT,
IN CASE YOU GOT A LITTLE INFECTION OR SOMETHING FROM YOUR OWN FLOOR,
BUT OTHERWISE FOLLOW UP WITH ANY KIND OF NEEDLE STICK THAT'S BLED.
ALRIGHT, LET'S DOCUMENT.
TIM, CAN YOU HIT THAT FIRST OR.. AND SECOND LIGHT OUT.
OKAY, SO IT IS 10:40
AND I GAVE HEPARIN, OKAY.
I CHECKED MY MED EARLIER TO KNOW IT WAS RIGHT ON THE CHART.
SO THAT'S LET'S JUST SAY IT'S 1700 AND KEEP THINGS KOSHER HERE.
OOPS, SO IF IT'S 1700, IT'LL BE OVER HERE.
1700, I GAVE A HEPARIN SHOT.
NOW WHEN WE GAVE OUR PILLS, THEY SAID TO GIVE PILLS BY MOUTH, RIGHT?
SO YOU DIDN'T HAVE TO WORRY ABOUT THE ROUTE.
IT WAS ALREADY IN THE ORDER AND IT'S A DONE DEAL.
SO YOU JUST DID THE TIME IN WITH YOUR INITIALS.
BUT WHEN YOU GIVE AN INJECTION, THERE'S A LOT OF SUBCUTANEOUS AREAS.
STOMACH, BACK OF ARMS, SIDES OF THIGHS,
TOP OF BUTTOCKS, ALL ARE SUBCUTANEOUS TISSUES.
SO I HAVE RIGHT, LEFT AND ALL OF THESE EXTREMITIES
WITH WHICH TO CHOOSE TO GIVE MY SHOT.
SO THE CHART NEEDS TO KNOW WHERE I GAVE THE SHOT
AND YOU NEED TO KNOW, SO THAT YOU KNOW WHERE TO PUT THE NEXT ONE.
SO WE HAVE TO TELL THE CHART WHAT WE DID.
SO IF YOU COME DOWN HERE TO THE BOTTOM,
IT SAYS, "IN CARE." AND IT SAYS LOCATIONS AND CODES.
SO IS IT RT, RIGHT THIGH, RD, RIGHT DELTOID, NO, RIGHT GLUTEAL, NO.
RIGHT LOWER ABDOMEN. THAT WOULD BE SOUNDING LIKE ME.
SO, I'M GOING TO COME OVER HERE
AND UNDER MY 1700, PUT RIGHT LOWER ABDOMEN AND THEN MY INITIALS.
SO ALWAYS WITH AN INJECTION YOU HAVE TO DOCUMENT WHERE AND WHEN, WHEN YOU HAVE CHOICE.
SO THE NEXT ONE WILL GO LEFT IN THE LOWER ABDOMEN.
OKAY, AGAIN MAKE SURE YOU HAVE SIGNED IN DOWN HERE.
AND THEN MY SIGNATURE IS GOOD FOR THE REST OF MY SHOTS.
OKAY. I JUST WANTED TO SHOW YOU MY FUNNY LITTLE...
..CHART HERE FOR HEPARIN AND COUMADIN LAB TEST.
COUMADIN PT, WARFARIN PRODUCT PT BOAT
AND THEN THE HEPARIN WITH YOU TWO H'S FOR THE TT.
MAYBE THAT WILL HELP YOU BECAUSE THEY'RE GOING TO ELIMINATE THE PT.
FOR THE COUMADIN TO GO WITH THE INR.
BUT IT'S THE PTT, PARTIAL THROMBOPLASTIN TIME
THAT ACTIVATED PARTIAL THROMBOPLASTIN TIME FOR THOSE LAB RESULTS.
VERY IMPORTANT. AND IT REPLAYS ON HEPARIN. THAT DOCTOR WILL ASK...
..WHAT IT IS. AN INR IS INTERNATIONAL NORMALIZED RATIO.
INTERNATIONAL NORMALIZED RATIO.
ALRIGHT, CLEANING PRECAUTIONS.
THINGS THAT YOU WANT TO THINK ABOUT ON SOMEONE WHO IS GETTING AN ANTl-COAGULANT.
RAZORS OUT, ELECTRIC IN, OKAY?
BECAUSE YOU DON'T WANT TO NICK THEM
AND THEN THEY JUST BLEED AND BLEED.
ASPIRIN, NO. NEEDLES, SMALLEST GAUGE.
D IS TO DECREASE THE NEEDLE STICKS.
AND WE WANT TO DO ANYTHING WE CAN TO PREVENT INJURIES.
SO WE'RE GOING TO MAKE SURE THAT THEY'RE NOT DOING A LOT OF HOUSEWORK,
MOVING FURNITURE, NOT GOING BACK TO THEIR CONSTRUCTION JOB FOR A WHILE.
IT'S JUST CONTRAINDICATED.
WE'RE GOING TO OBSERVE FOR BLOOD IN URINE, NOSE BLEEDS.
PROBABLY MOST COMMONLY SEEN IS BRUISING AND GUMS THAT ARE BLEEDING
AND SO YOU'D BE WATCHING FOR THOSE.
I THINK I HAVE PRETTY MUCH COVERED EVERYTHING.
RANDI IS YOUR ACRONYM FOR BLEEDING PRECAUTIONS.
THAT'S MY HUSBAND, IF IT HELPS YOU.
I LOVE HIM, WOULDN'T WANT HIM TO BLEED TO DEATH.
ALRIGHT, SO THERE WE HAVE HEPARIN PRETTY MUCH.
SO THAT'S ONE SHOT,
YOU'RE DONE. WASH YOUR HANDS. DOCUMENT. YOU'RE DONE.
OKAY, SECOND SHOT.
INSULIN.
WHAT WAS I DOING?
INJURY, PREVENT INJURY.
MOVING..
IT'S MEMORY. I THOUGHT I'D MEMORIZED IN THE BACK OF MY BRAIN.
LET'S GIVE SOME INSULIN.
NOW...
..WE WILL HAVE THE VIALS AT OUR STATIONS FOR YOU TO DRAW FROM.
ITS JUST EASIER. THERE'S NOT ENOUGH AND EVERYONE WILL BE SCRAMBLING TO BRING VIALS.
BUT YOU HAVE TO GATHER UP YOUR OWN SYRINGES AND YOUR OWN SUPPLIES TO GIVE THE SHOTS.
WE'LL KEEP THE VIALS AT OUR STATIONS
AND YOU'LL BE DRAWING UP IN FRONT OF US
BECAUSE WE WANT TO MAKE SURE THAT YOU ARE CHECKING DATES,
THAT YOU ARE CLEANING TOPS, PUTTING AIR IN,
GETTING RIGHT DOSING AND SO FORTH.
ALRIGHT. I'VE CHECKED MY DOCTOR'S ORDERS,
I AM GOING TO GIVE REGULAR INSULIN, 8 UNITS
AND MPH INSULIN, 14 UNITS, SUBQ, EVERYDAY, AC BREAKFAST.
WHAT DOES THAT MEAN?
BEFORE BREAKFAST. OKAY.
SO YOU WANT TO KEEP A COUPLE OF THINGS IN MIND HERE.
I HAVE TWO KINDS OF INSULIN.
ONE IS A SHORT-ACTING INSULIN
AND ONE IS AN INTERMEDIATE-ACTING INSULIN.
YOU GUYS DONE INSULIN STUFF YET? OKAY.
THERE IS ALL KINDS OF INSULIN AND YOU NEED TO KNOW THIS.
