| O2 BVM Extension:
Laerdal®
resuscitation bags are great; and by having a non-rebreathing valve which is separable
from the bag has the unique characteristic of allowing the interposition of two feet
(three feet, if loading aircraft or watercraft) of wide-bore (22 mm) corrugated
respiratory tubing between the valve which remains on the endotracheal tube (with NO
increase of "dead space") and the bag thus permitting an easy flexible extension
for transport. Stand Tall! Walk Freely! Use both hands on the bag with NO change
in "feel." Avoid those fateful and embarrassing disconnections or extubations! |
| Tegaderm® Uses:
Tegaderm® and Op-Site® are not only great IV dressings and
NGT fasteners but are also good for taping the foley catheter and leg bag connection on
patients being discharged. {And, of course, don't forget to secure the catheter to the leg
so that they don't come back with hematuria or dislodged catheter!) |
| Adhesive Pick-Up:
Glass
fragments can be lifted from wounds, or from floors (along with those difficult-to-pick-up
"snap-off" plastic tops from vials) with adhesive tape. |
A
"Difficult NG Tube" Passage or "Difficult"
Foleys:
A more effective, humane, and lubricious way
of easing tube insertion is to instill 2% Lidocaine Jelly through the orifice by syringe.
4 ml is sufficient for a nasal passage. 10-30 ml for a urethra. The anesthetic property
dulls the surface sensation (though not the deeper sense of pressure). Placing the
lubricant in the tract prior to insertion insures a slippery passage, and in the urethra
will "find and distend" or dilate any available path. Let your preparation allow
a brief time for the anesthetic to act. For nasal use, tell your patient that because it
is room temperature it will, at first, feel cool and gloppy and that as it warms it will
feel runny like a head cold but it's OK to swallow any that runs back and will help dull
the sensation in the throat as well {in addition to an anesthetic spray). The tube tip can
still be smeared with lubricant but now will encounter a better prepared and slippery
passage.
|
| "Stethoscope Ring Sign" or Dermatographia in
Respiratory Distress: An early and reversible sign of
systemic distress in Asthmatics and others who are SOB is the skin changes demonstrated
when auscultating the chest wherein as you lift the stethoscope a visible ring or impress
is left. This reliable sign corresponds to the present degree of circulatory change in the
skin. Considered with other observations and findings it gives a real-time indicator of
improvement or adverse change. |
Mask Ventilation: Wrong Size Mask for
Face ?
If you must mask ventilate (O2BVM) a
small-stature adult or child with a typical "Adult Mask" which is larger than
can readily seal on the patient's face, try inverting the mask so that the usual chin
portion lies across the nasion and cheek bones and the narrow nasal portion of the mask is
used to fit against or around the chin; this may be sufficient adaptation to control the
situation until an appropriately sized mask is available.
If the patient is edentulous and
has sunken cheeks and hasn't the customary facial architecture to effectively seal the
mask: try slipping a "Newborn Mask" in place and then into the patient's mouth.
Use your support hand to "cup" the chin and pull upwards stabilizing the mask
port within the "OK Sign" of your thumb and index fingers and pinch the nostrils
closed. This should allow satisfactory seal and ventilation until a definitive airway can
be placed.
An additional solution is to place
a nasopharyngeal airway with an endotracheal tube connector in place to which the O2BVM
can be attached. Support the chin and pinch the nostrils in the same fashion: continue
until a definitive airway is placed. This works well for "One-Man Band"
single-rescuer CPR until endotracheal intubation support arrives {the bag just hangs in
place at the patient's nose during compressions, and ventilations can be given more
quickly this way without changing positions or having to carefully fit a mask}.
|
| Refractory Dental Bleeding:
Persistent oozing from a dental socket that fails
swishing with warm saline and then firmly clenched damp gauze pledget for 15 minutes
without disturbance or inspection is often stanched by substituting a damp tea bag for the
pledget. The astringent action of the tea helps with hemostasis. |
Better EKG & Monitor Signals:
The most common cause of "artifact" and noisy
baselines in the tracing is inadequate preparation of the skin. Inspect the skin as you
check the patient. Look for diaphoresis, dry skin with a build up of dead and flaky skin
cells, accumulated brownish sebum and dirt on the skin (sort of a "cutaneous
smegma", bath powders and bath oils. Each will interfere with and degrade the
transmission of the electrical signal and must be removed. When the need for a clear
signal is especially urgent, the few moments roughly scrubbing the skin with gauze
4"X4"s soaked with rubbing alcohol or even the denatured absolute alcohol in the
ENT alcohol lamp will remove these substances, and drying the skin with dry gauze will
repay with a great savings of total effort. The skin should look mildly reddened and
abraded. Electrodes will now remain in place.
Remember that this accumulation of
interfering substances on the skin is common with infirm elders who may not bathe
frequently (due to easy chills, awkwardness and risk of falling using a tub or shower due
to arthritis or frailty), and whose sedentary life-style makes them unthinking about their
"insensible" perspiration, and the use of powders or oils by themselves or
caregivers. The ordinary foil-wrapped alcohol "wipes" are inadequate for the job
as they are too soft to mechanically scrub away the solubilized debris. Of course,
avoiding chills, immodesty, and ensuring rest or propping of extremities will also help
during the EKG. A heavy towel or bath-blanket across the precordial leads helps dampen
motion of the wires and electrodes.
|
| Secure That Loose Stethoscope Eartip:
Hard plastic eartips that come loose upon their threads
may be snugged securely with a couple of wraps of Teflon® thread-wrapping tape used by
plumbers (cheap; at the hardware or home repairs store). Soft eartips can be
"wired-on" with wire and pliers to more firmly grip the binaural's threads, cut
short, and covered with vinyl electrician's tape. A drop of simple glue in the threads may
help. Loc-Tite® in Blue or Red varieties (how permanent do you want to make it?) is a
product many machinists or mechanics would use. |
| Protect Your Own Wounds With Membrane While Working:
Frequent hand washing produces frequent skin cracks that could become portals for
infection. Covering them with bio-occlusive membrane dressings such as Tegaderm® or
Op-Site® provides a barrier that stays in place, avoids glove-powder in the wound, and
let's one slip on gloves quickly and painlessly. If one needs an adhesive bandage over a
knuckle-scrape, for example, covering this also with a membrane gives the same advantages
and eliminates the accidental dragging-off of the Coverlet® or Band-Aid® during rapid
glove changes. At the end of the shift remove the membrane and change the dressing as
maceration can occur in the humid environment produced. |
| Need To Weigh A Too-Heavy Patient On The Balance
Scale?
