Shift Observations: That First IV Start After Vacation

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photo: jparadisi 2012

Why does that very first IV start on the first shift back from a vacation always cause just a little apprehension?

My patient waits silently while I collect the supplies I need: a sterile IV pack, the angiocath, a normal saline flush. I tear a few small strips of tape and stick them to the edge of the bedside table, easily within reach, ready to secure the IV once it’s in the vein.

How many IV’s have I started over the past twenty-five years? Why does the first one after a vacation always feel like the first one ever?

My gloved fingers palpate the chosen vein one more time before I swab it clean, leaving a glistening sheen and contrasting shadow along its hill, a cairn on his forearm.

Collecting my thoughts, I focus on the vein until they are as sharp as the needle I use to puncture his skin and thread the catheter into the vein. A flash of blood tells me I’m in. Using one of the strips of tape, I secure the IV, then cover the site with a transparent dressing. It flushes easily.

I release my breath, which I realize I was holding.

I’m back.

Staycation

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Reflections on the Willamette River photo: jparadisi

I am on staycation this week. It means I scheduled a week off from the oncology infusion clinic, and spending the time here in Portland, where I live.

I admire nurse colleagues their ability to schedule travel vacations months in advance. They bring brochures of exotic places like Machu Picchu, Sidney, Tuscany, Spain, etc. to work, having booked cool hotels and fabulous dinner reservations. One coworker planned an extensive road trip, driving solo, through national parks. Besides being courageous, she has a sense of humor: she purchased an “inflatable man” to occupy the passenger seat of her car during the trip. Then she gave “Joe” away as a white elephant gift at our staff Christmas party. Better than a gnome.

My staycation reflects a lack of planning on my part. A few days after Christmas, I realized my mind wandered when I listened to small talk, the small talk my patients generate adapting to their role, connecting with me, making the experience pleasant for all of us. My sudden inability to concentrate on more than actual patient care signaled to me I let too much time lapse between vacations. There wasn’t enough time to coordinate David’s work schedule with mine, nevertheless, I needed a midwinter break sooner than later. Our scheduler received my request for vacation time that week.

So, how am I spending the time off? I booked a fallback Pedi Mani, then met a girlfriend for Happy Hour at a new tapas bar the first day. Over the weekend, David booked a two-night stay for us at a hotel on the Willamette River. The off-season rates were great. We saw the French film Le Havre, leisurely dined at restaurants we’ve only talked about, and slept in. I’ve booked a spa day for myself, complete with green tea service, and lunch later this week.

After that, who cares?

I Wish I Said It

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I don’t write for children. I write, and someone says, “That’s for children.”

Maurice Sendak

Learn and Live

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Hawthorne Bridge photo: jparadisi 2012

American Heart Association, are you messing with me?

I was a wee bambina sitting at the dinner table the first time I heard the acronym CPR. My father, a volunteer firefighter for the small town where we lived, certified that afternoon. I remember him saying, “It’s a terrible thing to need to do, but everyone should know how to do it,” and his words are true. Everyone should know CPR.

I got my first CPR card in high school, recerting off and on until becoming a nurse. Now, I recert (renew) every two years. All hospitals I have worked for in two different states require Registered Nurses to have current BLS certification. There is no grace period. If the card expires, the nurse cannot return to work until he or she has renewed their certification.

I love The Heart, however, few things swizzle an experienced nurse’s placid pool of confidence more than CPR recertification, aka, BLS (Basic Life Support). I know this, because I renewed my card last week. Everyone in the class expressed anxiety. Anxiety occurs because, every two years, we have to relearn breath to compression ratios, and how many compressions per minute. For one rescuer or two? Is the victim an adult or a child? The ratios are different for each. And what the hell is that little rhyme you’re supposed to repeat while changing positions with the other rescuer because you’re getting chest pains yourself from the exertion of doing (how many, again?) chest compressions? Don’t forget, you’re trying to save a person’s life while doing this.

Our instructor assured us changes occur only every five years, but it seems different every time. Not only for staff I work with: once, I was running behind two women runners on the Hawthorne Bridge, and overheard them talking about CPR, and how confusing all the numbers are to remember. I sprinted to them, asked if they were nurses. They were. We ran together for a while, commiserating over this albatross of our working lives.