SO WHEN YOU LOOK UP INSULIN, YOU MIGHT AS WELL START MEMORIZING IT.
IT WILL BE ON INPLEX SOMEWHERE. IT WILL FOLLOW YOU FOR THE REST OF YOUR DAYS.
INSULIN, VERY IMPORTANT.
THERE'S FOUR KINDS THAT WE'RE MOSTLY CONCERNED WITH
AND THAT'S RAPID, ONSET, SHORT-ACTING,
INTERMEDIATE AND LONG, OKAY? YOU'LL SEE THOSE FOUR.
I KNOW THAT I HAVE A SHORT AND AN INTERMEDIATE.
REGULAR INSULIN IS A SHORT-ACTING INSULIN.
AFTER YOU KNOW WHAT KIND OF INSULIN YOU HAVE,
WHAT IS THE CRITERIA? WHAT DOES THAT MEAN?
THERE'S THREE THINGS THAT YOU NEED TO LOOK UP AND KNOW ABOUT YOUR INSULIN.
AND THAT IS THE ONSET. WHEN DOES IT START WORKING?
WHEN DOES IT PEAK? AND HOW LONG DOES IT LAST?
BECAUSE EACH OF THESE CATEGORIES OF INSULIN START AT A DIFFERENT TIME.
PEAK, ARE MOST EFFECTIVE AT A PARTICULAR TIME,
AND THEN LAST FOR A CERTAIN AMOUNT OF TIME.
IT'S VERY, VERY COMMON THAT WE GIVE A SHORT-ACTING WITH AN INTERMEDIATE-ACTING,
SO THAT YOU GET RESULTS RIGHT AWAY.
BUT THEN THROUGHOUT THE DAY THEY STILL HAVE SOME COVERAGE FOR THEIR SUGAR,
BLOOD-SUGAR TO KEEP IT NORMAL. SO, SHORT-ACTING,
IT'S GOING TO ACT WITHIN ONE AND A HALF.. I MEAN, ONE HALF TO ONE HOUR
AND KNOWING THAT I NEED TO MAKE SURE THAT THEY GET BREAKFAST WITHIN 15 MINUTES OF THIS SHOT.
THEY GOT TO HAVE SOME SUGAR ONBOARD BEFORE THIS INSULIN HITS
OR THEY'RE GOING TO HAVE HYPOGLYCEMIC ATTACK, OKAY?
SO DON'T, "OH, I THINK I'LL GET A LITTLE AHEAD HERE."
AND THEN LUNCH -- OR BREAKFAST IS LATE.
OH MAN, YOU GOT TO FEED THAT DIABETIC AND GET SOMETHING GOING FOR THEM,
SO THAT SOMETHING'S ONBOARD.
ALRIGHT. INTERMEDIATE. I'VE GOT TO TELL YOU THE PEAKS.
THE PEAK IS 2 TO 4 HOURS WITH YOUR SHORT-ACTING,
AND IT'S ANYWHERE, 5 TO 7 OR 6 TO 8 HOURS FOR ITS DURATION.
IT DEPENDS ON WHAT'S AUTHOR YOU READ. THEY'RE ALL A LITTLE BIT DIFFERENT.
I DON'T REALLY LIKE TO KNOW MY PEAKS AND ONSETS PRETTY WELL.
INTERMEDIATE ON THE OTHER HAND DOESN'T EVEN START WORKING FOR 2 TO 3 HOURS,
UP TO 4 HOURS.
SO YOU GOT THIS BIG SPAN OF IT THAT DOESN'T EVEN WORK.
THEN IT'S GOING TO PEAK OUT SOMEWHERE BETWEEN 6 TO 12 HOURS
AND LAST ANYWHERE FROM 18 TO 28 HOURS,
DEPENDING ON THE PARTICULAR BRAND IT IS.
PROBABLY, REGULAR AND MPH ARE THE MOST COMMON.
THERE IS A FASTER ACTING. IT'S CALLED RAPID INSULIN. IT'S CALLED LISPRO.
AND IT ACTS IN LESS THAN 15 MINUTES, BOOM.
SO THEY GOT TO HAVE SOME FOOD ONBOARD OR THERE IS SOMEONE THAT'S REALLY HYPOGLYCEMIC
AND WE'RE NEEDING SOME IMMEDIATE RESPONSE FOR THEM
TO GET THEIR BLOOD-SUGAR ON DOWN.
ALRIGHT. SO I KNOW WHAT I HAVE GOING.
I KNOW I HAVE TO GET MY CLIENT READY TO EAT.
I KNOW WHAT KIND OF INSULINS I HAVE.
NOW I'VE GOT TO GATHER UP MY EQUIPMENT.
I HAVE WASHED MY HANDS TO PREPARE SHOTS
AND I'M GOING TO GET MY STUFF TOGETHER.
I HAVE TWO KINDS OF INSULIN, THE REGULAR AND THE MPH.
YOUR SHORT AND RAPID-ACTING INSULINS ARE CLEAR INSULINS
AND YOUR LONG-ACTING INSULINS ARE CLOUDY INSULINS,
WHICH MEANS THEY'VE ACTUALLY.. THEY PUT A ZINC PRODUCT IN THERE,
AND THAT'S WHAT PROLONGS THE ACTION OF THE MEDICINE ITSELF.
SO CLOUDY AND CLEAR,
THAT'S HOW YOU'LL HEAR THEM REFERRED TO ALL THE TIME.
ALRIGHT, I CHECKED EXPIRATION DATES AND THERE'S NONE ON HERE
AND I AM HOPING THEY'RE GOOD.
I'LL PUT MY DATE AND TIME AND INITIALS ON IT, IF THEY'RE BRAND NEW.
ACTUALLY, IF I FOUND INSULIN LIKE THIS
WITH NO EXPIRATION DATES, TOPS OFF, I'D CATCH THEM.
AND I CALL PHARMACY AND GET SOME MORE.
I HAVE NO IDEA ABOUT THIS, IF IT IS IN THE HOSPITAL.
IF IT WAS IN MY HOME, WELL, THEN I'D KNOW, I'D BE THE DIABETIC USING IT.
NOW MAYBE THAT'D BE DIFFERENT, BUT I DON'T USE THINGS
I DON'T KNOW ABOUT THEM IN THE HOSPITAL.
GET MORE. AND MAKE SURE THAT YOU'RE A LABELLER
OR WE'RE WASTING A LOT OF GOOD STUFF HERE.
ALRIGHT, I NEED A SYRINGE.
AN THIS TIME WHAT I'M GOING TO DO IS GET AN INSULIN SYRINGE.
AND THIS IS A HALF CC SYRINGE,
BUT THEY ALSO HAVE INSULIN SYRINGES THAT ARE 1 CC SYRINGES.
BECAUSE INSULIN IS A UNIT DRUG.
AND YOU'LL SEE THAT IT'S CALLED U100,
THERE'S A 100 UNITS PER MILLILITER.
AND IT'S THE SAME WITH THIS, IT'S A U100 PRODUCT.
ITS PURPOSE IS TO BE CALCULATED IN UNITS.
SO THAT'S WHY WE NEED INSULIN SYRINGE BECAUSE IT'S MEASURED IN UNITS.
ONE DAY, I WAS OUT WORKING AND I WENT TO GIVE A SHOT TO A DIABETIC.
AND THEY DIDN'T HAVE ANY NEEDLES, THEY'D RUN OUT.