Hang a small object on the balance beam
then weigh the patient with it in place. Next, weigh another person within the scale's
usual range with the weight in place, remove the weight and weigh again, calculate the
difference and add it to the measured weight of the outsize patient as checked with the
weight in place. Voila'. |
| Hands-free NGT Irrigation:
A great way to irrigate a nasogastric tube is to connect
an IV line to the air port on the NGT. Let some fluid in, then turn on the suction. You
may also open up the IV irrigation while maintaining suction. Both methods work quite well
while avoiding the mess and time expenditure associated with the irrigation (Toomey)
syringe set up. Dan & Suzanne Rinehart |
Where's that Nitro?:
Always looking for that pesky little brown bottle that
is easily lost or rolls away just when you're in a hurry? Laurie Bezner, RN, tapes a
bottle to her stethoscope tubing near the diaphragm: it's handy for giving a timely
sub-lingual tablet, a convenient reminder to check BP, and draped over the neck stays
cooler than in a pocket. Keep the cap on tight!
The Editor of this page keeps a
metered-dose spray of Nitro-Lingual® handy. It's even more rapid in action (none of that
"Lift your tongue up, No, lift it up, now close your mouth and the tablet will melt
away"), and drug stability is assured.
|
Another NGT Tip:
Still fumbling for the stethoscope and injecting air as
your first test of NGT placement just as you learned in nursing school? Abandon
that! There is greater economy of effort (speed/efficiency) when the first functional
test is to aspirate!
You should already have measured
the tube, flexed the head and neck well forward and observed the patient while advancing
the tube. If the patient is uncooperative or unconscious, take care to make your initial
passes while he exhales, as there is less likelihood of passing through the
narrower gap between the cords. If there was no cough, laryngospasm, or gagging, have the
patient speak so as to detect any dysphonia from being through the vocal cords. Mount the
syringe and aspirate: ---return of stomach contents indicates successful placement;
---resistance to aspiration suggests kinking or coiling.
Injection of air is useful if you
are concerned that the tip is esophageally placed; repeated checks as the tube is
advanced or withdrawn might be necessary. Stomach contents are unlikely to be returned
from the trachea and if present should be aspirated (Aha!) If the NGT is placed for
decompression of gastric air during resuscitation, you are withdrawing rather than adding.
(Aha!) The syringe is packaged with the plunger "in": ---don't bother pulling it
out as a first step.
|
| One picture = 1000 words:
When a patient presented with his dominant thumb transfixed, en brochette,
with a large wood sliver at an awkward angle, the customary written description of the
wound would have been awkward also. The patient and staff were amused to find that
photocopying his hand, sliver and all, was accurate as well as novel. This
has also worked for "nail-gun" impalements. |
| Vaccination Soreness Minimized:
Avoid or minimize residual soreness from those
"tetanus shots" by giving it in the deltoid muscle of the dominant arm.
The additional exercise and circulation of this arm will help clear the tissue reaction.
If the arm's mobility will be considerably impaired for a while, the thigh muscle is a
good choice. |
| A Trio of Tips for the Troubled and Truculent:
Some very agitated and combative patients despite being
fastened into four-point leather restraints continue to arch and buck against the
restraints with all their body mass, the momentum of which can cause the gurney to
literally "go airborne" and actually be off the floor in convulsive hops that
threaten to topple the bed over. This may be forestalled by restraining the patient with
one arm "up"to the head of the bed and the other "down," or in Left
Lateral Recumbent Airway Recovery position; a sheet or strap around the hips may prevent
the requisite "bucking." When
this occurs, and it is not yet feasible to chemically restrain the patient, it is
desirable to secure the safety of staff and patient. Do this by moving additional gurneys
to either side of that upon which the patient is lying. Strap these to the first as
"outriggers" so that the patient's bed has more mass than the patient can shift
and is braced against lateral movement. This places the patient within a wide padded
"island of safety." The patient who is acting out now is confronted with an
insurmountable difficulty which allows him to "give in." Many will now quieten.
Approach can be made across the top of either gurney to provide an intramuscular injection
of Droperidol or other agent.
If the patient is being involuntarily escorted
by staff into a seclusion room, it is not uncommon for him to resist being
"caged" and to brace himself against the door jam. This can be prevented and
overcome by his attendants doing a quick "surprise" wheel-about and enter the
room backwards; the startle effect of this tactic and the fact that attempts to
block passage will now go with the natural flexion of the arms leading to the collapse of
the effort rather than reinforcement by locked arms. He may now be confined in routine
fashion.
|
| Extravasation? Susan Moretto, RN, BSN ". . .
I have a hint for detecting an extravasated new IV. If you cannot determine that there is
proper venous access, and cannot see a wheal forming or a translucent area, try placing
fingertip pressure on either side of the distal tip of the catheter. If it is
extravasating, the flow rate will slow or stop. I have been
ER nursing for 11 years now, out of 20 nursing years. (That's 140 dog-years). Keep up the
good work."
|
Ear Irrigation?
TERRYBIKE@aol.com
writes to remind us
"To easily irrigate an ear without using the old hard-to-handle
ear syringes, attach a 14 - gauge Angiocath™ (minus the needle, of course,) to a 60
cc syringe with a Luer-Lok™ tip. Fill with warmed saline or water and proceed as
usual for ear irrigation. The flexible tip is more comfortable for the patient. This is
also much easier to use in pediatric ear irrigations."
***{Editor's note} Remember, however, with this widely used
suggestion that the larger bore cannulae are also stiffer and more likely to "poke"
uncomfortably or scratch the canal, and with a "squirmy" kid, could perforate
the eardrum. Many pediatricians use the softer and more supple tubing and hub from a
"butterfly"™ needle to prevent injury. For calm adults, a
"needleless" syringe cannula gives the little extra reach compared with a simple
luer™ tip and has smooth edges.
|
"Dustbuster™" Busts Glass
Fragments:
In our Emergency Room, we have a
Dustbuster™, that we use on patients that have been in MVA's and have a lot of glass
on them. It works like a charm and keeps the patient from any further cuts and also
protects the ER staff from cuts.
Lannette Harris RN, CEN
ER
Coordinator, Russell County Hospital, Russell Springs, Ky. |
Hearing Impaired; a Tip!
From: Brian Fletcher
In the elderly it is often difficult to communicate because of hearing
loss. A trick that I use regularly in the elderly population that I serve is to put my
stethoscope (after cleaning the ear pieces) into the patient's ears. I speak slowly,
softly and clearly into the diaphragm. This serves as my microphone. The patient gets the
message and without a lot of yelling and repeating! Brian Fletcher, RN
*****Editor's Note: I've tried this, too, without as
much success as you; it doesn't work for all but may help in a pinch . . . ----speaking of
pinches, a quick screening test to trap malingerers faking unilateral deafness is to
insert a double-tubing stethoscope in the patient's ears with the tubes leading
behind him, speaking softly into the bell and alternately or randomly pinch-occlude one
tubing to catch a false-response. Difficult cases may require formal audiometry, but
prompt confrontation and prompt confession . . .
|
ECG Electrodes On Diaphoretic Patients:
From:
Brian Fletcher, RN
As urgently as possible, you connect the ECG electrodes to your patient
with crushing chest pain to see what his rhythm is doing ONLY to be foiled with the ever
present diaphoresis. You have tried taping, alcohol prep, scratching, the whole works only
to have the darn electrode fall off again.
Next time this happens, try a little spray-on or dry roll-on anti-perspirant
(can't just be "deodorant") on the spot where you want to apply the electrode.
