Nurse's Notes

ACLS Algorithms - [ACLS.net]

2006-03-07T08:55:00.000-05:00

I always like to find some interesting articles and since i am on the ACLS mood...i tried to scour the net for some eay to remember algorithms...

ACLS.net has some good algorithms with mnemonics and simulation practices (love those!)

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Universal Algorithm for Adult Emergency Cardiac Care
and Primary Survey ABCDs (Excerpt)

Assess responsiveness by speaking loudly, or gently shaking the patient if there are no signs of trauma.
Call for help/crash cart if the patient is unresponsive.

A Airway: Open airway, look, listen, and feel for breathing.
B Breathing: If not breathing, slowly give 2 rescue breaths.
C Circulation: Check pulse. If pulseless, begin chest compressions at 100/min (15:2 ratio with unprotected airway). Consider precordial thump in witnessed arrest with no defibrillator immediately available.
D Defibrillation: Attach monitor/AED. Assess rhythm. Search for and Shock VF/PVT up to 3 times if needed.

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Secondary Survey ABCDs (Excerpt)

A Airway: Establish and secure an airway device.
B Breathing: Ventilate with 100% O2. Confirm airway device placement by exam, end-tidal CO2 monitor, and O2 saturation monitor.
C Circulation: Evaluate rhythm, check pulse, if pulseless continue chest compressions (5:1 ratio with protected airway), obtain IV access, give rhythm-appropriate medications.
D Differential Diagnosis: Attempt to identify and treat reversible causes.

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Asystole Algorithm

Asystole may be discovered during the primary ABCD survey after attaching a monitor, or it may develop in a previously monitored patient. In either case, it is essential that asystole be confirmed in another lead with properly functioning equipment. If the patient is in true asystole and is a candidate for resuscitation, then proceed with the secondary ABCD survey.

Interventions for asystole are guided by the instructive phrase and acronym,

"Asystole ..... Check me in another lead,
then let's have a cup of TEA."

Acronym - Intervention - Comments/Dose
T Transcutaneous Pacing (TCP) Only effective with early implementation
along with appropriate interventions and medications.
NOTE: Not effective with prolonged down time.

E Epinephrine 1 mg IV q3-5 min.

A Atropine 1 mg IV q3-5 min. (max. dose 0.04 mg/kg)

Consider termination of efforts if asystole persists despite appropriate interventions.

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Bradycardia Algorithm

Treatments for absolute bradycardia (<60 bpm) or relative bradycardia (slower than expected) with serious signs or symptoms due to the bradycardia are guided by the mnemonic:

"All Trained Dogs Eat Iams"

NOTE:(The sequence reflects interventions for increasingly severe bradycardia)

Mnemonic - Intervention - Comments/Dose

All - Atropine - 0.5-1.0 mg IV push q 3-5 min. (max. dose 0.03-0.04 mg/kg)
Trained - TCP - Use Transcutaneous Pacing (TCP) immediately with severely symptomatic patients.
Dogs - Dopamine 5-20 µg/kg/min.
Eat - Epinephrine 2-10 µg/min.
Iams - Isoproterenol 2-10 µg/min.

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PEA Algorithm

Pulseless Electrical Activity may be discovered during the primary ABCD survey when a monitor is attached to a pulseless patient and a rhythm is shown. As part of the secondary ABCD survey, a doppler should be used to confirm pulselessness.

Interventions for pulseless electrical activity are guided by the letters

"P-E-A"

Intervention - Comments/Dose
Problem - Search for the probable cause and intervene accordingly. (see PEA Problem Table )