I AM NOT A DIABETIC, I DIDN'T HAVE ANY EITHER.
SO, I HAPPENED TO HAVE MY BAG WITH ME AND I DON'T USUALLY CARRY AROUND SYRINGES,
BUT I HAPPENED TO HAVE A 1 CC SYRINGE IN MY BAG.
CAN YOU SUBSTITUTE A 1 CC SYRINGE AND A UNIT SYRINGE?
YES.
THE HUNDREDTHS ARE ACTUALLY UNITS
AND SO 1 CC,
0.1 CC OF A REGULAR SYRINGE IS ACTUALLY 10 UNITS.
SO YOU CAN DO THE EQUIVALENT THERE AND IF YOU GO THROUGH YOUR MATH BOOKS,
AND YOU GO TO THE PAGES WHERE IT TALKS ABOUT DRAWING UP FROM AN INSULIN SYRINGE,
IT WILL TELL YOU HOW TO DO EITHER THE INSULIN OR THE 1 CC SYRINGE.
SO, YES, YOU CAN INTERCHANGE THEM, IT'S JUST EASIER.
THE MARKINGS ARE EASIER TO READ ON THE INSULIN SYRINGE THAN ON THE 1 CC SYRINGE.
ALRIGHT. I HAVE MY INSULIN SYRINGE
AND THE ONES THAT I'M GOING TO GIVE YOU TO PRACTICE WITH
DO NOT HAVE A SAFETY DEVICE ON IT
BECAUSE I ORDERED THEM AND THEY DIDN'T COME IN.
THERE IS A NEW SYRINGE THAT'S JUST COME OUT,
LIKE, IN THE LAST YEAR FOR INSULIN. AND EVERYTHING OSHA..
I THINK IT WAS IN 2000. CAN'T REMEMBER NOW 1 OR 2, TIME FLIES,
REQUIRED THAT EVERY SYRINGE HAVE SOME KIND OF SAFETY DEVICE ON IT.
AND INSULIN WAS THE LAST ONE TO GET ANYTHING, I DON'T KNOW WHY.
BUT WHAT THEY CAME UP WITH..
EVERYTHING ABOUT THIS IS THE SAME AS FAR THE PLUNGER, THE PHALANGES,
THE BARREL, THE HUB, THE NEEDLE AND SO FORTH.
IT JUST SO HAPPENS THAT THIS IS A 28 GAUGE,
VERY THIN, HALF INCH NEEDLE.
WE JUST HAVE TO BREAK THROUGH THE SKIN HERE ON THIS.
VERY THIN, BUT THEY DIDN'T PUT THE LITTLE SLIDE THING ON.
WHAT THEY DID WAS PUT THIS LITTLE JOB ON HERE.
SO YOU GIVE YOUR SHOT, BOOM, IT GOES INTO THE SKIN
AND THEN YOU PRESS ON THIS AS IT COME OUT AND THAT COVERS UP THE NEEDLE FOR YOU.
THEY CALL IT SAFETY GLIDE. PRETTY COOL.
BUT ONCE YOU'VE LOCKED IT OFF,
YOU CAN'T PRACTICE WITH IT ANY MORE, ONCE IT'S LOCKED.
SO, WE'RE GOING TO USE THESE OTHERS SO YOU CAN PRACTICE
AND PRACTICE AND DART AND SO FORTH.
BUT HOPEFULLY, WHEN YOU'RE OUT IN THE FIELD YOU'LL SEE THESE.
SO USE THE LITTLE BUTTON.
ALRIGHT. I HAVE MY INSULIN SYRINGE, HALF CC.
I ALREADY TOLD YOU THAT THESE ARE THE MUCH SMALLER GAUGE,
AND THEY'RE SHORTER, USUALLY HALF INCH.
ALRIGHT. I NEED TO DRAW THIS UP,
SO WHAT I'M GOING TO DO IS CLEAN MY VIAL TOPS BECAUSE..
..THEY WERE OPEN.
NOW..
..WHEN WE'RE GOING TO GIVE INSULIN,
WE NEED TO BE CAREFUL THAT WE DON'T CONTAMINATE BOTH THE BOTTLES.
IF WE GET EITHER INSULIN INTO THE OTHER, IT DILUTES IT
AND IT BECOMES SOMETHING THAT IT'S NOT SUPPOSED TO BE.
SO WHAT WE WANT TO DO IS, TAKE YOU LITTLE CAP OFF YOUR PLUNGER.
I ALWAYS, KIND OF, RELEASE IT A LITTLE BIT HERE.
I WANT TO PUT AIR INTO BOTH VIALS, BUT I'M ONLY GOING TO DRAW UP FROM ONE FIRST.
BECAUSE ONCE I GET FLUID IN HERE, I CAN'T PUT AIR IN THE OTHER VIAL, RIGHT?
SO I GOT TO PUT THE AIR INTO BOTH AND THEN DRAW UP.
I WANT TO DRAW UP MY REGULAR FIRST BECAUSE I DON'T WANT THE CLOUDY,
I DON'T WANT ZINC GETTING INTO MY REGULAR.
IT JUST TURNS IT INTO THEN NOT A PURE PRODUCT.
SO, ACTUALLY MPH IS REGULAR WITH ZINC IN IT.
SO IF I GOT A LITTLE REGULAR IN IT,
IT'S NOT GOING TO DILUTE IT UP AS MUCH AS IF I GET THE LONG-ACTING IN.
IT DOESN'T REALLY CONVERT IT TO A LONG-ACTING, IT JUST DILUTES IT
AND SO THEY TRY TO KEEP THEM SEPARATE.
SO WHAT I WANT TO DO THEN IS I WANT TO PUT MY AIR IN MY CLOUDY VIAL FIRST,
WHICH IS ABOUT 14 UNITS, SO I DRAW UP MY 14 UNITS.
AND I JUST PUT THE AIR IN WITHOUT MY NEEDLE EVER TOUCHING THE VIAL
AND TAKE IT OUT. SO THIS ONE'S READY TO GO.
NOW I'M GOING TO PUT 8 UNITS WORTH OF AIR IN HERE
AND I JUST HOLD ON TO THESE. MOST OF THE TIME, THAT'S MY HABIT.
AND NOTICE HOW I PUT THE OPENING, LIKE, OUT, SO I'M NOT CONTAMINATING IT.
AND I'M GOING TO PUT MY NEEDLE IN, PUT MY AIR IN
AND THEN I AM GOING TO DRAW UP A LOT
BECAUSE I ALWAYS GET THAT LITTLE HUBS WORTH OF AIR INTO THE BARREL.
SO I DRAW UP A WHOLE BUNCH, IT DOESN'T MATTER HOW MUCH I PUT IN.
AND THEN I FLICK IT A LITTLE BIT, BUT YOU NEED TO BE PRETTY GENTLE.
OTHERWISE, YOU BEND THE NEEDLE BECAUSE IT'S SO THIN.
SO HOLD THIS STEADY AND THEN LET THIS SIT RIGHT ON THE PAD OF YOUR PALM.
KNOCK THAT AIR UP TO THE TOP OF THE CENTER AND THEN SQUIRT IT OUT.
YOU'LL GET IT CENTERED AND OUT.
AND THEN SET YOUR 8.
OKAY. IF IT WASN'T SET, AND I SAW A BIG, OLD BUBBLE HERE ON THE SIDE,
THEN WHAT I DO IS I PULL REAL, KIND OF, HARD AND FAST.
AND LOOSEN THAT BUBBLE OFF OF THE SIDE. WHOOSH!