After all this guy is sweating! We keep a can on the crash cart just for this purpose. As
always, make sure the patient is not allergic. If you use a roll-on, make sure it is a dry
roll-on. The wet ones work, but you have to hold the electrode in place until the wet
stuff dries up. This could take a few minutes. Dry powder sprays are not good because the
adhesive on the electrode will not stick to it. A very small amount of wet spray works
best. Fan the area briefly to cause drying then apply the electrode.
****Editor's Note: Good Reminder! Years ago, it was standard in
the ambulance service for which I was working to keep a spray can of Right Guard™ in
the monitor case. However, anti-perspirant alone is not sufficient without getting the
skin scrubbed clean, dry, and defatted first {q.v.
Better EKG & Monitor
Signals above}. Compound Tincture of Benzoin under the adhesive (not the
electrolyte) can help.
-----And don't forget the value of
eliminating patient tremor and motion with padded positioning, warmth, and adequate
analgesia. You also get a wonderfully clear motionless tracing when you repeat the EKG
after the Vecuronium has been given! Timing is everything in life!
|
| "Where's The Smelling Salts?"
Need an ammonia inhalant fast to forestall that swoon?
Need a noxious stimulus for that drunk who's pretending to be too asleep to be discharged
or to sort out whether someone is "really" Altered Mental Status? {Tom's
"First Law Of Neurology": Use ENOUGH Stimulus!} Want one
handy without it ever breaking in your pocket? [Yecch!] Try the "CIA
Model." Take an old large-barrel fountain pen or ball-point pen case {I used a Parker
"Big Red"}, and remove the "innards" leaving you with a pocket-size
(with clip) crush-proof container that will fit right next to your pen and penlight. {Don't
believe what you hear; ---I never wear a pocket protector when I'm off-duty!} |
| Need Things Handy When The Action's Intense?
If you're used to working from pockets or belt and your
floor plan is terribly cluttered, try an inexpensive carpenter's short work apron with
lots of pockets. Fill it with what you need, slip it on when that "yet another
ambulance" arrives, and you're ready to go. Since your nametag, work, and care-giving
relationship define you as a nurse to the patient, you'll find no real confusion as to who
and what you are, and still have a ready conversational item for the more alert "that's
a neat idea; ---you look like that guy on "Home Improvement©!" |
| Eye Flush:
From: William Robinson, ER Nurse
When I need to flush both eyes at the same time, I simply attach
a liter of 0.9% NaCl to a nasal cannula. Positioning the soft tips on the bridge of the
nose supplies a constant stream of saline to both eyes. This trick also allows you both
hands free to hold the lids open. This procedure is not necessary when you can find two
Morgan Lenses™ and a Y-connector in your eye box ---which is about as likely as
finding two extra staff to help you! *****{ Editor's
Note: Good reminder of a worthwhile tip. ---I've often keenly felt the amount of time
involved in setting up Morgan Lenses for o.u., (we don't have an ordinary industrial eye
wash fountain; so it's either try to get the patient's head under the faucet or into a
bowl!). This may well be a good way to get started faster until the lenses are ready}.
|
| "Don't Take Off Those Shoes!"
Haven't you heard coworkers gasp and cry out that phrase
in alarm, dreading that over-powering all-permeating stench of "Mission-Foot"
(as we call it in San Francisco after the name of our trauma center's ED) or more
descriptively "Toxic Socks Syndrome"? Yet, you though may have wished to avoid
having that odor "inflicted", you may have felt "conflicted" knowing
that unconscious alcoholics need a full head-to-toe nude exam. Room deodorant doesn't
always help. Bag it! Put each foot inside a clear plastic clothing bag and Voila' --odor
is confined while permitting visual inspection and check's for Babinski's Sign. There is a
"Greenhouse Effect" of confining warmth and moisture; so don't be surprised if
they are on for a good while. The patient may be quizzical when waking. When the bladder
fills and he starts to get up, footing can be lost; so it is best to have the patient
secured with a safety vest. Paper bags may be cooler. |
| Aromatic Oils:
It
was a common and successful practice, in my old unit, when attempting to encourage voiding
let-down in the "shy bladder" or urinary retention before resorting to a Foley
Catheter, to put one or two drops of Peppermint Oil, NF in the urinal or bedpan near (never
ON) the urinary meatus ---within a few minutes, micturation usually occurred.
The speculation was that the fumes from the oil "tickled" the meatus and
stimulated a reflex; alternatively or coincidentally the "Candy-Shop-Aroma"
might revive pleasant childhood memories and relaxation. Regardless of any actual
mechanism, in this as in most things, the strong influence of positive suggestion and a
plausible reason why it (might) work {say, "will work"}, whether scientifically
"valid" or not, enhances efficacy.
Not, too surprisingly then, occasionally a little of the oil might be placed on gauze
pinned near a patient such as in the "Toxic Socks Syndrome". In truly desperate
cases, some has even been nebulized into the atmosphere of the room! Sean Hogan, RN suggests that Wintergreen
Oil can be diluted 1:1 for a less potent mix. If other patients might be affected,
it would be good to be certain there is no likelihood of an allergic or asthmatic
reaction.
Clove Oil, NF, has often been used for painful
dental cavities wherein the Eugenol provides numbing analgesia. This, too, has been used
for general aromatic relief (not for the let-down reflex for which the Peppermint Oil is
used). It can be referred to more diplomatically as smelling like a nice baked ham then as
"that dentist's office smell."
|
| No "Dr. Benton's" Here, Please!:
One of the egregious things on TV's "ER"™
is the unpleasant command of "Dr. Benton": "All right, People! On my
count: one, two, three!" and the rough flight and landing the patient makes
as he thumps down on the gurney. This is to heighten the dramatic tension and show us how
much the patient needs the care of the doctors 'cause ya' gotta rush! Too often, however,
this can be the reality in the ED, or to spare the backs of the staff, the patient is
commanded to (laboriously and painfully) "move over" to the gurney. There are
ways, however, to make physical transfers easier for patient and staff.
The keys are the patient's trust and cooperation {Funny;
how true that is of everything that we do}, his physical relaxation {and, you
can't really bark out a command to RELAX! and expect someone to
do it}, so, remember two things: #1- watch for that end-expiration, and
#2- focus=distraction and vice versa.
Gently tell the patient that "we are going
to float you over to this bed"; "hold your elbows (your purse/that
oxygen tubing/etc.) close with your hands", {you may need more or less
explanation depending on the patient's anxiety} "take a deep full breath, then
breathe all the way out (so your muscles relax), (give a count if the patient or
the team need that cue: one=ready, two=take a deep breath, three=breathe out) as the
patient breathes out or reaches end-expiration, move/lift the patient, perform the
injection, or other task ("let us roll you over). If it is a familiar and adept team,
the move can even be done on silent agreement or cue as the patient hears or would have
expected to hear "three", before anxiety can reimpose tension.