[Pulmonary Embolism] - No pulse w/ CPR, JVD - Thrombolytics, surgery
[Acidosis] - (preexisting) Diabetic/renal patient, ABGs -Sodium bicarbonate,
hyperventilation
[Tension pneumothorax] - No pulse w/ CPR, JVD, tracheal deviation - Needle thoracostomy
[Cardaic Tamponade] - No pulse w/ CPR, JVD, narrow pulse pressure prior to arrest - Pericardiocentesis
[Hyperkalemia] - (preexisting) Renal patient, EKG, serum K level - Sodium bicarbonate, calcium chloride, albuterol nebulizer, insulin/glucose, dialysis, diuresis, kayexalate
[Hypothermia] - Core temperature - Hypothermia Algorithm
[Hypovolemia] - Collapsed vasculature - Fluids
[Hypoxia] - Airway, cyanosis, ABGs - Oxygen, ventilation
[Massive MI] - History, EKG - Acute Coronary Syndrome algorithm
[Drug Overdose] - Medications, illicit drug use - Treat accordingly

Epinephrine - 1 mg IV q3-5 min.
Atropine - With slow heart rate, 1 mg IV q3-5 min. (max. dose 0.04 mg/kg)

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Emergency Cardiovascular Care

2006-03-03T14:47:00.000-05:00

this is one of the few things that i always carry on my work bag (see side nav bar: my work bag). you could never go wrong with this one since it has almost everything that you needed in adult and pediatric emergencies (except for broselow pediatric tape). it is the bible of acls and pals providers. this one is the 2004 updated edition but soon it will be replaced by the 2005 guidelines.

Note: Please refer to American Heart Association - PDF of the 2005-2006 Winter issue of the ECC free quarterly newsletter, Currents for further information. This information is copyrighted by AHA. Also, please note the Purpose & Intent of the blog author on the right side nav bar.

The 5 major changes in the 2005 guidelines are these:

• Emphasis on, and recommendations to improve, delivery of effective chest compressions

• A single compression-to-ventilation ratio for all single rescuers for all victims
(except newborns)

• Recommendation that each rescue breath be given over 1 second and should
produce visible chest rise

• A new recommendation that single shocks, followed by immediate CPR, be used to
attempt defibrillation for VF cardiac arrest. Rhythm checks should be performed every
2 minutes.

• Endorsement of the 2003 ILCOR recommendation for use of AEDs in children 1 to 8 years old (and older); use a child dose-reduction system if available.

when i took my pals late last week, they tol us about the updated guidelines but as i have read on AHA website, they are going to release everyhting on december 2006. by updating their guidelines, they are giving easier to remember algorithms that is beneficial to both the rescuer and the patient. time is a valuable part of an emergency situation and assessments needed to be done by professionals and lay rescuers are now more definitive. chance of survival on emergency situations are increased with the new guidelines and recommendations. aed is still one of the most important things that a lay rescuer can learn. it remarkably increases the survival rate of adult cardiovascular emergency patients. especially now that a lot of establishments are investing on aed and training employees on how to use them. recommendations on aed for children ages 1 yr old and above is also promising although most of pediatric emergencies usually are respiratory in origin than cardiovascular.

there are still a lot to learn and i wish i can delve into it more. but i guess thats why AHA is there. i try to check for news and updates every week. i salute them for including lay rescuers in their endeavors to save lives.

No Lifting >5 lbs.: Working with Injury

2006-03-03T13:30:00.000-05:00

i really didn't know how to but i managed...like a good soldier, i went to the battle. especially now that i actually found my keys on time.

1806 - on my way to work

1826 - parking garage

1829 - clocked in

1840 - report taken [chatted with co-workers. went to copier to copy my own nursing form.]

1845 - started vital signs and assessments. flushed all iv ports. [patient 1 = arf/acute encephalopathy/afib; patient 2 = pneumonia/chest pain/nsr; patient 3 = aortic dissection/ng tube feed/afib]

1925 - started charting.

2005 - pain meds given to patient 1 along with 2100 meds. fsg = 446. md paged. Waiting for calabash

2020 - orders received. faxed to pharmacy. Waiting for meds

2025 - meds given to patient 1.

2030 - iv & po meds given to patient 2 & 3. [five r's!]

