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Who says flipping burgers is mindless? A good burger is hard to find these days...., but, all joking aside, I also agree with Leigh Ann. I am struggling, practically on a daily basis, to obtain central access for our "frequent flyers". I sent one of them just last Thursday for a translumbar access. She has nothing else. I am seeing more and more patients this way, and it is because peolpe just want to deal with the here and now. They do not want to think about the next admission down the road. There has to be a better process out there for this, and we need to all get together and figure it out. I'll buy the drinks if someone else gets the chips.......
Heather Nichols RN BSN CRNI
Infusion Services University of Louisville Trauma Institute 530 S. Jackson St. Lou. Ky. 40202 (502)562-3530 >>> "Nadine Nakazawa" <[EMAIL PROTECTED]> 8/10/2006 11:56 PM >>> I agree completely with Leigh Ann. I just finished putting in a very difficult PICC in a patient who came at 2 PM from the outpatient cancer center with a report that she had "green junk" at her PICC line exit site, and the MD wanted a PICC nurse to evaluate it. I looked at it, and indeed it looked like a green exudate at the exit site. I paged the MD and got orders to: culture the green stuff, tip culture (intracutaneous and distal tips---it takes two nurses and at least 2-3 scissors), and 2 sets of paired blood cultures (drawn peripherally). She hhad a bad skin reaction to either the Chloraprep or transparent dressing. I attempted her right arm at least 4 times, but could not even get the wire in til the last attempt, and then it got stuck in the axillary vein. She has had 1 implanted port (for chemo awhile ago), and 2 PICCs. I put the first PICC in a year and a half ago in the R arm---she said it went in easily, but got infected at the exit site after 1 year. She got a new PICC in June that lasted 2 months til this green yucky stuff.
She has end-stage ovarian CA and is on home TPN. She desparately needs the central access, and begged me to keep trying. I went back to the Left arm, and looked a sites away from the infected area and vein. Her basilic vein would not compress, and I hit the nerve while trying for the brachial vein (the other one was under the artery). I finally got in the cephalic vein (rarely use cephalic any more). It was now 7:30 PM, and the radiology techs yelled at me for bringing her over without calling first. I always bring outpatients to Radiology without calling first and they always take the patients (sometimes we have to wait a bit). The late evening crew is just not as nice as the day/early evening techs.
I went back to the Coronary Care Unit to try to decide what to do with a patient one of my 8-hr PICC colleagues tried to do today. She could NOT see the PICC tip despite manipulating the PICC twice and 3 CXRs. He's got cardiomyopathy, has very wet lungs due to fluid overload, he's a bit obese with an AICD. It's the wet lungs and AICD wires that obscured the CXRs. He was too fragile to go to the Radiology Dept for CXRs, so she was stuck with the portable CXRs. sometimes, despite our best efforts, things just do not go smoothly.
I am now trying to finish my last PICC (he was my first one today), but he's on the bedside commode, and he's MRSA. This rambling is a good example. so to kill time, I'm doing the venous listserv email. This is a good example of a bad PICC day. Maybe I can find a job I'm really good at---like flipping burgers at McDonalds...something mindless and I'll always be successful... Nadine Nakazawa, RN, BS, OCN PICC Program Coordinator
Stanford University Hospital and Clinics
Stanford University Medical Center
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