In short, the patient is more comfortable and
your backs are spared if the patient's muscles are relaxed and this is most reliably made
to occur at end-expiration [it's that old "dead-weight" versus
"live-weight" thing! You don't need to combat dynamic tensions when all you
want is a quick, safe, easy move.] If you've used hypnosis, guided imagery, or meditation
then you know that breathing exercises can provide focus and distraction and induce
physical and mental relaxation. The patient can even be told that this will make him
lighter and looser, and while he's trying to figure that one out, ---you've made the move.
{Since tense muscles make IM injections more uncomfortable, this is also a way of making
needle insertion less painful [propped comfortable positioning, slow rate of injection,
and Z-track method are the other important steps.]}
|
| "The 'Eyes' have it!:
A number of ophthalmic medications can have significant
systemic effects. Systemic side effects can be prevented and minimized, and the taste of
eyedrops eliminated by careful administration. ALWAYS press on the inner
canthus with a cotton ball, tissue, or gauze for one to two minutes after placing
eyedrops. {ii gtt.? place a drop, press one minute, place a drop, press one minute.} The
patient should "blink" the medicine around. This prevents drainage via the
lachrymal duct during uptake of the medicine by the eye, and secondarily decreases the
taste. Excessive dosage can be avoided by carefully placing only the prescribed number of
drops. If the medicine is not temperature-sensitive, keeping it cool or in the
refrigerator allows the patient to more discriminately sense the drop in the eye.
Body-temperature drops, e.g., kept in the pants pocket, are often not sensed
until there is a flow of excess down the cheek. |
| How far do you gotta' go when you gotta' GO?:
Discharging a person with back pain? Or a person who is
perhaps elderly or otherwise impaired in activities of daily living and may need a
temporary bedside commode because the bathroom will be too far away? Here's a couple of
tips. . . A 2lb. coffee can filled with cat litter and a plastic snap lid can accommodate
a good deal of urine with low risk of spillage or odor. A bedpan stuffed inside a large
plastic bag (the bag depressed into the bedpan as a liner) can be placed on a straight
chair next to the bed. A little bath powder will help keep the plastic from sticking to
the skin. After the bedpan has been used, invert the bag with the excreta and odor
contained within and knot the neck of the bag. The bag can then be disposed of when help
is available. |
| Good to the last drop!:
Straight
cath'ing a baby? Put a syringe on the end of the 5fr or 8fr feeding tube used for the
catheterization, especially if there is likely to be a low volume of urine within the
bladder. That way, gentle aspiration of urine can be done as the catheter is withdrawn
near the neck of the bladder. It's always a good idea to have an open urine sample cup
handy to catch a sample from the fountain of urine into the air if the child reacts to the
preparation with a let-down reflex or "cries and squirts" before the procedure
is complete. |
| "How to control that struggling patient while
trying to get the restraints applied!
From: Regina Drury
"Remember that the thumb is the weakest part of the hand. If you want to control the
hand always grab the thumb. As the thumb is directed toward the radius, the arm follows.
This also works when you are encouraging a patient to return to his or her cart. This is a
wonderfully effective tool." |
| "Seeing C-7":
Having
trouble getting ALL seven cervical vertebrae on that Cross-table Lateral neck film? Are
those shoulders too bulky or neck too short to get the last view clearly? Are you the one
who is always asked to help pull the shoulders down? Some ways to extend the
"length" of the patient's arms and to prevent back injury for you (and keep you
farther away from the X-Ray beam) include slipping a "clove hitch" knot over the wrists, using
the soft wrist-restraints perhaps already on the patient, or if the patient is cooperative
give him loops of tubular stockinet (or other reasonably sturdy material) that have been
joined with a "square knot" to
hold at the knots (as if they were suitcase handles). Explain how important it is to get a
clear view of all the c-spine without the shoulders in the way, "you can
really help do this by relaxing your muscles and letting your arms feel dragged down as if
you are walking through a long airport with heavy suitcases in each hand, ---practically
dragging on the ground. That's good!" Shoot the film. Of course, if this does not
succeed, alternative views such as a "Swimmer's" will need to be done or even
computed tomography. Perhaps, your X-Ray suite could install pulleys and weights hanging
on the wall with handles for the patient so that the radiographer doesn't always need to
seek assistance. |
Venous bleeding:
"When removing a cannula from a patient's arm, wrist or hand..it is often the case
that after asking the patient to "press on here" they move their pressure and
gauze swab and messy blood leakage occurs.....to the horror of some patients.
Tip: Prior to removing the cannula, I take the
gauze 5x5, un-ravel it, and tie a small tight knot in the centre of it. Then, when
instructing the patient to press on the knot they have not only a visual point of
reference but also a tactile one.....these combined, ensure correct pressure of a higher
grade than that of a finger alone.....haemostasis soon follows (if they have no
dyscrasia!) This technique can also be applied to varicose vein bleeds with
excellent effect!"
Andrew Thurgood Registered General Nurse (UK) RGN,
A&E Cert, ENB Higher Award, ACLS, TNCC. PHECC, ENP (A&E) |
| Pulse Oximetry Adhesive Wrap Sensors:
With restless or poorly-perfused patients, often even
the adhesive wrap sensors for fingers don't hold on or pick up the pulse very well, and
need strain relief for the wire to keep it from being yanked off. I've been reinforcing
with extra tape; but here's something better for special situations . . . Carefully apply
the sensor. Take an exam glove and cut off the fingers except that for the finger with the
sensor. Slip the glove onto the patient's hand.
This keeps the sensor snug (and the finger warm for better perfusion and pickup), protects
from snagging the sensor or letting it be picked at, and lets you see the other
fingertips. Just one piece of tape to the wire, now, for strain relief. It's
well-protected.
For infants, I've found that using the adhesive
sensor on a toe and covering it with the sock allows the child to "forget" about
the sensor, and the toe stays warm.
|
| Another Glove Trick:
An often-published useful tip for hand injuries which is often overlooked is to apply a
sterile glove to the hand with the injured finger. Cut the fingertip of the glove for the
injured finger. Roll it back to the knuckle (like a fingercot or condom). You now have a
previously dirty hand which does not soil the sterile field, the rolled portion now
tourniquets the finger for a bloodless field, and care can proceed more neatly. |
Securing Endotracheal Tubes:
Tim Soyars suggests:
When trying to secure an ET tube, few "simple" things
are vomit proof. One way to secure the tube is to take a nasal cannula, cut it off where
it meets the O2 supply tubing. Slide the smaller tubing around the patient's head with the
cannula tips to the back of the neck. Using the two free ends for the tubing, secure the
ET tube in place. The latex to latex contact will not slide, making the tube pretty much
"pukeproof".
Another is: When the adapter on the end
of the ET tube keeps coming out, wipe the end of it with an alcohol prep. Then replace the
adapter into the ET tube. This causes the latex to get tacky and hold the adapter in
place.
Thanks, Tim Soyars, EMT-C, Training Officer,
Boonsboro Fire & Rescue |
Ring Removal Tricks:
HakeJC sends two tips for ring removal that do
not require cutting the ring:
1. Spray ring and finger with Windex™ type product.
(use only on intact skin) the ring will slip right off. The window cleaner has a wetting
agent that decreases surface tension.
