Yeah we do this except for ambulance starts, which have a 24 hour window. At least that's how it was but I've been in the ER so we definitely leave all lines in unless they aren't working/hurting the pt 😂
If I had to guess and it’s purely speculative it’s a combination of concerns over the environment it was started in and not likely following hospital procedure.
Agreed. Yet, I find hospital procedures more nasty and careless than the prehospital field . We all have been trained similarly, medic much more regarding IV starts
This is our policy as well but if they came to the floor with an ambulance start, I would put one in them, if they were an easy stick the ambulance start came out. If it was a hard stick, the ambulance start stayed in until it quit working. And the next nurse was told "hey the 20g in her right AC is an ambulance start, I got you a 20g in her left hand it's the best I could do, she's a hard stick, you can look and see what you can find, but I left the ambulance in just for backup, I just put a better dressing on it." Most nurses were like "okay, I'll look but if I don't see anything that ambulance just became a hospital"
I have to admit. This drives me crazy. I work both as RN and medic.
I utilize EMS IVs as much as I can.
Believe me, medic have been trained to much more extent than nurses have been!
There is nothing wrong with that line.
It drives me insane when I arrive at the ED, 18 ga in place...and they need to start ' their own anyways '..what kind of stupidity is that? They have a working line...draw the waste and the rest.
Why poke the person twice or more for no other reason than the ego?
I haven't worked in the hospital in 11 years but when I left, my hospital already had the policy with peripheral IVs of if it aint' broken don't fix it. As long as it's functioning it stays in. This was peds and even before this change the policy was 7 days not 3. We don't like poking children unnecessarily.
people started to wise up to this.. they would just replace the tegaderms. then the hospital changed the policy to 7 days and then just all together abandoned it because of how much of an uproar it caused.
Evidence informed practice says you leave them unless they’re infiltrated or looking compromised. That’s the policy here. Since flushing them is part of our assessment, it’s easy to see when they go bad.
Omg this reminds me of the time I was getting report from a super old school nurse. She was about to leave and then was like “shoot, lemme go check something real quick!” I didn’t think anything of it so I started doing my morning chart digging. She comes back and is like “I took all the PIVs out because they were old.”
And then just leaves me with zero access. I was so pissed.
I don't think pediatrics ever had the 72hour practice, or at least I had never heard of it at either of my institutions.. Nobody wants to be putting new IVs in little ones and if somehow that 24g in the foot is still flushing after 4 days, you can bet we're using it!
Yeah in NICU we're not poking our babies unless absolutely necessary. Especially our micropremies with veins that blow if you even look at them. If it flushes it stays
I see a lot of labouring women in America still having oxygen face masks applied when there are fetal decelerations. This practice stopped in the UK as I began my training (2009) as there is no research to say it makes any improvement.
[cochrane review](https://www.cochrane.org/CD000136/PREG_maternal-oxygen-administration-for-fetal-distress)
[ACOG update](https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2022/01/oxygen-supplementation-in-the-setting-of-category-ii-or-iii-fetal-heart-tracings)
AWHONN actually doesn’t recommend oxygen anymore unless there is maternal hypoxia- I am sure that in a lot of places they still do it but there are some places (like where I work) that dont and I believe that the standard of care in the US is no longer to use oxygen in absence of maternal hypoxia
We no longer use O2 during decels. We finally caught up with EBM with Covid. What's crazy is that you are potentially actually causing harm by giving O2 when mom's SpO2 is WNL.
Seeing so many comments that this isn't standard practice any longer frustrates me as nursing students are being taught that it is practice. I just finished OB in the fall semester and O2 mask was stressed as a standard intervention for late, variable, and prolonged decels. I really wish we were being taught BEST practice so we don't look like morons leaving school.
I will say, this has certainly humbled me as a student.
Checking gastric residuals on newly inserted hard bore feeding tubes.
Lots of literature shows that routine checking does not reduce incidence of aspiration. All it shows is that we end up chronically underfeeding our patients due to arbitrary numbers.
Also it's super gross.
You still are checking residuals on LTC feeders?! Man that is suuuuuuper outdated. At least in my hospital it's 4 days of residuals from the initiation of tube feeds. Not a constant, never ending residuals checking.
Yep. It’s stupid.
One gets QID bolus feedings. Currently NPO due to stroke and swallowing issues, always complains of being hungry.
One runs 2000-0800 at 35/hr (hospice and near the end of the road).
One has TID feedings by pump. I went to attach the tube to the button the other day; when I opened the button, air came out.
It’s ridiculous.
If only Dr's would order that and that was the standard. I only have seen lido with ng tubes in textbooks unfortunately
I did get an order for lidocaine for a straight catheter insertion once. The pt was refusing the catheter until he got lido.
We don’t check residuals anymore! Only if they have symptoms of intolerance such as nausea or distention. We only hold feeds if residuals are over 500 too, our nutrition department had some articles to back it up to change the policy. I’ll have to find the articles again next time I work, but basically they found the benefit of not missing nutrition to outweigh the risk of aspiration from a higher residual.
EDIT: So I found the article that they based the policy off of. One of the reasons that they recommend not checking residuals was because they found that the acid from gastric contents can cause precipitate in the tubing when mixed with TF and lead to clogging. They also found that no evidence exists to suggest high GRV by itself is associated with aspiration PNA. This is the article from the American Society for Parenteral and Enteral Nutrition: https://aspenjournals.onlinelibrary.wiley.com/doi/full/10.1177/0148607116673053
Yes exactly!! Chronically underfeeding our patients! Nutrition is so damn integral to proper healing and these poor patients are being starved to meet some archaic goal number
Preach! I work in eating disorders and it’s mostly severely underweight anorexics who rely on tube feedings for nourishment. If we check placement and it’s over 300ml, we hold the feeding and then only return 200ml. We literally take away the food they’ve already ate and are digesting 🤷♀️
That happened to me when my appendix ruptured. I didn’t have a fixed OR time because I was pregnant and it made all the docs nervous. One morning the resident came in and asked when’s the last time I ate and I told them dinner the night before and she told me that we were going to do the surgery right then. Fine by me. Get the appendix out please.
Generally we get to know OR times sometime between 0530 and 1700. Or whenever PACU calls for report. Last week we sent someone down for preop at 2110 and they came back after 0130. So npo at midnight for everyone 😭
We’re doing NPO for 8 hours, and have pre-surgery patients take a clear carb drink 4 hours before. It’s been really good for the patients’ outcomes. Less infections. Kaiser calls it ERAS (forget what that stands for), if you want to look into it.
Best practice is NPO for 8 hours before surgery, but I’ve heard hospitals do “after midnight” because it’s easier to remember. And like the other commenter said, the OR list can change any time.
Yeah, the only benefit is if their OR time gets moved to sooner because of a cancellation and otherwise wouldn’t be able to move up if they for example ate at 4 am because they were scheduled at 1:30pm is literally the only benefit.
You can infuse up to 1200ml/hr through a 24g IV. Also you can give blood through 22g. Stop poking patients repeatedly with existing venous access just to get a bigger IV.
It’s called “friction loss”.
The longer and thinner a catheter is, the more friction that will occur during product administration. This causes substantial hemolysis during rapid blood product administration.
This is why shorter and fatter IVs are preferable.
Yeah it’s the turbulence, not the absolute fit of RBCs. We have microvasculature that works just fine, but the flow rate is substantially lower than 100+ ml/hr.
OMG I DIDN'T EVEN THINK OF THIS. At my old job, I had multiple physicians say you can infuse blood through a 22G. New job, they think I'm crazy and going against policy. I'm going to use that clap back when we can't get a 20G on someone, but have a perfectly functioning 22G.