AND THEN GET IT CENTERED AND SQUIRT IT BACK UP, OKAY?
LITTLE TINY LIKE CHAMPAGNE BUBBLES,
LITTLE, TINY BUBBLES THAT ADHERE TO THE BARREL DON'T MATTER,
THEY'RE JUST THERE. AND THEY'RE GOING TO GET STUCK IN THE HUB,
AND IT'S JUST NOT GOING TO MATTER.
THE BIG OLD BUBBLES THAT SIT AND CHANGE THE UNIT DOSE, THOSE MATTER.
SO THAT'S THE DIFFERENCE IN THE SIZE OF BUBBLE YOU WANT TO FIGHT ABOUT.
SOMETIMES IT HURTS MY FINGER TO KEEP FLICKING ON IT
SO IF YOU GRAB A PEN AND YOU, KIND OF, WHACK ON IT A COUPLE OF TIMES,
THAT'LL LOOSEN UP THAT BUBBLE.
THE KEY IS YOU GOT TO GET THE AIR CENTERED TO SQUIRT IT UP STRAIGHT.
ALRIGHT, JUST LIKE HEPARIN, I HAVE TO GET SOMEONE TO DOUBLE CHECK.
I NEED TO GIVE REGULAR INSULIN TO SALLY,
HERE'S MY REGULAR 8 UNITS.
REGULAR. REGULAR. 8. 8.
ALRIGHT. AND SHE SAYS, "OKAY."
SO, TAKE THIS OUT,
SET IT ASIDE. AND I WALKED AWAY FROM THIS,
SO I'M GOING TO GO AHEAD AND CLEAN IT.
AND I DID IT INADVERTENTLY AND I DIDN'T MENTION IT,
BUT ON YOUR CLOUDY INSULINS, THE ONLY WAY TO REALLY MIX IT IS TO ROLL IT.
YOU DON'T WANT TO SHAKE IT. BECAUSE IF YOU SHAKE IT, YOU ADD MORE BUBBLES TO THE VIAL.
AND YOU GET A LOT OF THOSE CHAMPAGNE BUBBLES AND THEN IT CHANGES THE DOSE.
SO JUST ROLL IT TO GET A GOOD MIX
AND NOW I WANT TO PUT MY SYRINGE IN.
AND AT THIS POINT, YOU CAN'T BE BACK AND FORTH IN IT.
YOU SHOULDN'T HAVE ANY AIR IN YOUR SYRINGE, RIGHT?
BECAUSE YOU'VE CLEARED OUT THAT HUB AND YOU'VE GOT IT SET.
SO NOW WHEN YOU PULL FLUID IN IT WILL COME STRAIGHT IN,
AND YOU WON'T HAVE ANY AIR BUBBLES.
WHAT I NEED TO PAY ATTENTION TO IS WHAT IS 8 PLUS 14.
22. SO WHEN I DRAW UP, I'VE GOT TO STOP EXACTLY ON 22.
I CAN'T GO TO 23. I CAN'T GO TO 25 AND SQUIRT BACK IN.
SO YOU'VE GOT TO PAY CLOSE ATTENTION HERE.
SO I PULL BACK, PULL BACK, NO AIR.
20. 21. 22.
COME BACK TO STACY WHO ALREADY SAW MY 8 UNITS
BECAUSE IT WOULDN'T DO ME ANY GOOD TO HAVE SOMEONE ELSE CHECK IT.
SO I HAVE ADDED MY MPH, SORED MY THUMB'S ON IT.
THERE IS MY MPH, NOT EXPIRED, 22 IS MY CALL ON IT.
OKAY.
SHE BLESSED IT. I'M GOOD TO GO.
ALRIGHT.
I PULL IT UP AND I ALWAYS GIVE MY NEEDLE A CHECK
TO SEE AFTER ALL THAT TAPPING AND POKING.
"DID I BEND THE THING TO SMITHEREENS?"
SO MAKE SURE YOUR NEEDLE IS IN GOOD SHAPE AND THEN RECAP.
AGAIN, BE CAREFUL OF THAT PLUNGER.
ALRIGHT, I AM HAPPY.
I'M GOING TO TAPE ON HERE, THAT I HAVE INSULIN REGULAR,
8, MPH 14 AND THEN I ADDED UP SO I KNEW I HAD NEEDED 22.
THAT'S WHY I DID MY MATH.
ALRIGHT. THESE CAN GO BACK INTO STORAGE.
I DO WANT TO MENTION
THAT IT USED TO BE THE THINKING FOR YEARS THAT..
WELL, WE REFRIGERATED FOR THE LONGEST TIME
AND THEN ABOUT 10, 15 YEARS AGO THEY SAID, "OH, YOU DON'T NEED TO REFRIGERATE IT.
YOU JUST KEEP IT AT ROOM TEMPERATURE BELOW 80 DEGREES, IT WILL BE FINE.
WELL, IN THE LAST YEAR OR SO THEY'VE COME OUT WITH SOME RESEARCH STUDIES THAT SAID,
YOU KNOW, YOU REALLY NEED TO REFRIGERATE IT.
WHAT WE FOUND IS THAT WITHIN A MONTH'S TIME,
IT ACTUALLY DETERIORATED ABOUT 1.5%. I AM THINKING THAT'S NOT VERY MUCH.
BUT THEY THOUGHT IT WAS SIGNIFICANT ENOUGH
THAT THEY REALLY HAVE US BACK TO REFRIGERATING INSULIN.
SO YOU'LL EITHER FIND INSULIN IN THE DRAWERS FOR YOUR CLIENT
OR IN THE REFRIGERATOR WHERE THEY STORE MEDS,
DEPENDING ON YOUR HOSPITAL POLICY.
ONE OF THE THINGS THAT YOU'LL RUN INTO
WHEN YOU GO TO DO INSULIN AND ESPECIALLY WHEN YOU'RE TEACHING YOUR CLIENTS TO DO IT.
BECAUSE YOU HAVE TO TEACH YOUR CLIENTS HOW TO DRAW UP THEIR MEDICINE
TO MAKE SURE THAT THEY'RE SAFE AND THEN THEY CAN BE INDEPENDENT.
BECAUSE DIABETES IS GOING WITH YOU WHEREVER YOU GO.
AND ONE OF THE THINGS IS THAT YOUR GERIATRIC CLIENTS IN PARTICULAR
HAVE A HECK OF A TIME SEEING THESE.
I MEAN, AND I'M BEGINNING TO APPRECIATE THAT AT THIS TIME.
I AM NOT SEEING VERY WELL MYSELF.
SO WHAT YOU CAN DO IS GET THIS LITTLE MAGNIFIER
AND IT FITS IN LIKE THIS.
I HOPE THIS WILL..
YOU KNOW WHAT? THIS IS PROBABLY GOING TO WORK.
OKAY, MY TOP IS CLEAN. IT FITS IN HERE.
AND THEN YOU PUT YOUR NUMBERS TO THIS SIDE
AND THEN THEY CAN SEE A LITTLE BIT BETTER TO DRAW UP THEIR OWN MEDS, OKAY.
SO THERE ARE GADGETS AND THINGS OUT THERE TO HELP YOUR CLIENT.
IT'S REALLY IMPORTANT IN THE HOSPITAL THAT YOU WATCH THEM DO SOME OF THESE..
OH, SEE I LOCKED IT.
THAT WOULD BE GREAT. GET IT ALL DRAWN UP AND THEN LOCK YOURSELF OUT.