2. Finger compression. On swollen fingers try this. Find the smallest
finger on the smallest glove in your department. Cut a tab that connects to the proximal
part of the the finger of the glove (you know from up in the hand part of the glove.) Then
coat the swollen finger with KY™ type product. slip the glove finger
over the swollen finger . Work the TABS up under the ring(s) then put more KY™
on the outside. Pull gently on the TABS, while working the rings over the knuckles. You
will find that the skin does not bunch up under the ring as bad. |
| Another Gastric Lavage Set-Up: P. McBlane, RN suggests:
"I have found that the easiest way to do gastric lavage for
overdose patients is to use a Cystoscopy set up. With a Y connector in place you can
irrigate with saline through the spiked port while connecting the suction to the other
side of the Y connector. All you need is a pair of hemostats to alternate clamping either
the suction or the fluids. When you are finished lavaging you can also cut a hole in the
liter bag of fluids and easily give activated charcoal with limited mess!" |
| NaHCO3 To The Rescue!:
Shimal@aol.com writes:
"This is an old trick, but I'm surprised more people don't remember it. I always keep
a couple of boxes of baking soda in the E.R. - its good for cleaning grease off of
patients and is especially helpful for the dreaded "toxic sock syndrome".
Sprinkle some in the shoes (if its really bad, you may need to set them outside) and you
can make a paste and apply to the patient's feet - I know its more time-intensive than
some like, but I think its better than everyone's eyes watering. You can also place an
open box in a room where you've put a badly infected wound, it absorbs odors, or sprinkle
it it the waste cans when you throw smelly dressings away." |
| Gastric Lavage Advice:
Adam Hill LPN writes: "The
winner of the GI lavage devices is by far the TUM-E-VAC™! This system comes complete
with an Ewald tube for an adult, closed delivery and recovery bags (delivery will hold
approx. 3500 cc of fluid, recovery will hold approx. 7000 cc) connected by an ample length
of tubing and clamps. The Y-site can be trimmed to fit a wide selection of tubes.
In the kit you also will receive a bite block. When the tummy is empty, you are
supplied with 2 tubes containing 25g of activated charcoal with 48g of sorbitol, and a
handy little tube roller. There is a port to screw the tube to the Y-site for ease of
instilling the black mess. A tip on removing any lavage tube is to drape a towel over the
top of your pt's head. Now grasp the tube close to the mouth/nose with the end of
the towel and pull. the towel will follow and cover the messy tube while preventing the pt
from vomiting charcoal all over the room and yourself. Thanks, Adam Hill LPN" |
| Easy Non-Cutting Removal of Rings:
Mary Anne McDougal, RN
reminds of a well-established technique: "Here is a tip for easy
removal of rings. Take a piece of umbilical tape or a large suture. Thread it under the
ring and wrap the tape tightly around finger so you are compressing the finger. Then take
the top of the tape and unwind it gently pulling the ring down the finger. I have never
had this method to fail and my patients are happy the ring is in one piece." |
| Need Lotion for your Hands? - Tired of the Greasiness?:
Wash your hands first (cool water, if skin is really
"dry"). Gently blot your hands with the paper towels. When the
towels are damp, and your hands still moist, squirt a little less lotion than you
usually would and rub well into your hands. As you finish the lotion, resume drying
your hands with the same damp towels. Your hands are now soft, freshly clean, and non-greasy.
You have enhanced the absorbtion and eliminated the excess while using less than
you used to do. Even charting can now be done without spots on the paper. |
Removing Foreign Bodies from Nose or Ears:
Mary Anne McDougal RN writes
I have another old trick my mother taught me, to remove all those little objects children
feel compelled to put in their nares. First have the child sit on a desk so he may be
comfortable. Have the parent place pressure on naris not occluded by object. Have parent
blow into the child's mouth. This usually works well (unless the object is a pony bead and
the hole is aligned in such a manner that air blows through it , rather than pushing it
out). I try this for all such cases and have been quite successful. The child is less
fearful and everyone goes home happy.
{*****Editor's Note: A number of variations of this positive pressure to
contralateral nostril technique have been published in recent years, even on "ER"
tv show. Another is at
http://www.rmch.org/blaster.htm
High success rates are usually reported. Caution, however, is urged with
any procedure in which risk to the airway may occur.}
I also
have had success in coaxing live insects from ears by shining a bright light into the ear
. This is noninvasive and works as long as the insect is alive. The last moth I coaxed out
couldn't fly but got around on the floor quite well !! the patient went home happy too !!
This is a great site- keep up the good work.
{*****Editor's Note: The classic advice for treatment of live insects in
the ear is to instill a small quantity of warm olive oil or mineral oil to simultaneously
still & smother the insect and float it out. Upon removing foxtails or other
foreign bodies from the ear, I have found that Benzocaine spray very gently fizzed into
the ear eases the irritation of the canal or allows the patient to relax so that further
instrumentation can occur. No residue is left. (The reaction feels warm at first.)}
|
| Easier Foley placement: From
Michelle Graves RN
"Here is a trick I learned from an old army nurse regarding Foley Catheter placement
for females that will make life much easier for you and your patient.
When most female patients learn
foley placement is necessary, they tense with fear making it much more difficult to
visualize the urethra as well as increasing the level of discomfort , particularly if the
patient has prior experience with a painful insertion. A great way to make the task easier
for all to endure is to explain to the patient prior to the procedure that you know a
"trick" to make the placement less painful. Tell your patient to focus on your
voice as you are going to give her specific instruction while you are placing the
catheter. (For one thing, if they focus on your voice, it distracts them from what you are
actually doing down there) Demonstrate to them that you will first tell them to inhale
deeply through their nose and then on your command to exhale forcefully through their
mouth with a blowing motion. At the precise moment that the patient exhales place the
catheter in the urethra. Most female patients comprehend this instruction well as they
equate it with breathing techniques during labor and delivery. As they exhale forcefully
through the mouth, the pelvic floor relaxes, allowing visualization and less resistance to
the catheter which will slide right in. I have tried this trick time and time again, and
patients have thanked me for a much more comfortable alternative to a unpleasant
procedure. Good Luck!"
|
| One more trick for finding an acceptable vein:
From:
Sherry Jones
"When common sites for peripheral venous access prove not to be
acceptable candidates, I've found applying a warm pack and wrapping the extremity in a
towel for a few minutes assists in venous dilation. The tiniest veins will present
themselves for blood draws and cannulation with warmth, even after all the other tricks
have failed. This is especially helpful with the fall season approaching, for those who
'usually have good veins ...'" |
Securing the ET tube-FAST!
From:
 David Bennett
"One of the ways that we use over here in
England to secure an ET tube is quick, easy, and cheap so the managers will like
it! When you are pre-cutting your tubes, keep the bit that you have cut off.