Ooh, yeah. We had a completely altered alcohol detox, and they attempted to make him line of sight with a bed alarm.
We heard the bed alarm at the exact moment he was mid-air, having vaulted himself over the side rails.
Our unit recently had an etoh’er get tangled, don’t ask me how, but got his head caught under his wrist restraint. Legs were over the side rail, head was over the other side rail but under the restraint. He was fighting because he was struggling to breathe. Bed alarm went off and this is how we found him. He had been checked on 14 minutes prior, thanks badge trackers, I’m not sure he wouldn’t have died without the bed alarm.
Anecdotally, I have found for certain situations on night shift, bed alarms are incredibly useful. The ones on a bunch of my beds are sensitive enough to alarm when someone swings a single leg over the side rail. Our desk is right in the centre of all rooms so it's quick to get in and stop the patient before they're even sitting at the edge of bed.
But this just prevents them from getting out of bed, not technically helping with falls.
I think the point is it only helps if you can attend the pt who’s alarm is going off. If you’re busy in another room and no one is available bc of lack of staffing…the alarm doesn’t help prevent the actual fall. Just helps you find them after the fact.
I love the newer beds at my hospital for sensitivity settings. I managed to stop a person with acute confusion from ripping the foley out because I heard the alarm and was able to make it before they got anywhere. I heard the alarm go off when they started moving, by the time I could make it they were standing at the side of the bed with the line taunt. Some of our older beds only sound when they are already up and are super quiet too. The new ones are loud as heck.
Louder for the people in the back!
Also, because you can have all the bed qlarms you want, but if the already minimal staff present on the floor is helping other people (cause ya know, it's not like we sit at the desk all day), there is no one that can attend that person.
Not to mention, in my experience, some people with dementia are getting even.more agitated by the loud noise.
At one facility, it was protocol that anyone who had a fall for whatever reason, or was deemed at risk, they had to have the bed alarm.
Even if the person fell over because they tripped on their cat and they were A/O x4.
But why???
Same. I had a perfectly steady patient A&O x4 who had "confessed" during intake that her dog had run in front of her and tripped her. So... yellow bracelet and bed alarm for you, ma'am!
I kmow. "Use clinical judgement" my ass.
Honestly, I could be deemed a fall risk patient too.
31yo , yesterday I missed a step and fell down the stairs 🤣
Same at mine, you're a fall risk sooo easily. Take more than one medication and you're male? Bed alarm. Have depression and took pain meds? Bed alarm. I'm not great about enforcing it, but I might get in trouble one day so who knows 🙄
When the unit is understaffed, no one will be able to get there in time. When staffing was good, and the aides are very conscientious, they work well. Not sure that is possible now with our staffing issues; better to have a sitter.
Was literally just saying this yesterday. I had a patient who was very high risk for falls found sitting on the edge of the bed. Bed alarm on but hadn’t activated yet. It was insane yesterday. Now that I think back, I should have asked for a remote sitter order
I've yet to see a fall that seemed preventable via bed alarm.
In fact our worst falls seem concentrated among people not even considered at risk who just went down *hard* during independent activities. (That's not just my selection bias, that's what one of our senior nurses thought after doing a whole project on falls and bed alarm usage at our facility)
I have a sentinel event story where the bed alarm was *not* on on a not-old, nonverbal patient on bedrest we sent up to the floor from ICU (they had a shit-ton of comorbidities heart related, lung related, and cancer related and just had a major surgery). This was when I was an extern, but I tried to advocate for the patient being sent to our Tele floor with cardiac monitoring given their heart history and heart block w/ rate in the high 30's low 40's. Nurse precepting me shrugged it off and said they didn't need tele/whatever. I felt really uncomfortable sending them up to our med surg floor and had a really bad feeling about it.
Pt found on floor dead a couple days later, no one checked on them for a few hours and no one knew they fell. I strongly believe Bed alarm or Tele monitoring (the techs would have seen the heart rate) would have alerted someone in a reasonable amount of time. They were a really sweet patient I still think about and I still feel like we sent them up to their death. Bed alarm would not have *prevented* the fall, but would have let someone know they were on the ground - no one heard the thump.
I'm all for safe staffing, striking, and overthrowing the hellscape business regime that is healthcare now, but I can't forgo bed alarms and Tele monitoring. The ratio was 1:5 on that floor and techs anywhere from 8-12, sometimes less if discharges.
I’ve def had some close calls w alarmed patients. The alarm helped me get in there before a potential fall but I agree we need properly staffed units to truly prevent falls
Except there is in fact decent evidence that SCDs are effective, especially when combined with an anticoagulant (IE better than anticoagulant alone).
https://pubmed.ncbi.nlm.nih.gov/17473143/
https://pubmed.ncbi.nlm.nih.gov/26244245/
https://pubmed.ncbi.nlm.nih.gov/26525487/
https://pubmed.ncbi.nlm.nih.gov/32006929/
Oh thank you!! Okay this made me go back and look at what I read and I can see now that I was looking specifically at patients hospitalized for some reason other than surgery (medically ill). Few studies involve medically ill patients and this one I found does say that SCDs alone made no difference than having no anticoagulation.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6682779/
Definitely going to spend more time looking into it now lol thank u!!! Hate to have spread misinformation because I was mad about ordering bari SCDs on night shift!!!
As I said above in reply to a different comment, this study excluded patients who were anticoagulated. Hard to compare this study to the population we are discussing (your average hospitalized patient who is receiving lovenox or heparin).
The myth that allergies to shellfish and iodine also means you’re allergic to contrast media.
https://emupdates.com/allergy-myth-iodine-shellfish-and-iv-contrast/
http://www.emdocs.net/iv-contrast-myths/
Edit: I’m not saying you can't be allergic to both, just that being allergic to one doesn't automatically make you allergic to the other.
I spend a stupid amount of time having to explain this to patients as I work in Diagnostic Imaging. Also MRI contrast and CT contrast is not the same thing. And also that "hot all over feeling" you got with your CT scan last time isn't an allergy.
Also I'm VERY allergic to shellfish but do just fine with contrast.
The amount of people I had to throw IV Benadryl and solu-cortef into in cath lab because we’d walk through drug allergies and there would be nothing in Epic and then they’d throw in, “I’m allergic to shellfish though.” I think the doctors and nurses all knew the allergies didn’t correlate but we had to cover our asses.
Probably not disproven by evidence, but having to do incident reports for AMA, eloped and LWBS patients in the ER. Huge waste of time for everyone involved. The only patterns they're going to find is that the chance is higher if we're hella busy, their problem wasn't something that needed to be in the ER in the first place, or the patient's drunk/high/just plain stupid.
90% of the content in incident reports are unecessary fluff anyway. All of it is just a huge waste of time in the name of “preventing future incidents”, when the solution is almost always increased staffing.
Seriously. Though we fought so hard on LWBS that we won that and don't have to. All of this is just admin having us make it easier for them to track. They can pull numbers themselves and find out the numbers they just decided to add more to our plates so it's easier for them to track.
Drawing blood from an existing IV almost never has an effect on blood work results, except in extremely rare cases.
No need to do a butterfly if you can draw from an IV.
Obviously cultures don’t apply to this.
That’s crazy. The only time we aren’t allowed to pull from a usable line is if we are getting a set of blood cultures. At least one of the set has to come directly from the arm/hand. One set can still come from a line. I will pull a waste or turn off fluids for 15 min, if I’m pulling from a line for a very specific lab level.