THESE NEW-FANGLED SYRINGES.
WATCH YOUR CLIENT. SEE THEIR TECHNIQUE.
SEE HOW ACCURATE THEY ARE IN GETTING THEIR INSULIN DRAWN UP
BECAUSE IF THEY'RE NOT GETTING THE RIGHT DOSING,
THEY'RE NOT GOING TO BE FILLED UP AS FAR AS THEIR MANAGEMENT AT HOME.
OKAY. I HAVE MY INSULIN.
I HAVE SOME ALCOHOL SWABS.
I DON'T REALLY NEED A 2X2 ON THIS ONE. I THINK I'M OKAY.
I'VE CLEANED UP MY AREA, PUT EVERYTHING BACK.
ONE OF THE THINGS I WANTED TO MAKE SURE AND MENTION
BEFORE I GET AWAY FROM MY THOUGHT
IS ON YOUR INSULIN, WHEN YOU'RE LOOKING AT YOUR CLOUDY,
MAKE SURE IT DOESN'T HAVE PRECIPITANT IN IT.
WHAT IS THAT?
CLUMPS, THINGS THAT ARE NOT NATURAL.
THIS SHOULD JUST BE.. IT SHOULD BE CLOUDY,
BUT IT SHOULD BE WITHOUT PARTICLES AND WITHOUT CLUMPS IN IT.
IF YOU HAD PRECIPITANT OR IF YOU HAD CLUMPS IN THE INSULIN
WHAT WOULD YOU DO?
THROW IT AWAY. IT'S NO GOOD.
YOU CAN'T UNCLUMP IT. YOU CAN'T RUN HOT WATER ON IT.
YOU CAN'T DILUTE IT. IT'S NO GOOD.
SIMPLE AS THAT. YOU GET RID OF IT AND YOU GET SOME MORE.
ALWAYS MAKE SURE THAT YOUR DIABETICS
HAVE AN EXTRA BOTTLE OF BOTH KINDS OF INSULIN THAT THEY TAKE
AND PLENTY OF SYRINGES BECAUSE YOU NEVER KNOW WHAT WILL HAPPEN
IF THIS WENT BAD OR IF THEY BROKE A BOTTLE.
THEY CAN'T BE WITHOUT INSULIN, SO THEY SHOULD ALWAYS HAVE A SPARE.
- IS THERE A REASON THEY JUST DON'T HAVE THE SOLUTION ALREADY MIXED UP,
SO YOU DON'T HAVE TO DO THIS?
- THEY DO HAVE SOME MIXED UP.
AND THERE'S TWO SCHOOLS OF THOUGHT ON THIS.
THERE IS AN INSULIN CALLED 70/30,
AND IT'S A MIX OF INSULIN AND THEY DO USE THAT.
ONE REASON IS, THEY USED TO THINK IT WOULDN'T BE STABLE.
THEY THOUGHT THAT IF YOU PUT MPH WITH REGULAR
THAT THEY WOULD MIX TOGETHER AND IT WOULD LOSE ITS POTENCY.
BUT THEY FOUND THAT IF YOU MIX REGULAR WITH LONG-ACTING TOGETHER
THAT THEY'RE ACTUALLY STABLE FOR ONE MONTH.
SO, YOU JUST.. IT'S NOT EASY TO CREATE A PRODUCT
THAT HAS ALL OF THE FEATURES IN IT AS SHORT AND LONG,
OTHER THAN THIS 70/30 PRODUCT THAT THEY CREATED.
SO, YES THERE IS ONE, BUT THIS IS ALSO CHEAPER AND EFFECTIVE.
- JUST ANOTHER THING, BEING SOMEONE THAT'S USED 70/30 -- YOU HAVE HORRIBLE CONTROL.
JUST AWFUL, I MEAN, JUST TYPE 1, I DON'T KNOW ABOUT TYPE 2, BUT...
- YEAH.
- YOU'RE BETTER OFF USING TWO DIFFERENT ONES.
- UH-HUH. AND THE OTHER THINKING
IS ESPECIALLY FOR PEOPLE THAT ARE YOUNG
AND WANTING TO KEEP THEIR BLOOD-SUGAR AS NORMAL AS POSSIBLE.
NOW IF THEY JUST GIVE REGULAR ALL DAY LONG, MIMICING
A REAL PANCREAS, THAT THEY WOULD GET BETTER COVERAGE
THAN HAVING TO JUGGLE THIS LONG-ACTING
AND NOT KNOWING ACCORDING TO THEIR ACTIVITY LEVEL
WHEN THEY'RE GOING TO PEAK AND WHEN THEY'RE GOING TO PLUMMET.
BECAUSE ACTIVITY BURNS UP SUGAR FASTER SO A HARDER GROUP TO MANAGE.
AND THERE IS SO MUCH ON DIABETES THAT'S JUST FASCINATING ACTUALLY, SUBJECT.
SO THANK YOU FOR THAT.
CAN YOU THROW THOSE AWAY IN A REGULAR TRASH CAN?
- YES. - THERE ARE NO OTHER INSTRUCTIONS?
- UH-HUH. YEAH, THESE YOU CAN.
BECAUSE THEY'RE NOT BLOODY, YOU CAN'T FLUSH THEM.
- YEAH, BUT I'M JUST SAYING ANYBODY GET INTO A TRASH CAN.
THAT'S A GOOD POINT. YOU MIGHT WANT TO DRAW IT OUT,
SQUIRT IT OUT IN THE SINK, BUT IF IT'S CLUMPY
DO YOU HAVE ANY THOUGHTS ON THAT?
WHAT DO YOU DO WITH YOUR INSULIN IN A VIAL, YOU JUST THROW IT OUT?
NO. WE'RE GOING TO TALK ABOUT WHAT TO DO WITH NEEDLES HERE IN A MINUTE.
ALRIGHT. YOU'RE GOING TO HAVE YOUR DRINK OF WATER.
OKAY, WHAT'S NEXT? WE'RE GOING TO GO GIVE THE SHOT.
ALRIGHT.
I HAVE CERTAINLY CHECKED ABOUT ALLERGIES.
THE RISK OF ALLERGY WITH HEPARIN AND INSULIN IS REALLY SLIM AND NONE
BECAUSE MOST OF THEM ARE HUMAN PRODUCTS.
WHERE YOU'LL RUN INTO SOME TROUBLE IS SOME OF YOUR INSULINS
WERE MADE FROM ANIMAL PRODUCTS.
THEY USED TO MAKE IT FROM PORK AND FROM BEEF,
BUT THEY DON'T DO THAT TOO MUCH ANY MORE, THEY'RE ALL HUMAN PRODUCTS
AND SO WE DON'T REALLY RUN INTO ANY PROBLEM RELATED TO ALLERGIES.
ALRIGHT, I'VE WASHED MY HANDS. I'VE IDENTIFIED MY CLIENT.
COULD YOU TELL ME YOUR NAME PLEASE?
GREAT. SALLY SMITH. 777889999.
I SHARED WITH PEOPLE IN MY GROUP WHEN THEY WERE TESTING,
THAT THERE'S.. THEY'RE ALWAYS TRYING TO FIGURE OUT A WAY FOR US NOT TO MAKE MED ERRORS,
BUT THEIR NEWEST PUSH IS THAT WE FIND TWO IDENTIFIERS FOR OUR CLIENT,
NOT ONE OF THEM NOT BEING A NAME.
