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.

My Dilemma

Several years ago I worked with a tech in the ED.  I'll call her Molly.  Molly was lazy, only liked working with certain people, and if she was asked to do anything she needed company.

At one point she was the tech working in my section.  I asked her to start a Foley Catheter in a room while I took care of an ambulance in another room.  Molly immediately turned around and asked her friend, the RN, to help her. This RN was already mad at me for starting an IV for me (she just wanted to sit in her section and literally do nothing).

The combination of Molly and this RN was enough to tarnish my name.  The RN stepped out of the room and started yelling that I was lazy and I needed to get off my ass and stop eating tacos so I could do my own job (at this point this RN had only started an IV and helped Molly do her job, literally nothing else).  The Charge nurse that night for the next several months harassed me about me doing my own work. Never allowed me to speak, etc, etc.

I lost all respect for Molly (and that RN, but that's another story).

Fast forward, Molly was terminated from my department for attendance problems (considering her work ethic, this was no loss in my mind).

Fast forward again to yesterday. It was a horribly busy day, we got slammed by multiple sick patients within a few minutes of each other (including a cardiac arrest).  This backed up the rest of the ED for several hours.  Molly checked in as a patient where people were waiting up to 3 hours just to get into a room.  

15 people ahead of Molly, she was the only one who came up to me and asked how much longer until she was seen.  Once again, not exactly the best thing to do when there are no rooms and the triage nurse has little respect for you as a person.

Molly was eventually seen and discharged.

Over the last several weeks the schools in the area have been sending us nursing students.  Guess who was sent our way today?  That's right, Molly.

She spent the first 4 hours of her shift with someone else.  I'm stewing in my section, avoiding her as much as possible but still keeping it professional (that's what I do). I vent to some people about the person, the situation and my complete lack of respect for her as a professional.

After those first 4 hours she is then transferred to me to I so I can precept her.  I'm not thrilled about the situation. 

I'm glad I could keep it cordial but she was no different at with my interactions tonight than she was when she tarnished my reputation several years ago. She was still the entitled, lazy tech who is now in nursing school. 

I still have no respect for her as a person. I hope she never works at my facility because I guarantee I will have no respect for her as a nurse.  

Is this a bad thing?

What if?

After a long day at work I went to the grocery store.  Nothing out of the ordinary.  As I pulled in I overheard a domestic dispute.  The lady in the car was yelling at the man in the car to "get out of my car", "stop it", etc.  I couldn't tell what was going on but I could see the woman hitting the man.

Thinking this was only an argument initially I thought nothing of it.  As I walked to the store entrance I got to thinking "What if?".  What if he was doing something to her? What if this was the start of a date rape, etc? What if?  I didn't know.  Because of the situation I didn't want to be the guy that could've stopped it but didn't do anything.  A simple phone call could stop a potentially dangerous situation.

I decided to call the police when I was out of their sight (I parked next to them and my car is pretty easy to point out. I also wanted to remain anonymous).  I gave them all the information I could and the police informed me they would check into it.

I finished shopping and less than 10 minutes later went back to my car.  Four police cruisers had responded.  The lady was arguing with one of the officers stating she was just having an argument with her boyfriend and they argue all the time.  The officer was handling it like a champ.

Though this may have been an over-reaction to the situation after the facts were known, what if?

I'll take a moment here to thank all the officers who respond to calls like this, potentially putting their lives on the line. They never know what they are walking into but they do it every time they respond to a call.  They are underappreciated in our time and we don't have nearly enough of them to help. 

Thank you, officers, for everything you do.

The Babysitter review (no spoilers that I know of)

I've seen a few of the Netflix original movies now and I gotta say they are getting entertaining.  Tonight I watched The Babysitter.  If you have time you should also watch Little Evil (a recently married man thinks his new stepson is the Devil incarnate) and Death Note (not the Anime version.  The detectives in the Anime version speculate a lot and somehow their thinking is spot on, similar to Adam West as Batman deciphering a "cryptic message" from the Riddler in the Batman Movie 1966, but not nearly as entertaining as Batman).