It is best to use the bit from a pre-cut 8mm tube or bigger as they give a good size. Cut
a hole in the middle of the piece of tubing so that it looks like a one hole flute. Feed
ribbon bandage or a narrow gauze bandage through the tube with enough bandage so that it
can go twice around a normal head. Then pull some of the bandage out through the hole to
form a loop. When it is time to secure the tube just slip the loop over the end of the
tube and tighten. Feed the ends around the head and tie off. You can keep several
different sizes in the crash kit to fit different sized patients. This avoids slipping as
the latex on latex grips and it avoids pinching the patients lips and cheeks with bandages
tied too tight in the rush to secure the tube." David Bennett, Qualified Ambulance Paramedic, East Anglian Ambulance
Service, National Health Service Trust. (Based at Ipswich, Suffolk, England.) |
| Why Dig For A Vein?:
Tim Weiant, RN, reports that he often finds a much-needed vein in the sculpted
depression underneath the wristwatch band. Since wristwatches are worn so
continuously, the permanent mild "tourniquet effect" tends to displace the
subcutaneous fat (or discourage so much of it in that spot as we add on the pounds) so
that it is less "buried" and more easily palpated. |
| Visualizing the "missing" Female Urethra for
Catheter Insertion: from Kristina Boggs, RN BSN
"Working in a Urology clinic, prior to becoming an ER nurse eight years ago, taught
me a trick for easy foley insertion that I have passed on to many. This trick is most
useful on the elderly patient or the patient with a urethra that is sometimes
"buried". Take a plastic vaginal speculum and separate the two pieces and use
only the bottom half. Lubricate the speculum and place in the vagina. This trick will open
not only hold the labia out of the way, but it will also "open" things up for
you to see better. Many patients have urethras which can be found either in the vagina or
very close to it, not always as shown in the "textbook". The speculum eliminates
the blind attempt. Although some may think of it as invasive, use of it (rather than
multiple blind attempts to find the urethra) much improves the patients satisfaction . As
we all know, the human body is not built by the book. This tip was used frequently by the
urologist; and I have made it standard in my practice when unable to visualize the
appropriate orifice. I hope it helps." |
| Odor Control: Michael Lamp, RN Austria writes
"If you have got problems with "smelly" patients, just place a cup or a
plate filled with coffee powder near that patient. The coffee powder will absorb the odour
of all ugly kinds of things and leaves a very pleasant smell in your rooms." |
| "You've got to drink this!":
Palatability and, therefore, consumption of
Muco-Myst™ N-Acetylcystein to block the hepatic pathways from the toxicity of
acetaminophen overdose, is enhanced most commonly with a cola drink. The overpowering
"rotten eggs" smell however can be concealed by using a covered cup with a
drinking straw. Using a screw-top specimen container for the cup helps contain the
sloshing that often occurs during persuasion. With color, smell, and taste confused, it is
easier to administer the entire dose. It is also said that Chocolate Milk works well with
Activated Charcoal to improve palatability. |
| Protecting Personal Wounds:
"Unfortunately, cuts and cracks in our skin subject us to infection. Band-Aids™
and Tegaderm™/bio-occlusives become wet and fall off. After cleansing my hands with
soap and water, I will use collodium (liquid plastic bandage) which unfortunately burns,
but does the trick; or preferably use some "crazy glue" on these open areas to
seal them. Both last an entire 12 hour shift (and then some). For you skeptics, I checked
this out with my dermatologist who agreed this is a doable solution except if
someone is allergic to either compound." Darel
DePompeo, RN CEN CCRN |
| Softening Up A Tough Problem:
"Often,
elderly patients are received from home or residential care facilities who have dried
feces on parts of their body. Rather than using the warm water, washcloth, and scrub
forever approach, --I use hand lotion on the washcloth. It softens the dried feces more
quickly, less abrasion is needed to remove, thus decreasing the possibility of inflicting
the beginnings of tissue breakdown in an already susceptible location, and it takes less
time to remove. And, when you are done the patient has a nice soft bottom, like a
baby's." Trudy Meehan |
| IV Starts On Very Edematous Patients:
"When the hands and arms have pitting edema, I press my
thumb down on various sites to "take a look underneath all the fluid", then when
I've found a vein, go for it quickly before the area fills with fluid again. It almost
always works, much to the wonder of others!" Sent by "Just
one of many dedicated emergency personnel" |
| Broselow™ Pediatric Tapes--Now Even
Faster!:
Our institution uses a pediatric code cart based
upon the Broselow™ Tape to estimate sizes of advanced life support equipment and
weight-based dosing of medications as judged by the color-coded measuring tape. But, the
folded tape from a drawer could be slow to find and easy to fumble. It's now firmly bound
between 4mm plexiglas strips 12cm wide X 156cm long; a short hanging chain is bolted to
the head end. It proudly hangs from a wall hook, instantly ready to simply lay on the
gurney alongside of the patient (even before his arrival), protected from damage or loss,
and always visible for reference or checking. |
| "Please Drink This":
"Most children will balk at just about anything,
---except chocolate milk! So, whenever I need to give activated
charcoal, I mix it with a pint of chocolate milk. I have never seen it fail.
Knock on wood!" Judy Kempher, RN
CEN |
| Avoiding Sticky Situations:
"I am a Pediatric Emergency Nurse here in "the
twin cities", --in Minneapolis. If you are using tape to secure a pediatric patient's
IV, you can minimize the painful removal of the tape by placing cotton on the back of the
tape in those areas that are not so crucial to be adhesive. This helps with removal of the
tape at the time of discharge and also prevents possible skin irritation. You can also
"double back" the tape (two pieces stuck adhesive-to-adhesive so that a smooth
non-sticky surface can be against the skin)." Kim Dehn, Clinical Educator, Children's
Hospitals and Clinics, Minneapolis, Minnesota. |
| Expanding on the eye flush tip:
From
George Olschewski
"Ever try washing your face with cold or even cool water? What's the first thing you
do? Clench up your eyes! Granted, it's our eyes' defense mechanism, but it can be
problematic when trying to flush out the peepers. To lessen the chances of this happening,
use warmed saline. Most ERs have a warmer for blankets and IV fluid for hypothermic
patients. Because the saline is at or close to normal body temperature, the eyes would
have less of a reaction to the fluid, as opposed to room temperature saline (or
refrigerated saline, depending how well the air conditioning is working in your
area!)." *****Editor's Note:
Be
sure to check the temperature of the solution before irrigation begins! It should be
evenly mixed and no warmer than "baby bottle" temperature when you test it on
the inside of your forearm! Mortan®,
Inc., the makers of the Morgan
lens, urge using Lactated Ringer's Solution instead of saline as it is a balanced and
buffered salt solution which is less acidic than unbuffered 0.9% NaCl and therefore better
tolerated by the eye. We have noted less reddening and irritation by following this
recommendation. Their website has much useful information that you should check before the
next ocular emergency arrives.
|
| Waitin' for that Urine
during the Febrile Infant & Fever Work-Up:
Laura
Jacobson, RN suggests "As soon as you find fever when checking the
rectal temperature of the infant, clean the perineum and apply a urine collection bag.