SO WHEN YOU'RE LOOKING AT ID BANDS YOU NEED TO CHECK AN ID NUMBER
AND A NAME, NOT JUST NAME NAME.
BECAUSE THERE COULD BE TWO SALLY SMITHS.
YOU KNOW, THAT'S WHY I HAVE TWO SMITHS IN MY LABS,
SO THAT WE'RE AWARE THAT NAMES CAN MATCH UP.
SO MAKE SURE THAT YOU'RE CHECKING SOMETHING ELSE BESIDES THAT.
AND THEY'RE RECOMMENDING AN ID NUMBER.
ALRIGHT, PROVIDED PRIVACY AND WE'RE READY TO GO.
SO, MRS. SMITH, I HAVE YOUR INSULIN FOR YOU.
CAN YOU GIVE YOUR OWN SHOT?
I WOULD LOVE TO WATCH YOU.
NO, YOU GIVE IT. I DO IT ALL THE TIME
AND THEY DO BOTH. AND IF I NEED TO SEE THEM, FINE.
IF I DON'T, IF I'VE SEEN IT, THEY JUST DON'T WANT TO DO IT FOR THE DAY,
I DON'T CARE, I'D GET TIRED OF DOING IT MYSELF SO WHATEVER, I DON'T CARE.
WE'RE GOING TO GIVE THIS ONE AGAIN IN THE STOMACH
SO WE WANT TO ROTATE OUR SITES.
ON YOUR DIABETICS..
IT USED TO BE RECOMMENDED THAT WE ROTATE TO ALL THE SUBCUTANEOUS SITES
I REVIEWED OVER THERE A MINUTE AGO.
BECAUSE WHAT THEY FOUND WAS THEY GOT SOME LIPOATROPHIES,
THEY GOT DIMPLING ON THE HARD PLACES IN THEIR SKIN FROM THE INSULIN.
WELL, THEY FOUND OUT THAT THOSE WERE ACTUALLY CAUSED BY THE BEEF AND PORK INSULINS
AND THAT IF THEY INJECTED THOSE ATROPHIED PLACES WITH HUMAN INSULIN,
THEY PUFFED RIGHT BACK UP, BECAME NORMAL LOOKING.
SO WHAT THEY FOUND WAS THAT THEY ACTUALLY GOT BETTER COVERAGE
AND MORE CONSISTENT COVERAGE
IF THEY WOULD GIVE THEIR SHOT IN THE SAME BODY AREA
AND THEN ROTATE WITHIN THAT BODY AREA.
THE OTHER REASON IS, IT'S JUST PLAIN HARD TO HIT SOME OF THESE ON YOUR SELF.
YOU KNOW, AND SO YOU'RE STANDING BY DOORS AND ALL KINDS OF THINGS
TO GET SOME FAT UP ON YOUR OWN SELF IF YOU CAN'T HOLD YOUR THING.
SO MOST OF THE TIME DIABETICS LIKE TO GIVE IN THE FRONT,
IT IS EASIER TO HIT THEIR THIGHS AND IT IS EASIER TO HIT STOMACH.
IF SOMEONE IS REALLY ACTIVE, AGAIN, THE SAME CRITERIA IS WITH HEPARIN.
THEY RECOMMEND THAT THE ABDOMEN IS THE PLACE OF INJECTION
BECAUSE IT DOESN'T INCREASE OR CHANGE THE ABSORPTION OF THE INSULIN ITSELF.
SO ONCE AGAIN, WE'RE GOING BACK TO THE ABDOMEN.
DO YOU REMEMBER WHERE YOUR LAST SHOT WAS?
IN YOUR STOMACH? RIGHT, LEFT, OH, YOU HAD HEPARIN ON THE RIGHT LEFT SIDE,
WELL THEN WE WILL JUST COME OVER HERE TO THE LEFT HAND SIDE.
I AM GOING TO INSPECT THE ABDOMEN, MAKE SURE IT'S CLEAN AGAIN
OF BRUISES, SCAR TISSUE, CREASES, HAIRY SPOTS, SMALL SORES, ANYTHING.
ALMOST BE A HOME STUDY EXCEPT FOR THE ACTUAL PRACTICE AT TESTING,
WOULDN'T THAT BE COOL? - I THINK SO.
OTHER THAN I JUST REALLY DON'T WANT YOUR FAMILY MEMBERS WATCHING ME.
IF I COULD SPEAK TO JUST YOU.. YOU KNOW.
ANYWAY, ALRIGHT. WE'RE BACK -- OH, I SHOULD HAVE GOT THESE OUT FIRST.
OKAY, SO I'VE CLEANED MY SKIN,
I'VE GOT MY NEEDLE. I'M DOING MY LAST CHECK, OKAY.
I HAVE YOUR INSULIN, I'M GIVING YOU 8 UNITS REGULAR.
THAT'S YOUR FAST-ACTING AND.. YOUR SHORT-ACTING
AND THEN YOUR MPH, YOUR LONG-ACTING, 14 UNITS.
I ALWAYS LIKE TO TELL MY DIABETICS WHAT THEY'RE GETTING,
BECAUSE THEY KNOW WHAT THEY'RE GETTING NOW
AND WHAT THEY GET AT HOME AND SO FORTH AND HOW TO ADJUST ACCORDINGLY.
OKAY, TAKE YOUR CAP OFF, SET IT DOWN.
ALRIGHT, ON HERE I'M GOING TO PINCH UP A LITTLE SKIN.
YOU DON'T HAVE TO BE QUITE AS GINGER AS WITH HEPARIN
BECAUSE YOU'RE NOT GOING TO BRUISE THEM UNLESS THEY'RE STILL ON HEPARIN.
I WANT TO PUT THE NEEDLE IN
AND AGAIN YOU CAN JUST DART IT IN.
YOU DON'T HAVE TO DART HARD, IT'S JUST SOFT SKIN, SOFT TISSUE.
I'VE RELEASED THE HOLD, YOU DON'T NEED TO ASPIRATE,
JUST PUT IT STRAIGHT IN,
PULL STRAIGHT OUT,
DAB IT IF YOU NEED TO.
THERE IS NO SAFETY DEVICE. SEE WHAT I DO WITH MY NEEDLE.
IT'S OUT HERE.
AND IT GOES STRAIGHT IN THERE.
I LOOK AT THEIR STOMACH, THERE'S NO NEED FOR A BAND AID.
DO NOT MASSAGE.
WHY WOULDN'T.. HOLD YOUR THOUGHT. WHY WOULDN'T WE MASSAGE?
IT IS GOING TO INCREASE THE ABSORPTION OF THE INSULIN.
WE JUST WANT INSULIN TO BE IN THERE AND TO ACT AS IT NORMALLY WOULD,
SO YOU DON'T WANT TO INCREASE. ALRIGHT, ROBERT.
- YOU HAVE TO LEAVE THE NEEDLE IN FOR 10 SECONDS?
- RIGHT. FOR ABSORPTION BUT WE DON'T WANT TO DO THAT WITH THE INSULIN.
SO IT'S NOT GOING TO TRACK IT. SO IT ABSORBS BETTER.
SO WE DON'T HAVE THE BRUISING AND THE SIDE-EFFECTS OF THE BLEEDING.
WHEREAS, WITH INSULIN IT DOESN'T REALLY MATTER.
ALRIGHT. GET RID OF MY GLOVES. I PUT MY CLIENT DOWN.
I WASHED MY HANDS AND DOCUMENT.
ALRIGHT, LET ME SEE IF I'VE HIT EVERYTHING HERE.