2045 - checking charts for orders, labs, transcriptions, scheduled meds

2115 - nursing rounds [toileting issues, snacks, answering questions of relatives and patients]

2216 - [patient 4] er admit arrives. assessment done. allergies, weight & height documented. fsg taken. Immediate needs given (water, food, socks etc) charge nurse in room to take history & list of medications

2225 - fsg of patient 1 taken = 333. md made aware. insulin iv ordered. faxed to pharmacy. given to patient 1

2240 - pain pill given to patient 2. checked patient 3 iv fluids. snack given to patient 1

2330 - picked up one more patient from leaving nurse [patient 5]. take report. started vital signs and focused assessments.

0010 - fsg of patient 3 & 1 taken. insulin given

0030 - forganized chart and entered orders for patient 4. called md for latest fsg of patient 1. catch up with charting then start 24 hour chart check

0200 - lunch

0230 - patient 3 to bedside commode with help of male monitor tech. my splint is still in place and at this time, everything is hurting on me]

0315 - family of patient 1 at nurses station. pt getting more agitated and confused. Trying to get out of bed.

0330 - charge rn and monitor tech settle pt in bed. anti anxiety meds given po. vital signs taken. litened and re-assured family.

0350 - started vital signs & focused assessments.

0430 - pain pill for patient 4 given. iv fluids changed on patient 3.

0445 - on patient 1 room. re-assuring family. checking patient 1 needs. Snack given.

0515 - fsg taken for patients 1, 3, 4 and 5. documented

0543 - meds given to patient 4. insulin coverage given to others as needed

0620 - start emptying foleys of patients 1, 3, 4 and 5. documented intake and output.

0645 - report given to voice mail system

0650 - patient 1 iv out. changed. pain meds given to patient 1 and 3. md inquires about patient 1

0710 - on my way to home [yipee! 5 nights off!]

it wast such a bad night. although i was really hurting. with all the signing and other stuff. i didn't need to lift anythig but constant movement was not also helping my wrist. maybe i should call employee health today.

Employee Injury: My Trip to ER

2006-03-02T12:50:00.000-05:00

Last night was a perfect exapmle how employee injuries are handled by management.

1900 - lost car keys.

1815 - car keys are still missing. called work as there might be a possibility that i will be late

1840 - found car keys. off to work

1900 - arrived at parking garage

1902 - slipped awkwardly on the hallway with a puddle of water besdie a cleaning equipment. NO SIGN OF WET FLOOR! i got up immedietely and took one of the floor signs that was sitting at the wall, unfolded it and stood it at the middle of the puddle. one witness.

1904 - at the unit desk. my right wrist ad right hip was hurting. blurted out to charde nurse that i was sorry i was late that my car keys were lost and i slipped on a puddle downstairs.

1905 - charge nurse on the phone with housekeeping and house supervisor. i was trying to get report and get started.

1910 - incident report was filled. my rigt wrist pain is now shooting to my elbow. charge notices my grimacing while typing. also got insultd by a housekeeper asking me why i was not wet if i really did fell on the floor.

1920 - on my way to ER.

1930 - reception desk at ER. my info were being taken by the clerk. id band in place

1945 - called by triage nurse. interrupted by another patient. i gave way to the other patient.

1950 - called by triage nurse again. triage completed. my vs stable. pain level = 2. right wrist slightly swollen

1955 - waiting for a nurse doctor at the reception area. [and im getting bored]

2015 - my unit manager came in and talked to me about the incident. was very sorry about what happened. [i thought she was really sincere]

2040 - called in to the fast track room. [id rather call it "long wait room']

2042 - changed gown [i dont like being on a hospital. its not guess or dkny]

2110 - er doc came in and evaluated me. [nope it wasnt george clooney].

2130 - toradol im given to me. ouch! called mike 7 told him what happened. [i htought the nurse was pretty rude]

2140 - waiting for radiology to do my xrays. marti came down and sked how i was doing. gave her the scenario and then she vehemently denied me coming back to work. oops! rad techs calling me in. [darn, i didnt shave my legs today!]