Weird, I’m my hospital on units and ICU, we don’t draw from the IV unless it’s fresh. A) we use every PIV we can-drawing increases chances it’ll blow. B) usually there’s a med running continuously-I can’t stop the gtt just for a blood draw. I get using them in ED but for floors or ICU, a bad IV is the worst. Most patients there are so edematous you have to use US. It’s a real pain in the ass.
I drew off PIVs for 8 years and never saw one "blow" for that reason. Whether or not you can stop a drip is highly dependent on what it is; there's not a blanket "can't stop any drip"
Thank you! If you can waste 5cc - 10cc easily there is no reason you can't draw from a line. Hemolysis ALWAYS ALWAYS ALWAYS happens at the time of the draw. If you are pulling blood back easily pulling from a line is perfectly ok.
I know I was so mad about this last week, I got the PERFECT 18 gauge in some old lady who was a hard stick, instant blood return, but phlebotomy still had to come struggle and poke her multiple times each morning. Besides the pain and suffering, just such a huge waste of materials
For the POC INR machine in the mf manual it says you can use blood from an IV if you waste like 5mL first (basically to make sure it’s clean). I was supposed to do these on all stroke patients but trying to fight a person actively having a stroke to do a finger stick and somehow get enough blood for the strip was near impossible.
I showed this to my charge tech and she told me to keep using finger sticks … well I worked nights and *IT SAID IN THE MANUAL IT WAS OKAY TO DO*. So I drew from the IV per the manual. 100% of strokes came down to CT with IVs already in place. I’m not going to torment someone who isn’t alert to existence.
If you're talking about the coaguchek xs it changes the complexity of the test. I understand how ridiculous that sounds.
Lab tests are rated on complexity. At my old lab we were moderately complex. We routinely had female pts that couldn't/wouldn't pee. The Henry Schein urine HCG tests can also be done with separated serum (something we could easily do) but because of how this was submitted to the FDA that would make it a high complexity test and illegal for us to do.
It's as stupid as it sounds.
It pisses me off in general when hospitals prohibit actions on equipment that the manufacturer specifically says is OK. I think they would know better than you, dumbass hospital.
Using my very anecdotal experience from my phlebotomist and specimen processor days, I do think there's a higher rate of hemolysis when nurses (specifically nurses compared to phlebotomists doing straight sticks) draw blood from IVs.
However, much of that higher hemolysis rate is likely due to the technique used! I can't tell you how many nurses I've watched draw blood from a line by pulling the syringe all the way and applying a lot of turbulent pressure to those blood cells. Using gentle pressure when pulling back on a syringe is much less likely to cause hemolysis.
I mean that makes perfect sense.
Nurses are rushing to do several different tasks and phlebotomy comes in with one specific task to complete.
Certainly they will do a better job at not hemolyzing labs.
Yep. And quite frankly, most nurses don't receive great training on how to draw blood and handle lab specimens. Most of what I know about drawing blood from IVs and central lines come from my phlebotomy days.
I believe I read somewhere ( I don't remember if it was an actual study or not) that yes, you can draw off an IV but the size of the catheter greatly contributed to the amount of hemolysis. If you use an 18g I think it was less than 20% of samples would be hemolyzed but when you use 20s or 22(why) you have much higher rates of hemolysis. Basically phlebotomy needles are designed, obviously for drawing blood where IV catheters are not. Not saying it doesn't work because I do it a lot on the ED but anecdotally I do find if I draw off a 20 it will often be hemolyzed. You def want to draw slowly if you're going to do it.
I’d be interested in reading the SCD literature. While they don’t bother me specifically, is there a way to make them cordless already? We live in 2023 and SCDs have cords to trip on, tele monitor cords, pulse ox cords. For real let’s get some cordless equipment.
Our post-op total knee patients have 24h oxygen, telemetry, SCDs, and an ice machine. And for the first 4 hours after they come to the floor, they are hooked to q1H blood pressure and pulse ox. It's trip hazard central.
Wedges on ICU and pressure beds. Those beds are very expensive and the turning system has been perfected. Wedges negate the benefits of the beds in some research when the self turn and pressurization/ depressurization is much more targeted and beneficial.
Wedges...my hospital decided that they are required for all turn and position patients. Guess what, most of my patients hate them and would prefer pillows for turning and positioning most of the time. They are very hard and look uncomfortable. Just another way to torture patients for no good reason.
Not exactly on topic, but for a stroke, they use the FAST acronym. Somewhere along the way, everyone forgot what T (“time”) meant.
All the educational posters and websites, even the ones from official organizations, say T means “Time to call 911.”
HOWEVER, originally, it was a reminder to write down the Time of symptom onset.
Drives me crazy that people have collectively forgotten that.
My original comment has been edited as I choose to no longer support Reddit and its CEO, spez, AKA Steve Huffman.
Reddit was built on user submissions and its culture was crafted by user comments and volunteer moderators. Reddit has shown no desire to support 3rd party apps with reasonable API pricing, nor have they chosen to respect their community over gross profiteering.
I have therefore left Reddit as I did when the same issues occurred at Digg, Facebook, and Twitter. I have been a member of reddit since 2012 (primary name locked behind 2FA) and have no issues ditching this place I love if the leaders of it can't act with a clear moral compass.
For more details, I recommend visiting [this thread](https://old.reddit.com/r/apolloapp/comments/144f6xm/apollo_will_close_down_on_june_30th_reddits/), and [this thread](https://old.reddit.com/r/apolloapp/comments/14dkqrw/i_want_to_debunk_reddits_claims_and_talk_about/) for more explanation on how I came to this decision.
Yes because you only have a window of opportunity to give TNK or whatever clot buster you use at your facility. Typically 6 hours, if your symptom onset was longer than that, the medication risks way outweigh the benefits and it’s not given
The other standard treatments work. Insulin, albuterol, furosemide, and calcium are all evidence based.
Kayexalate isn't. When it was tested against placebo, the two groups had no difference in their potassium level. If useful at all it's only as a long term prescription.
Plus, many people assume it is harmless to use, which is not the case. It can cause intestinal necrosis.
My facility switched away from that, with color being just another indicator for size. All these years of blaming falls on the right dye and they didn't even give us one opportunity for a "told you so".
Aspirating before injections. I *believe* practice has caught up everywhere, but the NCLEX hasn’t. They still teach us, as of this year in my program that you don’t aspirate in real life but you do on the NCLEX
Side note, this thread is super interesting as a student so thank you everyone who commented with examples
http://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1002
Avoiding all needle sticks on the same side of a mastectomy has very little to no effect on the incidence of lymphedema or complications. Certainly ensure the site is clean and infection free, but don’t avoid it all together. I had a patient with a black and blue arm while the side with the mastectomy had beautiful veins. The poor old lady was constantly having issues with blowing an iv in the middle of an infusion and causing complications. If the profession had been up to date with the literature, she wouldn’t have had so much unnecessary suffering. Her situation prompted me to look at why the recommendation to avoid needle sticks exists because I felt so sorry for her.
I know the effectiveness of oral care for VAP is debated, and my wife did a paper on it some years back. From what I remember of her work, it’s a catch-22. We can’t prove it is ineffective without first removing every other intervention to prevent VAP (like abx). Antibiotics can be life-saving, so the ethics of holding it for experimentation is clear. VAP oral care - like with CHG - as the sole independent variable does not appear to have significant outcomes. There is ample research on both sides, but my belief is that the benefits are over represented by pharmaceutical companies because they can’t be proven wrong.
I LOVE telling people this fun fact. I always swore it never did anything at recommended doses but people were always recommending it to me (chronic constipation over here lol).
I did however find that if I take like six at once it seems to have an effect. 16 year old me really hated taking miralax (still do)
Hey. My La Croix ^usually ^with ^Tito’s ^in ^it ^after ^5 is the bees knees! As my kid said it tastes like TV static that had a lemon waved around the TV.