THERE'S SO MUCH STUFF.
ALRIGHT. OH, YES. OKAY.
WHAT IN THE WORLD DID I START WRITING TO MYSELF?
ALRIGHT, REUSE OF SYRINGE.
DIABETICS TEND TO LIKE TO REUSE THEIR SYRINGES.
I DON'T KNOW IF YOU NOTED, AFTER WE DID OUR BLOOD GLUCOSE MONITORING,
HOW EXPENSIVE THAT IS, OKAY.
SO YOU'RE CHECKING YOUR BLOOD-SUGAR, 4, 6, 8 TIMES A DAY,
DEPENDING ON HOW TIGHTLY YOU'RE MANAGING YOURSELF.
AND THEN YOU'VE GOT SYRINGES. YOU'VE GOT ALCOHOL. YOU'VE GOT ALL THE STUFF OF IT.
SO YOU'LL FIND THAT MANY OF YOUR DIABETICS
LIKE TO REUSE THEIR PRODUCTS UNTIL THEY'RE JUST TOO DULL TO USE ANY MORE
SO THEY'LL USE THEIR FINGERSTICKS OVER AND OVER
AND THEY WILL USE THEIR SYRINGES OVER AND OVER.
THERE IS A COUPLE OF THINGS THAT YOU NEED TO KNOW ABOUT THAT.
ONE IS, THE MANUFACTURER RECOMMENDS ONE TIME USE.
THAT'S THE MANUFACTURER, THEY WANT YOU TO BUY THEIR PRODUCT
AND THEY WANT TO GUARANTEE STERILITY.
HOWEVER, WHAT THEY FOUND IS THAT IF A CLIENT REUSES THE SYRINGE,
IT'S THEIR FLOOR AND THEY TEND TO NOT GET INFECTED.
SECOND, MOST INSULIN HAS A BACTERIAL STATIC COMPONENT TO THE INSULIN
AND SO IT PREVENTS BACTERIA FROM GROWING ON THE SYRINGE
AND SO THEY CAN REUSE AND REUSE THE SYRINGE
UNTIL THE NEEDLE IS JUST TOO DULL TO POKE THROUGH ANY MORE.
THE NEEDLES ARE NOT GOING LAST NEAR AS LONG AS THEY USED TO
BECAUSE THEY'RE SO THIN THEY'RE GOING TO JUST WEAR OUT, BUT THEY CAN USE THEM.
THERE IS A COUPLE OF THINGS THAT YOU WANT TO MAKE SURE ARE NOT HAPPENING.
AND THAT IS THAT THE CLIENT ISN'T CLEANING THE SYRINGE WITH ALCOHOL.
IF THEY'RE.. AS THEY'RE PULLING UP ALCOHOL TO RINSE IT AND CLEAN IT,
WHAT HAPPENS IS THAT ALCOHOL STAYS INTO THE SYRINGE
AND IT ACTUALLY THEN GETS INTO THE TISSUE AND BREAKS DOWN THE TISSUE.
AND SO THAT'S A BAD PRACTICE, THEY'RE BETTER TO DO NOTHING.
AND THE OTHER THING IS NURSES TEND TO WANT TO MAKE SURE THEY WIPE OFF THE NEEDLE
TO MAKE SURE THAT IT STAYS CLEAN.
HOWEVER, MOST OF THE NEEDLES ARE TREATED WITH THE SILICONE PRODUCT
AND THAT MAKES THEM HAVE AN EASY NICE SLIDE IN.
AND IF WE KEEP CLEANING THEM WITH ALCOHOL,
THEY FOUND THAT IT REMOVED THAT SILICONE BARRIER OFF OF THE NEEDLE.
AND THEY DIDN'T GET AS LONG OF USE FROM THEIR NEEDLE.
SO THEY'RE BETTER JUST TO GIVE THEIR SHOT,
PUT IT IN THE CAP AND STORE IN THE SHELF,
OR YOU COULD REFRIGERATE IT IF YOU WANTED TO AND THAT WILL KEEP BACTERIA OUT.
AND THAT'S THE RECOMMENDATION FOR SYRINGES.
YOUR CLIENTS IN THEIR HOMES SHOULD PUT THEIR NEEDLES,
IF THEY DON'T HAVE A SHARP'S CONTAINER, INTO SOME PUNCTURE PROOF CONTAINER.
SO LIKE A CLOROX BOTTLE OR SOMETHING LIKE THAT AND PUT ALL OF THEIR NEEDLES IN.
AND THEY'RE STILL LETTING THEM JUST DISPOSE THEM IN NORMAL TRASH,
BUT THEY'RE SUPPOSED TO BE IN A PUNCTURE PROOF CONTAINER.
NOW CLIENTS CAN THROW THEM IN THE TRASH,
HEALTH PROFESSIONALS CANNOT.
AND THAT'S THE DIFFERENCE RIGHT NOW AS FAR AS BLOOD AND BODY FLUIDS.
WE HAVE TO DISPOSE OFF OURS APPROPRIATELY
AND SO WE HAVE, KIND OF, TO TAKE THEM TO THE APPROPRIATE INCINERATORS
OR BACK TO YOUR FACILITY TO HAVE THEM DISPOSED OFF.
OKAY.
I THINK I HAVE HIT THE GIST OF IT.
THERE IS A NEW INSULIN THAT'S COMING OUT. IT'S A 24 HOUR INSULIN.
I DON'T KNOW THE NAME OF IT AND WE WILL BE HEARING MORE ABOUT THAT.
THEY WERE ACTUALLY USING IT IN EUROPE.
IT'S JUST COME TO THE STATES IN THE LAST FEW MONTHS
AND I GUESS ITS BEEN WORKING PRETTY GOOD, ESPECIALLY FOR CLIENTS THAT ARE HARD TO MANAGE.
ALRIGHT. LET'S DOCUMENT.
AND IT'S NOW 8 O'CLOCK IN THE MORNING,
I AM GOING.. OH, 7:30.
JUST GIVEN OUR INSULIN, SO.
07:30.
I GAVE THAT IN THE LEFT LOWER ABDOMEN, LLA.
LLA, DB. OKAY.
AND PUT IT IN THAT ORDER, TIME, SITE, INITIALS,
SO THAT WE CAN DISTINGUISH BETWEEN THE TWO.
IT GETS A LITTLE... INITIALLY SOMETIMES
WITH ALL THAT STUFF IN THAT LITTLE SQUARE.
ALRIGHT.
NOW, AS FAR AS PRACTICING AND STUFF,
THERE IS JUST A COUPLE OF GUIDELINES WE WANT TO GIVE YOU.
WE HAVE TWO DIFFERENT KINDS OF TABS FOR YOU TO PRACTICE IN.
ONE HAS THIS NICE LITTLE LABEL THAT SAYS, 'INJECT AIR ONLY'.
WE WOULD APPRECIATE YOU JUST PUTTING AIR IN THESE
BECAUSE THEY GET MOLDY AND THEY GET NASTY AFTER A WHILE.
AND SO IF YOU JUST USE SOME OF THEM FOR AIR, THEN THEY WILL STAY GOOD.
AND THEN WE HAVE SOME THAT ARE DESIGNATED AS NOTHING.
AND YOU'LL SEE THESE AND THEY'RE STARTING TO GET OLDER AND ICKIER.
AND WE PUNCHED HOLES IN THE BOTTOM OF THEM
SO THAT WHEN THE FLUID COMES OUT THEY ACTUALLY, KIND OF, LEAK THROUGH.