2155 - talked to marti again in my fast rack room. nope, i definitely am not coming back to the floor to work. charge and supervisor agreed i should go home eventhough they are short of nurses. [i felt really bad at this point]

2230 - er tch checked on me. said doc will be here any minute.

2245 - er doc came. said everything was ok, no broke bones just a few minor sprain and muscle pulled. [i told him that when he firt checked me out]

2300 - splint applied to right wrist. prescription given. ace wrap to right knee. im off ot my floor to get my stuff

2315 - on my way home.

it wasnt fun but at the very least it was handled pretty well by management although i cannot blame er for the time it consumed to check my minor injuries. the housekeeper who earlier insulted me was apologetic when he saw me on the hallway and gave me a hug. i drove home despite a pain shot was dangerous but i was hurt when mike was laguhing at me ont he phone. but he actually came to the hospital to pick me up anyway eventhough i did not call me back to confirm that he was to pick me up.

Night Shift:: My Work Routine

2006-03-01T08:19:00.000-05:00

i've got four patients last night. there wasnt much of any challenges or interesting facts over the entire night. in fact, it was pretty quiet.

my daily routine starts out by getting report from the day nurse. i hate kardex's since they always prove useless to me since i still have to go to the chart anyway to do a 24 hour check. i also read transcripts from doctors since it is easier to read than their chicken scratch handwriting on the chart. sometimes i think they should be liable to how they write but then again thats a different topic.

after i get the pertinent info about my patients (name, age, doctor, diagnosis, diet, iv fluids, activity, current status, etc), i start by taking their vital signs and doing my general assessment. It takes me 5-8 minutes each patient for the complete assessment of ambulatory patients, 8-12 minutes for bedrest/very weak patients and sometimes 15-20 minutes for patiets who are either grossly obese or is a complicated case (several tubes, IV's, isolaton, vasoactive drips, restraints, etc.). My assessment includes full body assessments, noting the general systems, iv status, pain status, any tubes, iv drips, skin & fall risk asseement. After assessing the patients, if the patients have no pertinent or immediete needs, i chart my assessments. then i start out looking at their charts to check recent orders and carrying them out if needed.

luckily last night everything wsa done except for a couple of consent forms to be signed, plavix to be given as a pre-op med for cardiac catheterization and hanging of iv fluids that are almost finished.

medication pass starts at 9pm but i started out at 8:50 last night. checking the 5 R's (right patient, time, dose, route, medication) is very important to me. i carry the mars with me and check their armbands too. these mostly cover up my time till the next vital signs are to be taken. I had to call pharmacy a couple of times to correct some medication issues such as missing medications and incorrect medication dosage entered in the pyxis. it was a near miss incident since i could have given a double dose of cardizem bt as i have saig, it was caught and was a near miss situation instead f an incident report.

In between giving medications, patients needed to be taught about their expectations on the upcoming procedures, assist them in their toileting needs, inseritng IV's (which i did twice last night), and if someone is in distress (thank goodness nobody was in that position last night), i will have to take care of that too. As i have said earlier, it was pretty quiet for me so i finished my med pass as half past nine. then i dcisded to check teir labs, radiology reports, history, plan of care and doctors transcriptions of procedures and consults. this things are very helpful to me during my shift so i can understand better what their symptoms are telling me.

11:30 is the mark for my next vital signs. i also give out their midnight medications at this hour and check if any patients needs their sleep aid medications if indeicated in their charts. i briefly assess them during this time focusing on the symptoms for their diagnosis. I make it a habit to chart after all of this has occured so i wouldnt get behind on my charting.

then, it is time for 24 hour checks making sure their admission status is up to date, orders have been taken care of, medications have been signed and given. then we take or lunch break. this is the time when it gets really slow unless our patient are having distress.

afer this had all been done, we do our hourly nursing rounds until it is time for the 3rd vital signs. at appoximately 3:30 am, i start doing their vital signs and their wieghts. after this chart again (did you notice that we cart a lot?...yea...we are too liable to a lot of things and as they say in nusing school, at work and probably in court, you didnt you do it if you didnt chart it.

