IV frustrations

Less than a year ago I was trained for the first time how to start ultrasound guided IVs for the department.  The superiors are trying to have more IV "experts"  so we don't become so dependent on a few people.

This was by far my favorite training.  I wasn't given a lot of details on how to do it properly, just showed the differences between a vein and an artery.

Veins and Arteries appear like black circles on the screen, when you push on it arteries pulse and veins collapse

I wasn't given a lot of information other than that. I was great at finding veins, it's not that difficult.  I didn't know how to access the vein, that information was briefly discussed but that's it.

After the training I would find the vein, set down the device and stab blindly for the vein I had just found.  Any seasoned nurse can tell you that going in blindly for a vein is horrible.  You end up digging and chances are you're just hurting the patient.  I was so bad at the ultrasound IVs I hated when people asked for my assistance with the ultrasound IVs.

Right before Christmas I was called and asked to do additional training after the holidays.  I jumped on the opportunity because, as described, I was horrible.  I needed additional training, I'm sure everyone knew.

The trainer taught me to find a vein, no problem here.  He then showed me, using the ultrasound guided device, what the needle looked like when inserted into the skin.  He then showed me what the vein looked like when the needle was inserted.  

The bright thing in the middle of the vein is the IV needle. When you see this image you're in and just need to advance the catheter.

He explained a couple of more things, and something clicked in my brain.  I don't miss frequently anymore.  I know I'm not the best but I can get an US guided IV quickly, with blood work, in less than 15 minutes (sometimes longer, depends on how much extra skin they have).  The most difficult part for me is finding the needle after it's inserted (again, sometimes takes a while but I'm pretty good at it). 

The other day I started an IV on a patient, it worked perfectly.  Several hours later I found out the IV had infiltrated and nobody was able to get another IV.  Even the doctor entered the room and wasn't able to get the IV.  He contemplated starting an IO on the patient.

Later that evening, before I learned of the first IV infiltration, I had been called in to start another IV.  The patient was extremely sick and required 2 IVs.  I got them without a problem, both of them were started quickly and without difficulty. Both in the antecubital just like before.  This patient, right after I let go of his arm, bent the arm to keep himself warm.  

I learned about 2 hours later that all the IVs had infiltrated on both patients.

I've had a lot of IVs lately infiltrate after I leave the room.  It's becoming frustrating to me because it appears as though I'm incompetent with my IVs.  I've done research as to why the IVs would infiltrate after the fact and it basically boils down to the patients are moving too much causing the catheter to dislodge from where I secured it.

Or they are bending their elbows too much causing the catheter to kink.  Those are the only two explanations I can come up with.

I think ultimately I need to start trying for other locations for the IVs.  I think that's my only solution.  Talking with other nurses they aren't blaming me.  Personally I don't know, but I got to try something else.  I'll try again tomorrow.

Lazy Americans

I read an article today about how "lazy Americans" are hurting the economy and I gotta say I'm a little offended.

The article starts out with Tyler Cowen, an economist, pointing to the fact that Americans have not started nearly as many businesses were started in 2014 as in years past.  

Have you looked at the startup of a business venture?  Holy crap.  If you want to go with purchasing a franchise you need to have a large amount of liquid assets available, not to mention your net worth.

I looked into franchising a donut shop I think would succeed wonderfully on the East Coast.  Ever heard of Shipley's Donuts?  Oh my they are wonderful.  To franchise this company they require $200,000 liquid funds, $600,000 net worth, not including ability to purchase land in the area you are looking to build.

Most Americans I know don't have half of that even available.  Hell, even going a cheaper route would be the Taco Truck thing.  I've looked into it and it would still take almost $20,000 just to have a pull behind taco stand to set up.  That doesn't include purchasing recipes (I am no chef but I've found several recipes that are terrific, I would feel obligated to reach out to those whose recipes I would use and purchase them), advertising, food costs, utensils, plates, the list goes on.

I wouldn't consider myself a Lazy American by any means but I definitely won't be starting any businesses just for the simple fact that I'm trying to get out of debt, not dig myself deeper.  I work my ass off for what I have and so does my wife.  Besides, I like to travel and if I were to open a business I wouldn't be able to travel at all unless it becomes a successful business, and that could take several years.