So you can imagine my chagrin, last week when our instructors explained the changing numbers confuses so many health care professionals and lay people, they were not even attempting CPR outside of hospitals, for fear of doing it wrong. This led the AHA to research hands-only CPR. They found:

• Hands-Only CPR (CPR with just chest compressions) has been proven to be as effective as CPR with breaths in treating adult cardiac arrest victims.
• The American Heart Association has recommended Hands-Only CPR for adults since 2008.
As of June 2011

I support the American Heart Association listening to our concerns. I applaud its continual research, which saves lives. Everyone should know CPR.

All the same, does this mean, these past twenty-five years I’ve been a nurse, whether it was one or two breaths between compressions has never really mattered?

American Heart Association, are you just messing with me?

To find a BLS/CPR class near you, click on this link.

I Wish I’d Said It

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Keep your chin up,

No one expected you to save the world,

Otherwise, you would have been born wearing a cape and tights.

Just do the best you can.

Happinessinyourlife.com

AJN’s On the Web

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This morning I’m drinking my first cup of coffee, thumbing through the January 2012 issue of the American Journal of Nursing. A familiar sentence catches my eyes in On the Web, page 22. It’s a line from a post published (and I wrote) on their blog Off the Charts. Thanks AJN!

It’s gonna be a good day.

Next Career, No Body Fluids

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XXXL Pajama Pants pencil and pastel by jparadisi 2012

“Next career, no body fluids.”

That’s what I tell myself.

I admire hospital management their ability to wear cute dresses and pumps to work or, if they are male, slacks and sweaters. Oh, and jewelry: modestly dangling earrings and longish necklaces. I knew the most talented and charming surgeon who got away with it too, mostly because she’s so damn good at what she does. I once saw her come from the OR wearing green surgical scrubs, a string of black pearls around her neck, and pumps covered in paper surgery booties. I was so impressed I splurged on a string of black pearls for myself, and wore them to work with green surgical scrubs too. Imitation truly is the best form of flattery.

I digress.

I don’t wear cute dresses, few necklaces, or modestly dangling earrings to work because I do direct patient care.  A pediatric nurse quickly learns dangling jewelry is a handhold for infants and children to grab, snapping them or ripping an earlobe. Adult patients suffering dementia put a nurse and his or her jewelry at risk too, and long necklaces tangle into stethoscopes.

The other day, in the adult ambulatory clinic, I started an IV. Unexpectedly, a gush of blood erupted, running warm down my pant leg as if it were the slope of a volcano. I couldn’t get my leg out of the way because I was trying to keep up a calm facade for my patient (“Everything is just fine, just fine.”) while frantically taping the IV in a successful effort to maintain it. When I saw the blood on my pant leg, it looked like I had stabbed myself.

I remembered the last time my clothes were soiled this badly at work. I was a new PICU nurse and a child threw up ALL OVER my pink scrubs.  A nursing supervisor acquired clean scrubs from the OR dressing room for me, and I finished my shift.

I work in an outpatient setting now. There are no kindly nursing supervisors willing to go to the OR for fresh scrubs. I had to think of something else.

In ambulatory care, patients wear their own clothes. Our linen closet is not stocked with an array of gowns or pajama bottoms; however, I managed to find a pair of XXXL pale blue drawstring pajama bottoms stuffed behind the fitted bed sheets. They were so gi-normous, I had to hike and tie the drawstring waist at my bust line. The pant legs were three times wider than both my legs put together. You can imagine how ridiculous I looked (if you can’t, I drew a picture for you above) even with a white lab coat buttoned over the ensemble to hide it. My coworkers were busy, and unaware of my dilemma. When one noticed, all she could say was, “Uh oh.”

Clearly, I needed another plan. Fortuitously, David had the day off, and was near where I work. I called for help, and he brought a pair of pants for me from home. I changed, and resumed patient care.

Apparently, I need a preparedness plan for my clothing at work. Do any ambulatory care nurses have one?

Next career, no body fluids.