5:30 is the mark for gathering 6 am medications but since our monitor tech went home early cause she was sick, i rotated with the chrage nurse to be at the monitor room. my patients are pretty mucjust sleeping away and their IV fluids are all set for the next bag. nobody had 6 am medications.

0620 cath lab called toask if patient 4 is ready. i informed the patient of the intent and was okay about it. she told me to notiy a friend about it and proceeded to brush her teeth while waiting for the courier.

0630 they came to get patietn 4 and patient 2 is now asking for pain medication.
after all of this has been done. we gave report and proceeded to go home!

PALS: Pediatric Emergencies

2006-02-24T23:52:00.000-05:00

I finished my PALS (pediatric advance life support) course today. I was given my Pin reward for completing the 2 day course in addition to the standard wallet size card certification.

Everybody in that room was an emergency nurse. I was the only one who were not from that department. Rounding the table for names and work background, I always joke around and told them I was a lost sheep among wolves. I have worked as a cardiac / stepdown nurse my entire career and I am ready to take on a more challenging position. Taking ACLS was the first step, then PALS to seal my certification toward the career choice that I have wanted. The only missing piece now is the actual full time position on an emergency department.

Ok, back to PALS...

I hate working with children. Not because i hated children but i just don't have the emotional restriction in caring for children. It just breaks my heart to see a child suffer. I have a child myself which makes it more difficult for me to take care of other children who are sick. I did not want to take this course but as i have said above, i had to if i want an advancement in my career and it also looks good in my resume.

Anyway, PALS is much simpler than ACLS as i remember. There are slight differences in BLS procedure, less drugs to memorize and the chain of survival involves prevention of injuries and accidents that may lead to the emergency.
This are the summary of the things that i have learned during that course.

1. BLS Procedures

- Check for responsiveness
- Check airway (do not do blind sweep on mouth!)
- Check breathing
- Give 2 full breaths
- Check for circulation
- Give 5 compressions if no pulse
- Alternate 1 breathe and 5 compressions for one whole minute
(with at least 100 bpm)
- Call 911 for assistance
- Use defibrillator if indicated / as needed

2. Chain of Survival

- prevention of injuries or emergencies requiring resuscitation
(VERY IMPORTANT!)
- early CPR
- early defibrillation
- early advanced life support

3. Medications

- coming soon

4. PALS Megacode

- if you need to practice megacodes, i have found a great site for you to practice
http://www.mdchoice.com/cyberpt/pals/pals.asp

5. Important points to consider

- Respiratory cases are more prevalent in pediatrics on acute amercgency situation than cardiovascular cases.
- If you witness a pediatric patient fall down without warning, there's a big chance the case is cardiovascular. But if you dont witness the fall, assume it to be a respiratory case.
- Remember: AIRWAY MANAGEMENT is the very first thing to consider in pediatric emergencies. Open, maintain and support airway!
- Intraosseous site is much better than intravenous site since there is very little or no chance of infiltration.
- Rapid cardiopulmonary assessment is very very important on the first 30 seconds! Learn it by heart!
- Do not forget to treat the cause of emergency first! (Remember your 4H & 4T!)

AHA: Basic Life Support [Renewal Course]

2006-02-21T23:55:00.000-05:00

Basic Life Support for Healthcare Providers
My BLS certification expired last January and technically, I was only allowed to take renewal course 30 days after it expired or else i would have had to take the full 8 hour BLS course. Luckily for me i got in the last renewal class for this month.

It was a 3 hour session with 14 other "students". The first thing we did was to watch a video on the basics. We reviewed the ABCD's of BLS for adults, pediatrics and infants. Heimlich maneuver was also covered for choking victims. The chain of survival for both adults and pediatrics were briefly discussed. The inevitable skills check off came next to the agenda were we were paired 2-3 people in one group. And last but not the least, the BLS test.