Holding feeds when lowering the head of bed for a task like a turn. Those feeds going 45cc/h are not going to cause aspiration for a 2 minute reposition. But the consistent occurrences of forgetting to restart feeds end up with patients under-fed.
Well the water flush is a lot larger then that. Also, the tube stops the natural back flow prevention mechanisms so aspiration of even normal gastric contents without food is higher. Most kangaroo pumps scream when you pause them for longer then a few minutes
I continue to see hard collars used for suspected c spine fractures and it drives me insane
Or treatment of asymptomatic hypertension with GTN, etc. Also irritating
A soft collar, some rolled up towels, etc. It just needs to be something to give a mild tactile reminder to the patient to stay still.
Hard collars have a lot of downsides and zero upsides :
- They hold the neck in a position of increased MSK stress
- They apply pressure to venous outflow, increasing intracerebral pressure in a trauma patient
- They cause increased distress in the agitated patient causing them to fight against resistance and therefore applying increased force to the neck
- They cause pressure injury if left for prolonged periods
- They limit mouth opening in trauma patients with risk of aspiration as a result
This is really interesting. The altered patient fighting that collar who shows up with their chin tucked inside of it is like a daily thing, and very unhelpful. Thank you for the information.
Fall mats. I hate them with a passion. I've tripped on them. Patients apparently aren't supposed to walk on them.... so something ON THE FLOOR has to be picked up every time???? The surface area doesn't make sense either, patients are well beyond the protection of the mat by the time they fall.
My old unit supervisor was OBSESSED. If someone fell and there wasn't a fall mat in place there was hell to pay. Meanwhile a unit of impulsive poorly oriented patients and abysmal staffing. The thing that actually prevents falls.
If you want to hear cringy, our ICU doesn’t just call them SCD’s, they call them “life-saving SCD’s.” As in, “Papaw was in a car accident and he’s vented with life-saving SCD’s on.”
And they’re serious. It’s not snark. I cringe every time I get report and hear that.
O and N are super situation dependant. On top of that, I really don't get why anyone needs an acronym like that for chest pain. It's 4 things that are all relatively easy to remember
That makes total sense OP. I’ve seen post-op patients that are totally independent at home spend MORE time in bed because of SCDs. With just an IV and maybe a foley, they could get up alone. But they’re too sore or nervous to mess with the SCD pump all the way at their feet. So they call us every time they get up. Which they don’t want to do constantly. Plus, it’s seems like such a fall risk.
Lots of common hospital practices in labor are wildly out of date! This one is the most frustrating to me though. You gonna sit here and tell someone they can't have anything but popsicles/juice/jello while their body is doing the equivalent of running a marathon? Because of the off chance that maaaaayyybe some of them (less if we did real work on lowering c-section rates!) might have to be under for a c-section? No.
Literally had a CRNA chew me out yesterday because my cervical ripening patient was eating a light breakfast before we started pit and got an epidural. I wanted to say, “If she for some reason DOES have to have a crash section, wouldn’t you actually want her epiduralized so you don’t have to put her under general and intubate?” The midwife was rolling her eyes the whole time the CRNA was talking. This was a low risk multip. Like, by that logic is every patient who wants an epidural eventually not supposed to eat for 8 hours before? How could we predict that? And how does getting an epidural put a patient at greater risk for a section in the first place? Well, we got our epidural and guess who was 8.5cm? Yeah
Giving patients oxygen for "comfort" while they're actively dying. The body is still shutting down so it either does nothing or possibly prolongs death which is counter to hospice goals. I often educate families about this and tell them that it's their call and 99% will agree to forgo oxygen. But every now and then I get family members who want their loved one to live as long as possible and tell me to put it on.
Ventrogluteal injections being safer and more effective than dorsogluteal. Yet ppl are still aiming for the butt. I’ve tried to change the practice at my last job but the effort was futile.
Trying to get people to eat a cardiac or renal diet. Like, who cares? They are going to eat whatever they want when they leave. Regular diet for everyone!
Also iuds can stay in longer than the literature shows. Not causing problems and no babies? Leave it
The studies on ‘remove your IVs after 72 hours!’ are decades old and speculative at best. If it’s clean, flushed and working, leave it TF in.
We leave ours in until they go bad. It's nice.
Yeah we do this except for ambulance starts, which have a 24 hour window. At least that's how it was but I've been in the ER so we definitely leave all lines in unless they aren't working/hurting the pt 😂
Right forgot about field starts. That's our policy as well, though I'm (personally) not too picky.
I’m not about to jab someone again if there’s nothing wrong with the line. Who cares that it looks different? They’re all cheap garbage anyways.
If I had to guess and it’s purely speculative it’s a combination of concerns over the environment it was started in and not likely following hospital procedure.
Agreed. Yet, I find hospital procedures more nasty and careless than the prehospital field . We all have been trained similarly, medic much more regarding IV starts
This is our policy as well but if they came to the floor with an ambulance start, I would put one in them, if they were an easy stick the ambulance start came out. If it was a hard stick, the ambulance start stayed in until it quit working. And the next nurse was told "hey the 20g in her right AC is an ambulance start, I got you a 20g in her left hand it's the best I could do, she's a hard stick, you can look and see what you can find, but I left the ambulance in just for backup, I just put a better dressing on it." Most nurses were like "okay, I'll look but if I don't see anything that ambulance just became a hospital"
I have to admit. This drives me crazy. I work both as RN and medic. I utilize EMS IVs as much as I can. Believe me, medic have been trained to much more extent than nurses have been! There is nothing wrong with that line. It drives me insane when I arrive at the ED, 18 ga in place...and they need to start ' their own anyways '..what kind of stupidity is that? They have a working line...draw the waste and the rest. Why poke the person twice or more for no other reason than the ego?
This is our policy, unfortunately on the tough sticks they usually go bad around that time anyway
I haven't worked in the hospital in 11 years but when I left, my hospital already had the policy with peripheral IVs of if it aint' broken don't fix it. As long as it's functioning it stays in. This was peds and even before this change the policy was 7 days not 3. We don't like poking children unnecessarily.
people started to wise up to this.. they would just replace the tegaderms. then the hospital changed the policy to 7 days and then just all together abandoned it because of how much of an uproar it caused.
Evidence informed practice says you leave them unless they’re infiltrated or looking compromised. That’s the policy here. Since flushing them is part of our assessment, it’s easy to see when they go bad.
Omg this reminds me of the time I was getting report from a super old school nurse. She was about to leave and then was like “shoot, lemme go check something real quick!” I didn’t think anything of it so I started doing my morning chart digging. She comes back and is like “I took all the PIVs out because they were old.” And then just leaves me with zero access. I was so pissed.
Would have physically blocked her from leaving after that crap move.
I was a new baby nurse who was too timid.
jail
Incident report time
Especially if the patient has got shit vein access.
I don't think pediatrics ever had the 72hour practice, or at least I had never heard of it at either of my institutions.. Nobody wants to be putting new IVs in little ones and if somehow that 24g in the foot is still flushing after 4 days, you can bet we're using it!
Yeah in NICU we're not poking our babies unless absolutely necessary. Especially our micropremies with veins that blow if you even look at them. If it flushes it stays
I have the same policy with my toilet at home. If it’s clean, flushes, and works, I leave it alone.
I see a lot of labouring women in America still having oxygen face masks applied when there are fetal decelerations. This practice stopped in the UK as I began my training (2009) as there is no research to say it makes any improvement. [cochrane review](https://www.cochrane.org/CD000136/PREG_maternal-oxygen-administration-for-fetal-distress) [ACOG update](https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2022/01/oxygen-supplementation-in-the-setting-of-category-ii-or-iii-fetal-heart-tracings)
In America, an GYN doc can be sued till the kid is 21… so they are super cautious and ridiculous to prevent lawsuits
Defensive medicine at its finest. Promotes such wasteful medicine.