And no way I'm going to be a landlord, been there, done that (at least assisted with my father's slum lordship and I'm not going down that road, especially with this economy).

He claims we Americans have created an insulated life for ourselves and our children and we're afraid of change.  Ok, I'll give him this point.  Change is scary for a lot of people.  I look to my own family and extended family and I see a lot of people going through the same motions because they are afraid of changing their norm.  They complain about their life on Facebook but do nothing to change it (and that's part of the reason I'm only on Facebook a few minutes a day, my eyes can only roll so many times before they start to hurt).  Even our little family has a routine that is difficult to change (we allow a lot of flexibility but for the most part it's the same, even down to the food).

Cowen also reports that we Americans aren't moving as often as we used to.  Is that a bad thing?  Living in one house usually means you're paying your mortgage down.  I've lived in the same house for almost 12 years.  We would like to make some major changes to it now that we can afford to do it but financially it doesn't make sense (to me, wifey might think differently at times).  Yes we could probably sell our house but it would be at a significant loss from when we purchased it (right before the crash when everything was inflated).  The only thing I would want to do is move closer to my wife's job so she doesn't have to commute so far but the houses in that area are a lot smaller and have no land (I need the land, I can't live so close to people, they bother me in large groups).

The article continues stating there is a great reset going to happen soon into Trump's presidency.  He claims it usually happens after a great trauma or war (considering we've bombed Syria and Afghanistan in the last few days, I'm leaning toward a war).

The last thing I'll point out from this article is the fact that he wants people to take more risks in their personal lives.  Once again, I'll give him this but only to an extent.  Making a change in your life to improve it for the better is always a good thing.  Taking a risk here can be extremely beneficial in many aspects.  But before just "flipping a coin" there should be a lot of thought and consideration that goes into the decision.  In addition to studying out the options one should pray for guidance (I will always encourage someone to reach out to Heavenly Father for guidance, as long as you believe he will help direct you).

After working in group homes and the parks and recreation department for over 10 years I realized I wasn't going to ever support a family.  I needed to make a change so I returned to school and became a nurse.  It wasn't cheap (combined debt for 2 bachelors degrees was well over $50k) but it has been significantly better for our lives.  Now at this point in my nursing career, as much as I would like to further my education it doesn't make sense.  I would have to return to school (not a bad thing) but that would take time away from my family for the 2-4 years.  It would incur more debt, probably close to $100k, and I won't even double my current annual income doing this.  Is it worthwhile?  Probably not (it hasn't stopped one director from trying to convince me to return).

Going back to the offended part, just because we're not taking as many risks to "help the economy", why does that make us lazy?  There are many more educated people out there than in the past, many of whom are living frugally so they can save for a nicer retirement.  Or vacation.  Our captivation on the internet is living vicariously through people who can afford to do things (at least for me).  Why is it wrong to live frugally, save money, so we can have that week or two extravagant vacation with a few other nice outings while we wait?  Once again, I work my ass off as does my wife, for what we have.

The Wall

So we all know Trump is planning on building a wall between the US and Mexico border.  I even joked about it in a previous post (see joking with the parents).

I was watching Arrested Development the other night.  Definitely one of the best shows they took off the air, scoring a solid 89% on Metacritic and an 83% on Rotten Tomatoes.  And of course this is in my opinion, if you like comedy you need to watch this show.  As I tell all people about this show, they build up the jokes in the beginning so the end is hilarious.  They also build up jokes throughout the series that lend a hand to some of the hilarity in later seasons.  You can't jump in the middle of a show and miss half of what they built up because then you won't know what they're joking about.

Anyway, back to a theory I have.  Slight spoilers, nothing serious if you want to continue reading.  In Season 4, Episode 2 George Bluth Sr. steals plans from a competitor (they are property developers) for what he thinks is a monument dedicated to George W. Bush.  It's revealed later that his wife Lucille originally had the idea and it actually a wall, not a monument, that is to be built on the border between California and Mexico to prevent illegals from entering the US.

So, where did Trump come up with his idea?  Maybe someone on his team saw the show (they do have lives outside their campaign, I think) and shot the idea to The Donald?  Who knows, but now you'll be wondering the same thing (especially if the wall is built).