Apply a fresh diaper, but push your thumb through the perineum of the diaper
through which the bag can protrude. (If diarrhea is reported that might leak through the
hole, keep a Chux™ or hospital baby blanket under the child.) You can now begin
antipyretics, fluids, and detailed exam, with the confidence that the first urine will be
caught, and noticed, without the frequent disruptive "inspections" that
may dislodge it and cause a leak. |
| Giving Pediatric Medications:
Kim Dehn, RN, who is a Clinical
Educator for the Children's Hospital and
Clinic system in the Twin Cities area, writes: "When you have difficulty giving
oral medicines to pediatric patients, often grape juice will disguise the taste of the
"awful tasting" medications. You also can gently blow into the child's face when
giving the med; this helps to initiate the swallowing reflex." |
| Helping Kids Retain Enemata:
Kim Dehn, RN, also writes: "If
little ones have trouble holding enema solution, gently place a small-sized Foley catheter
into the rectum, inflate the balloon to approx 3 cc's and it will hold the enema solution
in place. Deflate the balloon and remove the catheter after 10 minutes. Works great!" |
| Instilling Rectal Sedation: When giving
rectal sedation in pediatric patients, e.g., 2% Methohexital, draw up the
calculated dose in a syringe that will allow 5 ml "airspace" behind the dose and
affix to an 8-french feeding tube. Insert the lubricated tip a short distance past the
anus into the rectum. Squeeze the buttocks together with one hand while
"injecting" the agent, keep squeezing as the tube is withdrawn, and place a
strip of paper tape across both cheeks to maintain closure for 5 minutes while finishing
preparations for the procedure or transport, then remove. Easy sedation. |
| Securing an Ewald Tube during Gastric Lavage : Toby S.Knight Meigs, RN BSN EMT-P writes: "When doing a Gastric Lavage, I have found
the easiest way to secure the Ewald tube is with a Thomas brand ET tube holder(or a
similar device). These are the ones that EMS crews carry that have the large plastic mouth
piece & a thumbscrew to secure the tube. Just measure out the desired length of the
Ewald, insert it and secure it with the thumbscrew. The integral biteblock works much
better than the small one that is easily spit out by the patient which is included with
the Ewald kit. The thumbscrew helps prevent dislodgement of the tube on a wildly flailing
patient who could aspirate. I hope people find this helpful." |
| Shaving foam for whole-body cleanup: Andrew Maruoka, RN uses foamy shaving lather as
soap when cleaning patients who have been "found down several days". It
applies easily, wets and softens crusts of soil, stays in place, smells nice, and is easy
on the skin. It lessens the amount of work, too. |
| Stethoscope assistance when starting an E.J. IV:
If you're starting an External Jugular Vein intravenous line without a helper, you may
find added greater visibility and distention of the vein by taking a stethoscope with a
strong spring on the binaural earpieces and applying it to the patient's neck
diagonally. The pressure acts like a finger to tamponade the vein and the dangling
stethoscope "tail" helps keep it out of the operating area. Do not
apply it in an anteroposterior dimension where it would press against the trachea and
cause a cough sensation; only apply it to the side of the neck. Remember, of course, to
use appropriate other aids such as Trendelenburg's Position, head and neck rotation,
Valsalva's Maneuver by the patient, to better demonstrate the vein. |
| Putting Gravity to work:
Cheryl Clutter, RN BSN writes:
"When you're in the ER working with your patients and they keep sliding down on the
Stryker™ carrier, you can easily move even the largest of patients by yourself
without fear of injury. If there is no contraindication to Trendelenburg's Position, then
elevate the bed to the highest position. Once in high position, place the patient in
Trendelenburg's Position. Stand at the head of the bed. Pull the patient up in the bed by
the sheet. {Editor's Note: Beware of shearing forces with fragile skin or decubiti.}
This procedure requires minimal effort. Level and lower the bed again when the patient is
correctly positioned. I have used this method many many times --and it works. It takes
less than 10 seconds to move even the largest of patient up in bed."
*****{Editor's Note: Improve comfort and defeat the power of Gravity
that causes the patient to slide and slouch into an uncomfortable unsupported body position.
Raise the knees with the crank or a bolster under the knees "like a lounge
chair" to brace him. Restless patients who lean or creep forward to the foot of the
bed can be maintained in position by placing them in Fowler's Position and tilting the bed
steeply into Trendelenburg's Position. It's comfortable, and harder to move forward.}
|
| Toxic Sock Syndrome Tip: Cynthia Franks, RN BSN writes: "Use Benzoin
(Aerozoin™) spray as a deodorizer. Just a few sprays on a Chux™ and hang it in
the room (lay it over a chair, or stool). Voila'! Instant deodorizer! The
resulting pad works for hours. In our ER, we have 4-5 patient beds in most rooms. This way
we don't have to single out the smelly offender! Works wonders!!! |
Struggles In Sensing Pulse Oximetry:
Christie Connor, RN CEN MICN, advises: "If
you have a patient who has an altered mental status, is in vascular compromise, has cold
extremities with delayed capillary refill, or is plain combative; and you need accurate
SaO2 reads, try this . . .
Cleanse the patient's forehead with an alcohol pledget. Then, apply an adhesive SaO2
sensorstrip (pediatric kind) across his forehead. Secure with silk/paper/adhesive tape
across the SaO2 strip to approximately 1" on either end of the strip. As the richly
vascular head is usually better perfused on a "clamped down" patient, and, you
don't have to struggle to keep a probe on a dirty/cold, moving finger, you may well get a
better pulse oximetry reading from a sensor which stays on until you remove it. I use this
frequently having tried this in desperation ten years ago. In testing it against a digital
source, it seems very accurate." |
| Flavoring Charcoal: Bryan M. Loetterle, RN BSN, writes "I have
found an easy way to get a child or adult to drink their charcoal. Simply mix it with
instant hot chocolate powder and serve it in a covered cup. It doesn't add a lot of extra
volume like chocolate milk or other liquids, and it tastes pretty good. I use it in the ER
all the time." Bryan M. Loetterle, RN BSN,
Clinical Simulation Skills Lab Coordinator, College of Nursing, Arizona State University |
| "The Rectal Trumpet":
A
soft nasopharyngeal airway has literature support (The
rectal trumpet: use of a nasopharyngeal airway to contain fecal incontinence in critically
ill patients. J Wound Ostomy Continence Nurs. 2002
Jul;29(4):193-201. PubMedID: 12114937 ) as an alternative to diapers, fecal
incontinence pouches, or large rectally inserted foley catheters for patients with ongoing
diarrhea that threatens skin integrity or compromises care of critical patients. Users
report ease of insertion, effective drainage, and easy tolerance. |
Everyone's got a cure for
hiccups; this one works!: Seems like suggestions for relieving
hiccups (intractable singultus) are a "dime-a-dozen". Medical fallback is
usually IV clorpromazine; not a drug to use if it can be avoided. Most interventions not
requiring drugs or a neurosurgeon lack efficacy or belief in their efficacy. I've had
95-98% success with this method in providing symptomatic relief from hiccups (hiccups may
recur if there is causative pathology) and it has no side effects; some cooperation is
required.