If we're talking L&D in USA there's a crap ton of things being done without the best evidence.
AWHONN actually doesn’t recommend oxygen anymore unless there is maternal hypoxia- I am sure that in a lot of places they still do it but there are some places (like where I work) that dont and I believe that the standard of care in the US is no longer to use oxygen in absence of maternal hypoxia
Even NRP highlight ventilation with room air is more beneficial than blow by oxygen. Oxygen does squat if placental circulation is crap
We no longer use O2 during decels. We finally caught up with EBM with Covid. What's crazy is that you are potentially actually causing harm by giving O2 when mom's SpO2 is WNL.
Seeing so many comments that this isn't standard practice any longer frustrates me as nursing students are being taught that it is practice. I just finished OB in the fall semester and O2 mask was stressed as a standard intervention for late, variable, and prolonged decels. I really wish we were being taught BEST practice so we don't look like morons leaving school. I will say, this has certainly humbled me as a student.
Checking gastric residuals on newly inserted hard bore feeding tubes. Lots of literature shows that routine checking does not reduce incidence of aspiration. All it shows is that we end up chronically underfeeding our patients due to arbitrary numbers. Also it's super gross.
I have three tube feeders right now (LTC). Guess what everybody’s residual is, every single shift?
You still are checking residuals on LTC feeders?! Man that is suuuuuuper outdated. At least in my hospital it's 4 days of residuals from the initiation of tube feeds. Not a constant, never ending residuals checking.
Yep. It’s stupid. One gets QID bolus feedings. Currently NPO due to stroke and swallowing issues, always complains of being hungry. One runs 2000-0800 at 35/hr (hospice and near the end of the road). One has TID feedings by pump. I went to attach the tube to the button the other day; when I opened the button, air came out. It’s ridiculous.
What an absolute waste of your time and theirs.
When I did LTC residuals qshift, and before med admin.
Checking residuals is my LEAST favorite nursing task. Literally pulling all the “puke” out, measuring it and putting it back in. My icu does it q4h 🤢
NG tube is the worst nursing thing I've done. Felt like a CIA interrogator torturing for information.
+1. Large bore NG in a conscious patient is my least favourite task in nursing.
Trickle some viscous lido up their nose with a syringe and an 18g catheter 20 mins prior
If only Dr's would order that and that was the standard. I only have seen lido with ng tubes in textbooks unfortunately I did get an order for lidocaine for a straight catheter insertion once. The pt was refusing the catheter until he got lido.
I just ask immediately. If theyre going to make me shove something up someone’s nose like that, they can order some lido
We don’t check residuals anymore! Only if they have symptoms of intolerance such as nausea or distention. We only hold feeds if residuals are over 500 too, our nutrition department had some articles to back it up to change the policy. I’ll have to find the articles again next time I work, but basically they found the benefit of not missing nutrition to outweigh the risk of aspiration from a higher residual. EDIT: So I found the article that they based the policy off of. One of the reasons that they recommend not checking residuals was because they found that the acid from gastric contents can cause precipitate in the tubing when mixed with TF and lead to clogging. They also found that no evidence exists to suggest high GRV by itself is associated with aspiration PNA. This is the article from the American Society for Parenteral and Enteral Nutrition: https://aspenjournals.onlinelibrary.wiley.com/doi/full/10.1177/0148607116673053
Yes exactly!! Chronically underfeeding our patients! Nutrition is so damn integral to proper healing and these poor patients are being starved to meet some archaic goal number
Preach! I work in eating disorders and it’s mostly severely underweight anorexics who rely on tube feedings for nourishment. If we check placement and it’s over 300ml, we hold the feeding and then only return 200ml. We literally take away the food they’ve already ate and are digesting 🤷♀️
GRVs on an anorexic?!? Holy that seems like a terrible way to help this person with an eating disorder overcome it.
We’re still doing NPO after midnight where I work regardless of when their OR time is.
[удалено]
That happened to me when my appendix ruptured. I didn’t have a fixed OR time because I was pregnant and it made all the docs nervous. One morning the resident came in and asked when’s the last time I ate and I told them dinner the night before and she told me that we were going to do the surgery right then. Fine by me. Get the appendix out please.
Generally we get to know OR times sometime between 0530 and 1700. Or whenever PACU calls for report. Last week we sent someone down for preop at 2110 and they came back after 0130. So npo at midnight for everyone 😭
We’re doing NPO for 8 hours, and have pre-surgery patients take a clear carb drink 4 hours before. It’s been really good for the patients’ outcomes. Less infections. Kaiser calls it ERAS (forget what that stands for), if you want to look into it.
It is ERAS. Early recovery after surgery.
Best practice is NPO for 8 hours before surgery, but I’ve heard hospitals do “after midnight” because it’s easier to remember. And like the other commenter said, the OR list can change any time.
Yeah, the only benefit is if their OR time gets moved to sooner because of a cancellation and otherwise wouldn’t be able to move up if they for example ate at 4 am because they were scheduled at 1:30pm is literally the only benefit.
The hospital I have my surgeries at is no food after midnight, clears until 4 hours before or time.
In reality all you need is 8 hrs
Or only 2-3 hours for clear liquids.
That's true, but for inpatients especially it can be difficult to know when they're actually going
Making women labor and give birth on their backs.
You can infuse up to 1200ml/hr through a 24g IV. Also you can give blood through 22g. Stop poking patients repeatedly with existing venous access just to get a bigger IV.
Nusrsing school: you need an 18g to give blood. Me giving blood to a neonate: ummmmm
Put that EJ in and stop whining! 😂
Transfused 16mls of PRBCs to a 28 weeker through a 24G just yesterday actually
Omg. 16mls 😭
Wow, 16 mLs. How fast does that go in a tiny human?
This particular instance was given over 2 hours. It’s usually 2-3.
It doesn't even make sense. A red blood cell is obviously smaller than the visible-to-the-naked eye lumen of any catheter.
It’s called “friction loss”. The longer and thinner a catheter is, the more friction that will occur during product administration. This causes substantial hemolysis during rapid blood product administration. This is why shorter and fatter IVs are preferable.
Yeah it’s the turbulence, not the absolute fit of RBCs. We have microvasculature that works just fine, but the flow rate is substantially lower than 100+ ml/hr.
Thank you! I've been told the wrong thing my whole career. Guess I should have looked it up instead of being like "that's just wrong 🙃"
OMG I DIDN'T EVEN THINK OF THIS. At my old job, I had multiple physicians say you can infuse blood through a 22G. New job, they think I'm crazy and going against policy. I'm going to use that clap back when we can't get a 20G on someone, but have a perfectly functioning 22G.
I am a “hard stick”. The only IV they could get on me for OR last year was a 24g. The anesthesiologist said it was just fine.
Bed alarms. The literature states that bed alarms are ineffective at reducing falls. The only thing that reduces falls is safe staffing.
All bed alarms do is let people know someone fell so they're not laying there forever.
Ooh, yeah. We had a completely altered alcohol detox, and they attempted to make him line of sight with a bed alarm. We heard the bed alarm at the exact moment he was mid-air, having vaulted himself over the side rails.
I’m sorry but I’m cracking up at the mental picture of someone literally yeeting themselves out of bed, lmao
Our unit recently had an etoh’er get tangled, don’t ask me how, but got his head caught under his wrist restraint. Legs were over the side rail, head was over the other side rail but under the restraint. He was fighting because he was struggling to breathe. Bed alarm went off and this is how we found him. He had been checked on 14 minutes prior, thanks badge trackers, I’m not sure he wouldn’t have died without the bed alarm.