I'll talk about each stage whether you like it or not since i do the blog work. For anyone who might stumble in to this blog and finds out that anything is out of line, please let me know so i don't become a mockery of myself.

1. ABCD - this is the mnemonics for airway, breathing, circulation & defibrillation which is crucial in adult and pediatric resuscitation efforts. This is true to healthcare providers but for layperson / non-healthcare providers, checking the circulation or finding the pulse is going to be eliminated by AHA guidelines since it takes too much time for them to find what is necessary thus reducing the time to do the next crucial step of chest compressions. [This statement is according out instructor since AHA will be releasing new guidelines for BLS this coming September 2006]. The following steps is what i have learned for adult CPR. Pediatric CPR mandates the care provider to do CPR first for one minute before calling the EMS. The scenario for all of the following steps is mostly when you are alone on a general public setting.

REMINDER: This entire thing is for the sole purpose of retaining my knowledge and is not intended to be utilized for own personal education or reference. Please refer to professional sites that i will include at the end of this text and also on my links. I will not be liable for any injury that may occur in refering to this blog.

- Check for responsiveness. Do whatever you need to do to make sure the person is not in any way conscious.
- If unresponsive, call 911. When you are on a public setting, there's a lot of bystanders who have access to their cellphone. Make use of them at this time and elt them know that an AED and ambulance is needed right away.
- Check the airway. Look for signs of any foreign objects in the mouth and do blind sweep in the mouth, being careful not to push anything down the throat. Open the airway by doing a head tilt manuever. (Only for professionals) Use jaw thrust manuever if trauma is suspected.
- Check for signs of breathing. Do you feel air coming out from mouth or nose? Do you see the chest rising? If answered yes to both question, the patient is breathing. If not breathing, give 2 rescue breaths while opening the airway.
- Check for circulation. Find the carotid pulse. If absent, start doing 15 chest compressions. Be careful not to do compressions on the xyphoid process to avoid injury to patient. One can find the spot where to do compressions by looking at the nipple alignment and using the center of it to do chest compressions or by followin the ridge of the ribcage towards the xyphoid process and going 3-4 fingers up from there.
- Use the AED or Automatic External Defibrillator. Alternate 15 compressions to 2 breaths. Do the cycle 4 times or for one whole minute then check again for circulation. If AED is present; start the AED, attach electrode pads to appropriate area or as directed, follow instructions as directed by the voice direction system. If shock is indicated, make sure everybody is "clear" or not touching the patient before delivering the shock. The AED will continue to analyze patient 3 times or until it deterines an unshockable rhythm.
- Check your ABC's again and perform CPR if circulation is not present until EMS or the ambulance arrives.

Notes:Before using AED, make sure you check 4 things: [1] Age of patient: AED's mostly have pediatric pads but can only be used for children >1 year old [2] Patient is dry and not on a wet surface [3] Keep pacemakers and AICD's as far away from the electrode pads since it may impede the flow of energy [4] Take off medication patches if present and dry thoroughly before electrode pads are applied

2. Choking & Heimlich Maneuver - The same steps and guidelines are the same for choking victims both adults and children >1 yr old. The universal sign for choking is hand on their neck. Heimlich manuever is used for both age grop while infants <1 yr old needs to have 5 back blows and 5 chest thrusts while stabilizing the neck and the head. [I strongly recommend that anyone who reads this must get their certification or their knowledge from a licensed organization before attempting to help an infant choke victim.]

- Ask the person if he/she is choking, then ask if he/she can cough or talk If the patient responds yes to choking and no to talking r coughing (of course they will do shake their head if theyre not talking, duh!), tell them that you are going to help them, wrap your arms around the person, then make a fist on you right hand, put the flat thumb just above the navel and well below the xyphiod process, hold the right hand with the left hand and do abdominal thrusts until the foreign object is disodged or the pateint becomes unconcious.
- If patient becomes unconscious, Lay the patient slowly down to the floor on a supine position. For adults, do a blind sweep, do a head tilt, attempt 2 rescue breaths, straddle the patient on the thighs and do 5 abdominal thrusts. Alternating 2 rescue breaths and 5 abdominal thrusts until foreign object is dislodged.