- First engage the patient's attention, belief, and
understanding cooperation. Ask at least three patient-centered questions requiring his
answer of "yes." "You must really be uncomfortable and frustrated by
those hiccups, aren't you?" "Yes" "I'll bet that you'd really
like to get rid of them, wouldn't you?" "Yes." "If I showed
you a way of controlling them whenever you want, you would like that, wouldn't you?"
"Yes." This programs the patient to agree with your proposal and to accept that
it will work.
- Explain that the nerve carrying the impulses for the hiccup spasms
runs down the back of the throat. If we "confuse" the nerve and break up the
cycle of impulses, the hiccups will stop ("won't they?"). (If
necessary, draw an analogy to pacemaker control of arrhythmias.) If we counter-stimulate
the vagus nerve with strong vigorous swallowing movements of the Adam's Apple going up and
down, we will break up the pattern of impulses. ("Uh, huh.") We can
"amplify" the sensations of the swallowing in the back of the throat by doing so
with the ears and the nose stopped up. If the patient needs a prop for swallowing, he can
drink a glass of *anything* (or nothing at all, it is not essential) while doing
so. The key is vigorous swallowing (like gulping down a hot dog) on a full breath
so as to "get through at least two or three "hic-cycles". When you
run out of breath, "just stop and relax, there won't be any reason for the
hiccups to start again, will there?
- Provide the patient with something to drink, if needed and
permitted. If there is confusion over the next steps, be consistently encouraging and
confident, as with passing a nasogastric tube. Use your fingertips to firmly press the
tragus of the ear into the ear canal to seal, and to press the nares firmly against the
septum of the nose. Remember, the actual drinking is not essential ("you can even
do this in your car"). Encourage a comfortable full breath when starting, "swallow-swallow-swallow"
with up and down movement of the Adam's Apple. At the end of the patient's breath, have
him simply stop and relax. Release the ears and nose. If the duration of the swallowing
stimulus exceeded the time of two or three hic-cycles, the hiccups will have ceased.
- Congratulate the patient. Encourage him that he can apply this
method whenever needed for symptomatic relief. Remember, and caution, if needed that if a
pathologic cause exists, e.g., GI bleeding, brain tumor, subphrenic abscess, etc.,
that symptoms may recur and need medical treatment.
|
Tension-Reducing
Tips for Foley Insertion on elderly females:
Gretchen Caruso, RN, writes: "Sometimes the Patient is very tense and "holds
it" so well that the catheter tip won't advance into the meatus--or you
can't even find the meatus. If this is what you suspect, have the Patient
actively "hold it" while you prepare your supplies and the site. Then
when you're ready to insert, you instruct the Patient to "Take a long slow
deep breath and count to ten." This usually distracts the Patient so that
their meatus relaxes and opens for the insertion."
|
| "The
Blind Procedure" Female Foley Catheter Insertion:
I
had a difficult foley on a squirming woman with altered mental status the
other day . . . one of those can't-see-it /in the introitus/ prolapsed
uterus/ up and behind the symphysis pubis type of insertions. After the
standard 16 french amber latex foley came back out the vagina, I did the
second attempt in a "breeze" with a 16 french coude' tip tiemann catheter
(has foley balloon). Angled tip; ball-tip end; a little stiffer, yet supple;
--it was very easy to find the meatus blindly and gentle to insert, with
control, compared to the floppy round tip standard catheter. I felt quite
pleased with it, and don't know why I never thought of it before (as I
use them so frequently in men with difficult catheterizations)! |
"Can't
Find The Call Button?":
Linda Williams, RN
of Prestonsburg, Kentucky, wisely points out . . . "A blind
patient can find the call button on the bed easier if you tape an
electrode with the button side out to the call button. Then, they can
feel for the button."
|
Multiple
Steri-Strip™ Placement: Gretchen
Caruso, RN writes: "You have a long,
straight wound to dress with Steri-Strip™s. Try
this. It's neater and easier. Cut the Steri-Strip™
card in half lengthwise. Then peel back the paper from the edge of all
the strips about 1/3". Position all of the edges of the strips near the
wound border, then stick ALL of the steri-strips on the card to the
wound border at once by peeling back the rest of the card. This keeps
the Steri-Strip™s very neat in addition to
speeding up the process of closing a wound. A surgeon taught me to use
this method to dress a midline abdominal surgical wound after all the
staples had been removed."
|
|
Safely
Breaking Glass Medication Ampoules:
Brenda Hunt, RN writes "I have found
that the rubber nipple from a baby bottle (found in Peds or OB) is the
perfect tool for opening glass vials. Just slip the rubber nipple over the
tip of the vial and "snap". It allows for a non-slip grip as well as helps
to protect you from any cuts that could occur from those pesky glass vials."
*****{Editor's Note:
I've used
alcohol wipe wrappers or 2X2 gauze. Sometimes your pharmacy or drug
representatives might have plastic snapper shields to give away.}
|
"Magic
Bubbles":
Pat Ming,
RNC writes: "I have read your work for several years and enjoy
the humor and tips.
I started in pediatrics and then moved to the ED about 8 years
ago. I carry "Magic Bubbles" with me. I use them for the
kids. They contain glycerine so they last longer, but I am sure any
(brand) would do. I use them to calm my little patients, to break
the ice of a scary situation, as a reward, and as an assessment tool
when parents bring their kids in and say they won't move an arm.
Sometimes, I even share them with my big patients.
*****{Editor's
Note: You might find these links useful: <http://www.creativekidsathome.com/activities/activity_5a.html>
or <http://www.kerala.com/science/project1_page3.htm>.}
|
|
Removing
Odors from Hands:
Luis Lim,
RN writes from Western Australia: "I have found that after handling
terrible body fluids, one's hands can become rather offensive even after
scrubbing with copious amounts of soap and water. This makes eating meals
difficult. However, if you place a small dob of toothpaste, preferable a
scented toothpaste such as mint, then rub it in and wash as if it were soap,
this will immediately replace a rotten odour with a much more pleasant one,
and make your mealtime a more pleasant time as well." |
Sounding
Out A Fracture:
Luis Lim,
RN writes from Western Australia: When an elderly patient is brought
into the ED post fall with a suspected # NOF (Fracture Neck Of Femur), we all look for the external
rotation of the leg, accompanied by leg shortening, and the
obvious pain score continuing on with standard neurovascular observations. Another
tip taught to me by a "salty" nurse was to place a stethoscope on the patient's symphysis
pubis, and gently tap on the knee of the intact joint and listen
carefully to the distinct sound produced. Now, GENTLY tap on the knee of the
leg with the suspected # NOF. If the sound produced is different then you
may conclude that the NOF probably is #. The greater the difference in the
pitch of the two sounds produced the greater the degree of separation
associated with the #. Try to let the Doctor know this bit of information
GENTLY and always remember that "Nurses Rule while Doctors Drool".
|
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Before instituting any practice change, check all applicable standards and policies. |
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"Tips & Tricks"
[http://ENW.org/Tips&Tricks.htm]
is a webarticle presented by:
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©Tom Trimble, RN CEN [Tom@ENW.org]
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