The Babysitter

This movie is about a nervous, naive 12 year old boy whose babysitter is hot.  Everyone picks on him except his babysitter. She is supportive of his intelligence and "weirdness". 

Google Samara Weaving, you'll thank me (yes its totally SFW)

His parents go away on "business trip", leaving the babysitter in charge while they are out for the weekend.  His best friend (who happens to be a girl his same age) convinces him that all adults, including his babysitter, have sex when kids are sleeping.  She convinces him to stay awake to spy on his babysitter to prove she is right.

As I said earlier, this is actually an entertaining slasher flick.  It's predictable to an extent but it is still very entertaining.  If you like slasher flicks, watch it.  Also watch (as I said in the intro) Little Evil and the Death Note (again, not the Anime version).

Sweet, Sweet Karma

I usually vent about work here but this time I'm telling a story about sweet Karma.  I'm changing the names (for obvious reasons).

A few days ago I was assigned to be float nurse and to give lunch breaks.  I took an ambulance report, a 20 year old male patient who had a seizure.  I receive word he is being non-compliant so the EMTs administered 5mg of versed to help him calm down.

On arrival to the room I see George accompanied by his mother and father figure (no clue if it's his dad, where I live it's not unusual to have a large age gap between husband and wife).  During triage I recognized him but unable to figure out where from.  I ask George if he wanted help.  He only agreed to let me get vital signs on him.  As I attempted to get a temperature, his charming personality shone through and he became combative.

After a few short minutes of George verbally abusing everyone in the room I make sure he is oriented.  When he shows he is mentally competent I asked if he wanted treatment.  To my surprise he refused.  

George's mother then spoke up and demanded we treat him.  I explain to the mother that George is an adult and we cannot force treatment on him.  She continued to demand that we treat him so I explain a second time that it's against the law to give treatment to anyone who refuses. I then explain the only way we can treat someone who refuses is if they lacked capacity to make his own decisions.  She then asked if we could at least medicate George, I explained I would have to speak to the doctor.  

Mother then went off on me.  She claimed she did not like my answers and I could have worded them differently.  She continued stating we need to try something and she did not like that I wasn't going to do anything.  I apologized that we couldn't do anything to help but reiterated he had refused. 

As I stepped out of the room she asked to have another nurse take care of them.  Ignoring that statement I explained the situation to the doctor, the refusal and the other behaviors that happened.  He informed me he would return to the room and talk to George and his family.

As I started documenting on the conversation I was able to place where I knew George.  Several years ago I took care of him. At 16 he was a healthy young male with no medical history.  He suffered a seizure without any reason.  George came to the ER and I took care of him.  He had a wonderful personality, refused treatment and treated everyone like crap.  His mother was even a victim of his verbal abuse.  

After several hours of refusing treatment and verbally abusing everyone George was told if he could walk around the room without having any problems he would be able to leave.  Unfortunately for him shortly after he stood up he had a grand maul seizure.  I helped him to the floor and my coworker did abdominal thrusts (he had a mouthful of crackers).

George's mother finally stepped into her role as a mother and played the trump card, "I'm mom, you're the minor, you're getting treatment."  She apologized multiple times for his behavior and thanked us for helping as much as we did.  He was transferred out and never thought about him again.

So four years and George's charming personality hasn't really changed.  Shocker.

The verbal abuse in the room continues, George's mom calls the attending doctor an asshole, security is called to have them escorted out of the ER.  When security gets there George's family refuses to leave and demand that we treat George.  The security guard explains to them that he has to defer to the charge nurse to figure out what to do since they didn't want to leave.

Again, I am the float nurse relieving lunches.  The charge nurse has stepped out for her lunch break leaving me in charge.  Pointing out again they treated me like crap and did not like the way I treated them and the way I explained things to them.

The security guard asks who is in charge, I tell them it's me.  When I walk into the room the George's mom, wide eyed, says "Oh, you're in charge?"

The look on her face and her reaction were priceless.  I wish I could see it again, over and over.    

To finish the story, George and his family left without George getting any treatment.  I did notice that he no longer had a mouth full of teeth like he did when he was 16, his lovely personality must have helped him lose a few over the years.