AND WE HAVE THEM SET ON TOWELS AND ON CHUX,
AND SO YOU CAN DRAW UP YOUR SOLUTIONS OR WHATEVER
AND THEN PUT THEM INTO THESE,
IF YOU WANT TO GET THE FEEL OF REAL LIQUIDS.
THERE'S PADS EVERYWHERE, WE HAVE THEM ON CARTS
AND WE STICK THEM IN STOMACHS AND THEY'RE JUST EVERYWHERE.
SO BE SURE TO PRACTICE ON THOSE.
ONE OTHER THING I JUST WANTED TO MENTION AS FAR AS SPEED OF GIVING AN INJECTION.
I WORKED PEDS WHEN I FIRST STARTED DOING NURSING.
AND I WAS TEACHING THIS LITTLE FIVE-YEAR-OLD HOW TO GIVE INSULIN
AND I WAS.. I FELT A LITTLE INTIMIDATED,
OH, TEACHING A LITTLE FIVE-YEAR-OLD HOW TO GIVE INSULIN, YOU KNOW,
BUT SHE'D BEEN GIVEN IT FOR A WHILE.
AND I WAS SUPPOSED TO OVER TECHNIQUE WITH HER AND SO FORTH.
SO SHE DREW UP HER SHOT AND SO WE WERE GOING OVER HOW TO GIVE IT.
I SAID, "OKAY. NOW HOLD IT LIKE A PENCIL AND JUST DART IT IN."
AND SHE LOOKED AT ME AND SAID, "NO."
"WHAT DO YOU MEAN NO?" "I'M NOT DARTING IT IN."
I SAID "WELL, YOU GOT TO. YOU GOT TO GET IT IN. IT WON'T HURT SO MUCH."
SHE SAYS "NO." WELL, YOU KNOW, IF YOU HAVE EVER TALKED TO A FIVE-YEAR-OLD,
NO IS NO AND THAT'S ALL THAT'S GOING WITH THAT.
AND I SAID, "OKAY, WELL THEN YOU SHOW ME HOW YOU ARE GOING TO DO IT."
SHE TOOK THAT LITTLE NEEDLE.. I DON'T KNOW IF I HAVE MINE.
AND SHE JUST TOOK IT AND SHE GOES.
AND SHE JUST PUSHED IT IN AS SLOW AS YOU COULD EVER PUSH A NEEDLE IN.
AND I LOOKED AT HER AND I SAID, "OH, DOESN'T THAT HURT YOU?"
AND SHE GOES, "NO. IT'S STUCK."
I SAID, "ALRIGHT." SHE GAVE A LITTLE SHOT AND PULLED IT OUT.
WELL, FROM THAT TIME ON I STARTED WATCHING MY CLIENTS PUT THEM IN.
AND KIDS, ESPECIALLY, BECAUSE I WORKED WITH KIDS FOR A WHILE.
AND SLOW, FAST, IT DOESN'T MATTER.
AS LONG AS YOU GET IT IN AND THEY SAID IT DIDN'T HURT.
THEY DIDN'T LIKE DARTING IN. AND WHEN YOU ARE DOING IT TO YOURSELF,
IT'S, KIND OF, HARD TO WHAM YOURSELF, YOU KNOW?
BUT.. AND IT JUST DIDN'T SEEM TO HURT THEM AT ALL.
AND THE NEEDLES ARE SO THIN AND SO SHARP
THAT YOU DON'T REALLY HAVE TO BE ALL INTENT ON THAT..
KIND OF THING.
ALRIGHT? - IS THERE A FAST MIX?
- I JUST DO MODERATELY. I DON'T PUT IT IN REAL FAST
BECAUSE I JUST THINK IT WOULD BE UNCOMFORTABLE.
BECAUSE YOU ARE PUSHING FLUID THROUGH THAT TINY LITTLE GAUGE SO JUST STEADY.
OTHER MEDS THAT MIGHT BURN OR SOMETHING, I WOULD GO SLOW
BUT THESE TWO MEDS NOT IN PARTICULAR. JUST STEADY, IT'S FINE.
ANY OTHER POINTERS FOR US?
ALRIGHT.
- AT OUR FACILITY WE DISPOSE OF ALL THE MED VIALS
IN THE SHARP'S CONTAINER SO NOBODY CAN RETRIEVE IT.
- MM-HMM. - AND THAT YOU DON'T, LIKE, RISK BREAKING IT
AND THEN HAVING SOMEBODY TO PICK THEM UP.
AND ALSO, LIKE, IF YOU DON'T HAVE THE BARREL,
THE SAFETY GLIDER OR WHATEVER,
IF YOU PULL OUT A NEEDLE AND THERE'S, LIKE, PEOPLE AROUND YOU,
I JUST LIKE FIND IT EASY TO JUST SAY IT OUT LOUD.
LIKE, I HAVE A DIRTY NEEDLE, SO PEOPLE STAY OUT OF YOUR WAY.
IT'S A GOOD IDEA.
KIND OF, LIKE WAITRESSES, "CORNER."
YOU KNOW, DIRTY NEEDLE.
BUT YOU DON'T WANT TO WALK DOWN THE HALLS, YOU KNOW, "DIRTY NEEDLE."
ATTENTION IN THE ROOM, SO THAT'D BE A GOOD THING.
ABOUT VIALS IN THE SHARP'S CONTAINER, THAT'S TOTALLY A POLICY OF THAT HOSPITAL
BECAUSE OTHER HOSPITALS YOU WILL GO TO WILL BE UPSET ABOUT THAT.
THEY DON'T LIKE THE EXTRA WEIGHT.
BECAUSE THEY'RE CHARGED BY WEIGHT ON THEIR SHARP'S CONTAINERS.
SO DO WHATEVER THE HOSPITAL SAYS.
I MEAN, I COULD CARE LESS ONE WAY OR THE OTHER, WHATEVER THEY WANT.
BUT I'VE BEEN IN HOSPITALS. MAN, THEY WOULDN'T LET US
PUT ANYTHING IN THERE BUT NEEDLES, PERIOD BECAUSE OF WEIGHT ISSUES.
THEY WERE TRYING TO CUT DOWN IN THESE DAYS OF COST CONTAINMENT.
THERE'S ALWAYS DAYS OF COST CONTAINMENT.
THANK YOU, GOOD POINT.
ANYTHING ELSE?
ALRIGHT, SHOTS ARE FUN. MAINLY BE CAREFUL.
PULL THOSE APART, BE CAREFUL. IF YOU STICK YOURSELF -- LET ME JUST DO THIS ONE OTHER THING.
IF YOU STICK YOURSELF IN THE LAB,
OUR NEEDLES OBVIOUSLY ARE NOT BLOODY.
BUT ONCE YOU'VE STUCK YOU, THEN IT IS BLOODY.
SO MAKE SURE THAT THAT GETS PITCHED.
MAKE SURE YOU SCRUB YOUR HANDS AND THEN CONNIE AND I WANT TO KNOW,
ONE OF THE TWO OF US, IT DOESN'T MATTER.
AND WE'RE GOING TO SEND YOU OVER TO HEALTH SERVICES TO MAKE SURE
THAT YOU GET REPORTED IN, IN CASE THERE'S A PROBLEM.
AND YOU CAN GET FOLLOWED UP THROUGH THE SCHOOL
SO WE JUST WANT TO MAKE SURE ITS REPORTED FOR YOUR SAKES.
OKAY? SO BE CAREFUL.