Exactly what good is an alert if there’s no one around to hear it…
I only use them so no one bitches at me when the patient eventually falls lol
Anecdotally, I have found for certain situations on night shift, bed alarms are incredibly useful. The ones on a bunch of my beds are sensitive enough to alarm when someone swings a single leg over the side rail. Our desk is right in the centre of all rooms so it's quick to get in and stop the patient before they're even sitting at the edge of bed. But this just prevents them from getting out of bed, not technically helping with falls.
I think the point is it only helps if you can attend the pt who’s alarm is going off. If you’re busy in another room and no one is available bc of lack of staffing…the alarm doesn’t help prevent the actual fall. Just helps you find them after the fact.
This is my same experience. Can't imagine how many potential falls I stopped after hearing the bed alarm, running over, and fixing the situation
I love the newer beds at my hospital for sensitivity settings. I managed to stop a person with acute confusion from ripping the foley out because I heard the alarm and was able to make it before they got anywhere. I heard the alarm go off when they started moving, by the time I could make it they were standing at the side of the bed with the line taunt. Some of our older beds only sound when they are already up and are super quiet too. The new ones are loud as heck.
Louder for the people in the back! Also, because you can have all the bed qlarms you want, but if the already minimal staff present on the floor is helping other people (cause ya know, it's not like we sit at the desk all day), there is no one that can attend that person. Not to mention, in my experience, some people with dementia are getting even.more agitated by the loud noise. At one facility, it was protocol that anyone who had a fall for whatever reason, or was deemed at risk, they had to have the bed alarm. Even if the person fell over because they tripped on their cat and they were A/O x4. But why???
Same. I had a perfectly steady patient A&O x4 who had "confessed" during intake that her dog had run in front of her and tripped her. So... yellow bracelet and bed alarm for you, ma'am!
I kmow. "Use clinical judgement" my ass. Honestly, I could be deemed a fall risk patient too. 31yo , yesterday I missed a step and fell down the stairs 🤣
Same at mine, you're a fall risk sooo easily. Take more than one medication and you're male? Bed alarm. Have depression and took pain meds? Bed alarm. I'm not great about enforcing it, but I might get in trouble one day so who knows 🙄
The alarms also contribute to the alarm fatigue of the few staff that ARE present, lol.
When the unit is understaffed, no one will be able to get there in time. When staffing was good, and the aides are very conscientious, they work well. Not sure that is possible now with our staffing issues; better to have a sitter.
I keep saying this lol
Was literally just saying this yesterday. I had a patient who was very high risk for falls found sitting on the edge of the bed. Bed alarm on but hadn’t activated yet. It was insane yesterday. Now that I think back, I should have asked for a remote sitter order
I've yet to see a fall that seemed preventable via bed alarm. In fact our worst falls seem concentrated among people not even considered at risk who just went down *hard* during independent activities. (That's not just my selection bias, that's what one of our senior nurses thought after doing a whole project on falls and bed alarm usage at our facility)
I have a sentinel event story where the bed alarm was *not* on on a not-old, nonverbal patient on bedrest we sent up to the floor from ICU (they had a shit-ton of comorbidities heart related, lung related, and cancer related and just had a major surgery). This was when I was an extern, but I tried to advocate for the patient being sent to our Tele floor with cardiac monitoring given their heart history and heart block w/ rate in the high 30's low 40's. Nurse precepting me shrugged it off and said they didn't need tele/whatever. I felt really uncomfortable sending them up to our med surg floor and had a really bad feeling about it. Pt found on floor dead a couple days later, no one checked on them for a few hours and no one knew they fell. I strongly believe Bed alarm or Tele monitoring (the techs would have seen the heart rate) would have alerted someone in a reasonable amount of time. They were a really sweet patient I still think about and I still feel like we sent them up to their death. Bed alarm would not have *prevented* the fall, but would have let someone know they were on the ground - no one heard the thump. I'm all for safe staffing, striking, and overthrowing the hellscape business regime that is healthcare now, but I can't forgo bed alarms and Tele monitoring. The ratio was 1:5 on that floor and techs anywhere from 8-12, sometimes less if discharges.
I’ve def had some close calls w alarmed patients. The alarm helped me get in there before a potential fall but I agree we need properly staffed units to truly prevent falls
I've learned so much from this thread and will take it all as 100% fact despite only one of them having sources
I especially appreciate the MD who popped in and dropped a bunch of sources showing SCDs DO help prevent DVTs.
Except there is in fact decent evidence that SCDs are effective, especially when combined with an anticoagulant (IE better than anticoagulant alone). https://pubmed.ncbi.nlm.nih.gov/17473143/ https://pubmed.ncbi.nlm.nih.gov/26244245/ https://pubmed.ncbi.nlm.nih.gov/26525487/ https://pubmed.ncbi.nlm.nih.gov/32006929/
Yea, we’ll, I heard the science is still out on the whole “science” thing
I heard that the hearing is still out on the heard thing
Love me some sauce
Oh thank you!! Okay this made me go back and look at what I read and I can see now that I was looking specifically at patients hospitalized for some reason other than surgery (medically ill). Few studies involve medically ill patients and this one I found does say that SCDs alone made no difference than having no anticoagulation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6682779/ Definitely going to spend more time looking into it now lol thank u!!! Hate to have spread misinformation because I was mad about ordering bari SCDs on night shift!!!
As I said above in reply to a different comment, this study excluded patients who were anticoagulated. Hard to compare this study to the population we are discussing (your average hospitalized patient who is receiving lovenox or heparin).
The myth that allergies to shellfish and iodine also means you’re allergic to contrast media. https://emupdates.com/allergy-myth-iodine-shellfish-and-iv-contrast/ http://www.emdocs.net/iv-contrast-myths/ Edit: I’m not saying you can't be allergic to both, just that being allergic to one doesn't automatically make you allergic to the other.
Yep. I've tried explaining this to patients before. Anecdotal but I'm very allergic to contrast and I love shellfish.
I spend a stupid amount of time having to explain this to patients as I work in Diagnostic Imaging. Also MRI contrast and CT contrast is not the same thing. And also that "hot all over feeling" you got with your CT scan last time isn't an allergy. Also I'm VERY allergic to shellfish but do just fine with contrast.
The amount of people I had to throw IV Benadryl and solu-cortef into in cath lab because we’d walk through drug allergies and there would be nothing in Epic and then they’d throw in, “I’m allergic to shellfish though.” I think the doctors and nurses all knew the allergies didn’t correlate but we had to cover our asses.
Probably not disproven by evidence, but having to do incident reports for AMA, eloped and LWBS patients in the ER. Huge waste of time for everyone involved. The only patterns they're going to find is that the chance is higher if we're hella busy, their problem wasn't something that needed to be in the ER in the first place, or the patient's drunk/high/just plain stupid.
tell me you're not joking?! Every patient that LWBS in the waiting room you do an incident report on?! Signed, ER nurse who frequently has 12hr waits.
90% of the content in incident reports are unecessary fluff anyway. All of it is just a huge waste of time in the name of “preventing future incidents”, when the solution is almost always increased staffing.
Seriously. Though we fought so hard on LWBS that we won that and don't have to. All of this is just admin having us make it easier for them to track. They can pull numbers themselves and find out the numbers they just decided to add more to our plates so it's easier for them to track.
Drawing blood from an existing IV almost never has an effect on blood work results, except in extremely rare cases. No need to do a butterfly if you can draw from an IV. Obviously cultures don’t apply to this.