Note: If this persists and patient remained unconscious after several attempts, check circulation and begin CPR if needed until EMS arrives.

3. Chain of Survival - These are critical actions that are performed by rescuers that links the victim of cardiovascular emergency to survival.

- ADULTS [1] Early access to EMS or Emergency Medical Services or 911 [2] early CPR [3] eary defibrillation [4] early advanced life support

- PEDIATRICS [1] prevention of injuries or emergencies requiring resuscitation [2] early CPR [3] early defibrillation {4] early advanced life support

Note: Excerpt from Heartsaver CPR for Schools - PDF manual
[americanheart.org - page 4].

I am not going to elaborate the skills check off and the test. It is easy if you truly listen to their subtle (or not so subtle) hints. Mind you, we were laughing at some rumor, at the expense of one cardiologist that failed the first test. He had to take the second test to pass.
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American Heart Association
WorldPoint-ECC, Inc
Channing Bete Company
Laerdal Medical Corporation

Boomerang™ ClosureWire Vascular Closure System (VCS)

2006-02-20T06:16:00.000-05:00

We have been testing this closure device after a cardiac catheterization, PTCA, or stent placement. In a unit like ours who accepts patients with arterial/venous sheaths still in place, we usually take approximately 40 minutes or more of our time just for pulling sheaths and making sure that they don't bleed excessively. This is more time taken from other patients who might need our immediate attention. This particular closure device reduces that time to almost half of the regular alloted time for this type of procedure. And since it is only 19 gauge compared to most arterial sheaths, bleeding is less common than with those who have 5 or 6 French on their groin. So far i really like it, i just hope our facility decides to use the product

Boomerang™ ClosureWire Vascular Closure System (VCS)
Cardiva Medical, Inc.

The Boomerang™ ClosureWire Vascular Closure System (VCS) utilizes a new technique called Arteriotomy Site-Specific Compression.

The Boomerang ClosureWire technique creates a site-specific compression between the inside of the arteriotomy and just outside the tissue tract, resulting in a targeted internal compression of both the arteriotomy and tract. The device is deployed, which creates immediate hemostasis and a secure seal in the cath lab in under 30 seconds. With the device in place, the arteriotomy relaxes back naturally around the Boomerang Wire (0.037 inches) while normal clotting mechanisms begin. Natural elastic recoil of the arteriotomy is known as the Boomerang Effect, which returns the arteriotomy to its original puncture size (approximately a 20 gauge needle). Following the procedure, the device is completely removed, leaving nothing in the artery or tissue tract. Final hemostasis is achieved with just a few minutes of occlusive finger pressure to close the remaining needle puncture site left by removing the Boomerang ClosureWire device.

Courtesy of: MedCompare

Charge RNs: Leadership, Appreciation & Resource

2006-02-15T06:55:00.000-05:00

I have never been a charge nurse.
I was given an opportunity once but declined the offer for fear of a lot of things. Fear of being hated by peers. Fear of responsibility perhaps.
But i admire people who have the guts to do it. They've got more than compassion, knowledge and nursing skills. They are our resource person, our leader, our helper, our guide. They can be our friend, a confidante, a listener. I seldom meet this kind of charge RN. I certainly found not only one but a lot of them who really cares abot their peers.

The gifts shown above was given to every single nurse on our unit by our charge nurses on Valentine's Day as a token of their appreciation. I was touched by their gesture not by the contents. Not only by the gifts did they show their kindness and concern but also everyday when i come to work. They not only ask how i was but also asks what they can do for me during the shift. It was refreshing and stress free just knowing that you have another soul that cares and appreciates what you do.

I admire all the charge nurses on all health facilities all over the world. Their leadership, knowledge, patience & compassion helps all the other nurses survive what is becoming of them on stressful situations at work.