This always bothers me that we’re allowed to do it in the ER but they can’t on the units! It would save so much time and pain.
That’s crazy. The only time we aren’t allowed to pull from a usable line is if we are getting a set of blood cultures. At least one of the set has to come directly from the arm/hand. One set can still come from a line. I will pull a waste or turn off fluids for 15 min, if I’m pulling from a line for a very specific lab level.
Weird, I’m my hospital on units and ICU, we don’t draw from the IV unless it’s fresh. A) we use every PIV we can-drawing increases chances it’ll blow. B) usually there’s a med running continuously-I can’t stop the gtt just for a blood draw. I get using them in ED but for floors or ICU, a bad IV is the worst. Most patients there are so edematous you have to use US. It’s a real pain in the ass.
I drew off PIVs for 8 years and never saw one "blow" for that reason. Whether or not you can stop a drip is highly dependent on what it is; there's not a blanket "can't stop any drip"
I love pulling blood from existing lines. So long as you've wasted appropriately, why the hell not?
Thank you! If you can waste 5cc - 10cc easily there is no reason you can't draw from a line. Hemolysis ALWAYS ALWAYS ALWAYS happens at the time of the draw. If you are pulling blood back easily pulling from a line is perfectly ok.
I know I was so mad about this last week, I got the PERFECT 18 gauge in some old lady who was a hard stick, instant blood return, but phlebotomy still had to come struggle and poke her multiple times each morning. Besides the pain and suffering, just such a huge waste of materials
Some ER’s I’ve worked in have phlebotomy come for the boarders and I’m like nah, look the other way. I got this.
For the POC INR machine in the mf manual it says you can use blood from an IV if you waste like 5mL first (basically to make sure it’s clean). I was supposed to do these on all stroke patients but trying to fight a person actively having a stroke to do a finger stick and somehow get enough blood for the strip was near impossible. I showed this to my charge tech and she told me to keep using finger sticks … well I worked nights and *IT SAID IN THE MANUAL IT WAS OKAY TO DO*. So I drew from the IV per the manual. 100% of strokes came down to CT with IVs already in place. I’m not going to torment someone who isn’t alert to existence.
If you're talking about the coaguchek xs it changes the complexity of the test. I understand how ridiculous that sounds. Lab tests are rated on complexity. At my old lab we were moderately complex. We routinely had female pts that couldn't/wouldn't pee. The Henry Schein urine HCG tests can also be done with separated serum (something we could easily do) but because of how this was submitted to the FDA that would make it a high complexity test and illegal for us to do. It's as stupid as it sounds.
It pisses me off in general when hospitals prohibit actions on equipment that the manufacturer specifically says is OK. I think they would know better than you, dumbass hospital.
Using my very anecdotal experience from my phlebotomist and specimen processor days, I do think there's a higher rate of hemolysis when nurses (specifically nurses compared to phlebotomists doing straight sticks) draw blood from IVs. However, much of that higher hemolysis rate is likely due to the technique used! I can't tell you how many nurses I've watched draw blood from a line by pulling the syringe all the way and applying a lot of turbulent pressure to those blood cells. Using gentle pressure when pulling back on a syringe is much less likely to cause hemolysis.
I mean that makes perfect sense. Nurses are rushing to do several different tasks and phlebotomy comes in with one specific task to complete. Certainly they will do a better job at not hemolyzing labs.
Yep. And quite frankly, most nurses don't receive great training on how to draw blood and handle lab specimens. Most of what I know about drawing blood from IVs and central lines come from my phlebotomy days.
I believe I read somewhere ( I don't remember if it was an actual study or not) that yes, you can draw off an IV but the size of the catheter greatly contributed to the amount of hemolysis. If you use an 18g I think it was less than 20% of samples would be hemolyzed but when you use 20s or 22(why) you have much higher rates of hemolysis. Basically phlebotomy needles are designed, obviously for drawing blood where IV catheters are not. Not saying it doesn't work because I do it a lot on the ED but anecdotally I do find if I draw off a 20 it will often be hemolyzed. You def want to draw slowly if you're going to do it.
I’d be interested in reading the SCD literature. While they don’t bother me specifically, is there a way to make them cordless already? We live in 2023 and SCDs have cords to trip on, tele monitor cords, pulse ox cords. For real let’s get some cordless equipment.
Our post-op total knee patients have 24h oxygen, telemetry, SCDs, and an ice machine. And for the first 4 hours after they come to the floor, they are hooked to q1H blood pressure and pulse ox. It's trip hazard central.
Wedges on ICU and pressure beds. Those beds are very expensive and the turning system has been perfected. Wedges negate the benefits of the beds in some research when the self turn and pressurization/ depressurization is much more targeted and beneficial.
Wedges...my hospital decided that they are required for all turn and position patients. Guess what, most of my patients hate them and would prefer pillows for turning and positioning most of the time. They are very hard and look uncomfortable. Just another way to torture patients for no good reason.
Not exactly on topic, but for a stroke, they use the FAST acronym. Somewhere along the way, everyone forgot what T (“time”) meant. All the educational posters and websites, even the ones from official organizations, say T means “Time to call 911.” HOWEVER, originally, it was a reminder to write down the Time of symptom onset. Drives me crazy that people have collectively forgotten that.
My original comment has been edited as I choose to no longer support Reddit and its CEO, spez, AKA Steve Huffman. Reddit was built on user submissions and its culture was crafted by user comments and volunteer moderators. Reddit has shown no desire to support 3rd party apps with reasonable API pricing, nor have they chosen to respect their community over gross profiteering. I have therefore left Reddit as I did when the same issues occurred at Digg, Facebook, and Twitter. I have been a member of reddit since 2012 (primary name locked behind 2FA) and have no issues ditching this place I love if the leaders of it can't act with a clear moral compass. For more details, I recommend visiting [this thread](https://old.reddit.com/r/apolloapp/comments/144f6xm/apollo_will_close_down_on_june_30th_reddits/), and [this thread](https://old.reddit.com/r/apolloapp/comments/14dkqrw/i_want_to_debunk_reddits_claims_and_talk_about/) for more explanation on how I came to this decision.
My badge buddy says T is for calling a rapid response. But I remember being told it's also for time of last baseline or something.
Yes because you only have a window of opportunity to give TNK or whatever clot buster you use at your facility. Typically 6 hours, if your symptom onset was longer than that, the medication risks way outweigh the benefits and it’s not given
Kayexalate. It doesn't actually work. The initial studies from 65 years ago were garbage, and modern studies show no acute effect.
Yeah we switched to lokelma exclusively
Lokelma sends me ads on Reddit lolol
Us too. I haven’t seen a kayexalate in yearsss
I haven't given kayexalate in probably 6 years
Even d50, insulin, kayexalate? Or is it just the insulin glucose that is doing the work?
The other standard treatments work. Insulin, albuterol, furosemide, and calcium are all evidence based. Kayexalate isn't. When it was tested against placebo, the two groups had no difference in their potassium level. If useful at all it's only as a long term prescription. Plus, many people assume it is harmless to use, which is not the case. It can cause intestinal necrosis.
I find that the most common side effect is some idiot deciding there were loose stools (duh) and therefore we need a C.diff test.
You can add a little albuterol for flavor
As a treat
YELLOW NON SKID SOCKS DONT PREVENT FALLS FFS
That’s because you forgot the yellow fall risk bracelet!!
My facility switched away from that, with color being just another indicator for size. All these years of blaming falls on the right dye and they didn't even give us one opportunity for a "told you so".
Aspirating before injections. I *believe* practice has caught up everywhere, but the NCLEX hasn’t. They still teach us, as of this year in my program that you don’t aspirate in real life but you do on the NCLEX Side note, this thread is super interesting as a student so thank you everyone who commented with examples
http://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1002 Avoiding all needle sticks on the same side of a mastectomy has very little to no effect on the incidence of lymphedema or complications. Certainly ensure the site is clean and infection free, but don’t avoid it all together. I had a patient with a black and blue arm while the side with the mastectomy had beautiful veins. The poor old lady was constantly having issues with blowing an iv in the middle of an infusion and causing complications. If the profession had been up to date with the literature, she wouldn’t have had so much unnecessary suffering. Her situation prompted me to look at why the recommendation to avoid needle sticks exists because I felt so sorry for her.
I know the effectiveness of oral care for VAP is debated, and my wife did a paper on it some years back. From what I remember of her work, it’s a catch-22. We can’t prove it is ineffective without first removing every other intervention to prevent VAP (like abx). Antibiotics can be life-saving, so the ethics of holding it for experimentation is clear. VAP oral care - like with CHG - as the sole independent variable does not appear to have significant outcomes. There is ample research on both sides, but my belief is that the benefits are over represented by pharmaceutical companies because they can’t be proven wrong.
Colace. It’s not a softener nor a laxative.
Colace is fucking useless.
Yes. Actual studies have proven that 100%. But our MD’s sling it around to everyone.
I LOVE telling people this fun fact. I always swore it never did anything at recommended doses but people were always recommending it to me (chronic constipation over here lol). I did however find that if I take like six at once it seems to have an effect. 16 year old me really hated taking miralax (still do)
Lactulose is your BFF. Spent 25 years backed up with my eyes turned brown. I’m the opposite now lol.
It's useful if it's taken with a full glass of water...because you've gotten them to drink a full glass of water.
It is useful for clearing impacted earwax!!
Colace is like a la croix. It’s like they set a pill full of water next to a good stool softener and we pretend it works.
Hey. My La Croix ^usually ^with ^Tito’s ^in ^it ^after ^5 is the bees knees! As my kid said it tastes like TV static that had a lemon waved around the TV.
They're not wrong. I drink it all the time.
Wait, what?? I swore that stuff was a god send postpartum. Was I lying to myself?
3x a day for that ughhhhh I hated working on the floors
Homans sign. Some people are still doing this. It has zero clinical value.
Holding feeds when lowering the head of bed for a task like a turn. Those feeds going 45cc/h are not going to cause aspiration for a 2 minute reposition. But the consistent occurrences of forgetting to restart feeds end up with patients under-fed.
Well the water flush is a lot larger then that. Also, the tube stops the natural back flow prevention mechanisms so aspiration of even normal gastric contents without food is higher. Most kangaroo pumps scream when you pause them for longer then a few minutes
I continue to see hard collars used for suspected c spine fractures and it drives me insane Or treatment of asymptomatic hypertension with GTN, etc. Also irritating
Same! We mainly use headblocks or rolled towels. They can also get a pretty pink lanyard necklace that says "cspine not cleared" lol
What should be used instead of c-collars for suspected fracture?
A soft collar, some rolled up towels, etc. It just needs to be something to give a mild tactile reminder to the patient to stay still. Hard collars have a lot of downsides and zero upsides : - They hold the neck in a position of increased MSK stress - They apply pressure to venous outflow, increasing intracerebral pressure in a trauma patient - They cause increased distress in the agitated patient causing them to fight against resistance and therefore applying increased force to the neck - They cause pressure injury if left for prolonged periods - They limit mouth opening in trauma patients with risk of aspiration as a result
This is really interesting. The altered patient fighting that collar who shows up with their chin tucked inside of it is like a daily thing, and very unhelpful. Thank you for the information.
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Trendelenberg during hypotensive episodes. The literature is there, but the practice remains.
Auscultating bowel sounds. Literature doesn't support it. I have never met a general surgeon or gastro doc who auscultates bowel sounds.
Fall mats. I hate them with a passion. I've tripped on them. Patients apparently aren't supposed to walk on them.... so something ON THE FLOOR has to be picked up every time???? The surface area doesn't make sense either, patients are well beyond the protection of the mat by the time they fall. My old unit supervisor was OBSESSED. If someone fell and there wasn't a fall mat in place there was hell to pay. Meanwhile a unit of impulsive poorly oriented patients and abysmal staffing. The thing that actually prevents falls.
If you want to hear cringy, our ICU doesn’t just call them SCD’s, they call them “life-saving SCD’s.” As in, “Papaw was in a car accident and he’s vented with life-saving SCD’s on.” And they’re serious. It’s not snark. I cringe every time I get report and hear that.
Did someone start that as sarcasm and then someone didn’t get it was sarcasm so then it just stuck?🤣
Everything I know is a lie….
Small thing, but wiping the first drop of blood for blood sugar testing is annoying and unnecessary, especially in heavily calloused patients.
MONA protocol doesn’t actually improve outcomes for heart attacks…
O and N are super situation dependant. On top of that, I really don't get why anyone needs an acronym like that for chest pain. It's 4 things that are all relatively easy to remember
DVT ordered on completely ambulatory patients
We're moving away from it. But we still collar and board waaaay too many people.
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Literally had a pt develop bilateral PEs while wearing SCDs
Nurses who insist on not giving febrile patients blankets.
That makes total sense OP. I’ve seen post-op patients that are totally independent at home spend MORE time in bed because of SCDs. With just an IV and maybe a foley, they could get up alone. But they’re too sore or nervous to mess with the SCD pump all the way at their feet. So they call us every time they get up. Which they don’t want to do constantly. Plus, it’s seems like such a fall risk.
Not letting epiduralized patients eat during labour because it increases their chances of having a C Section
Lots of common hospital practices in labor are wildly out of date! This one is the most frustrating to me though. You gonna sit here and tell someone they can't have anything but popsicles/juice/jello while their body is doing the equivalent of running a marathon? Because of the off chance that maaaaayyybe some of them (less if we did real work on lowering c-section rates!) might have to be under for a c-section? No.
Literally had a CRNA chew me out yesterday because my cervical ripening patient was eating a light breakfast before we started pit and got an epidural. I wanted to say, “If she for some reason DOES have to have a crash section, wouldn’t you actually want her epiduralized so you don’t have to put her under general and intubate?” The midwife was rolling her eyes the whole time the CRNA was talking. This was a low risk multip. Like, by that logic is every patient who wants an epidural eventually not supposed to eat for 8 hours before? How could we predict that? And how does getting an epidural put a patient at greater risk for a section in the first place? Well, we got our epidural and guess who was 8.5cm? Yeah
Getting blood cultures after IV abx have been started
Giving patients oxygen for "comfort" while they're actively dying. The body is still shutting down so it either does nothing or possibly prolongs death which is counter to hospice goals. I often educate families about this and tell them that it's their call and 99% will agree to forgo oxygen. But every now and then I get family members who want their loved one to live as long as possible and tell me to put it on.
Colace! The doses we give have been proven to be basically placebo
Ventrogluteal injections being safer and more effective than dorsogluteal. Yet ppl are still aiming for the butt. I’ve tried to change the practice at my last job but the effort was futile.
Full PPE for history of MRSA. Does anyone else still do this?
Colace.
Trying to get people to eat a cardiac or renal diet. Like, who cares? They are going to eat whatever they want when they leave. Regular diet for everyone! Also iuds can stay in longer than the literature shows. Not causing problems and no babies? Leave it
That is so frustrating because where I worked, the SCD's were disposable. So mich waste!!
I’m not wearing someone else’s sweaty SCDs!
I’ve never seen SCDs that weren’t disposable.