Apply tourniquet → pick a vein and clean with CHG → pull down skill to stabilize vein → hold IV bevel up → poke and see for blood return, then push slightly further → "thread" catheter in → apply pressure to cather → press down on safety button to remove needle → connect IV port w/flush → check for blood return → flush the IV (push/pause) → clamp port and apply blue cap → secure IV with biopatch + dressing → secure IV tubing with tape in J shape → initial and date

Make sure to document IV insertion into LDA Avatar, as well as IV Assessment on flowsheets.

First: Check for patent IV site w/blood return, signed informed consent in patient Binder, MD order

Supplies: Blood tubing (Blood administration set AKA Y tubing), normal saline bag

Steps: Take out blood tubing and roll the clamps of the Y tubing → take the spike and spike the normal saline, then hang it on IV pole → Open the red port closest to IV bag → prime the saline into a trash can (ensure stopper is opened) → once primed, connect to IV port of the patient → place IV tubing into pump → retrive bag of blood: check color, consistency. then that verify info between transfusion request slip, bag of blood label, and pt's blood bank bracelet matches with second RN: name, account and MR number, DOB, blood type, unit number, cross-match verification.

Once verified, sign the transfusion slip. → Set up blood by: Getting initial set of vital signs → Then open port on blood tubing and connect the spike → then hang blood on the pole → MAKE SURE saline is clamped → prime blood line by starting pump, setting it at a quick rate like 900 mL/hr → watch until blood reaches the patient and note the time → then set to the appropriate rate → stay with pt for first 15 minutes and retake vital signs → retake vital signs q 30 min for 4 hours

keep in mind that blood can only be transfused within 4 hours.

You can adjust the rate faster depending on pt's tolerance/reaction.

First, check PICC line dressing change order, how often it needs to be done

Supplies: Dressing change kit, Stterile transparent dressing, gloves, alcohol wipes, mask

First, change all the caps with new caps w/every use → change the IV port itself every dressing change → Open dressing change kit, don mask → remove dressing while stabilizing the tubes → remove stabilization device and rest of dressing (use alcohol pads) → remove gloves → don sterile gloves → drop the stabilization device into kit → crack CHG and wipe insertion area on the pt and wait to dry → apply skin protectant to area → apply biopatch → apply stabilization device → apply dressing over the site, ensuring CHG is lined up over port of entry → Write initials and date

Make sure to document dressing change under flowsheets.

Supplies: Biohazard bag, correct lab tubes, stickers/labels (printed), vacutainer, alcohol pads, tourniquet

Apply tourniquet → unclamp IV → flush → clean the hub → apply vacutainer → get discard sample of blood → apply tubes to vacutainer until filled → disconnect and invert tubes 8-10 times → release tourniquet → release vacutainer → flush IV with saline → label the specimens → place them in biohazard bag → send them to lab. → make sure you've documented, labeled, and it has been scanned. → Wait for results (~ 1 hour)

Question: When do I use the blue vs. red vacutainer?

Supplies: Gloves, 10 CC syringe, flush, alcohol pad, blood collection tubes and labels, blood transfer unit, biohazard bag

Verify the order → Trace the lines and stop ALL IV fluids that are infusing → Remove protective cap, scrub the hub → Apply flush to connector → unclamp and aspirate for blood return slowly → If NO blood return, do not force, notify MD → If there is blood return, flush slowly → then obtain blood sample that you you will discard → obtain blood samples to be sent to lab → clamp the line and scrub the hub → flush with NS and disconnect. → Continue and IV Meds that were infusing → send to lab and dociment

Supplies: Alcohol pads, flush, 10 cc syringe, 22 G safety needle, blood collection tube, biohazard bag, Luer Connector

Verify MD Order → Don Gloves → check for signs of infection → turn off any infusing solutions → D/C IV tubing and scrub the hub → withdraw blood until it reaches the syringe but doesn't enter → flush → withdraw blood using same syringe to 10 cc → discard this syringe into biohazard container → attach new empty 10cc syringe to port → withdraw blood sample (10cc) → remove syringe → attach blood transfer device to syringe → fill blood tubes → discard syringe in biohazard container → get a new flush and flush line → discard in biohazard sharps container → connect new access cap → connect IV tubing to extension tube → label specimen with date, time, initials, site → place in biohazard bag → send to lab

Indications: COPD, pulmonary fibrosis

Use dial to adjust flow of O@ based on MD order → connect tubing by placing one end over the nozzle on the tanks regulator. Reognize when humidifier bottle fluid is too high or too low

Supplies: appropriate tubes, appropriate needle size, vacutainer,

How to anchor veins(?): find a straight vein that is easily visible → create tension on the vein → position thumb 1-2 inches below insertion site and hold the vein down and in place →

Place tourniquet → palpate for vein on AC (medial or cephalic veins in the middle of the elbow) → cleanse site with alcohol pad → apply needle to vacutainer while keeping cover on the needle → hold vacutainer assembly and remove the needle cover (you should be holding it with thumb on top and fingers on the bottom) → anchor the vein by stretching skin downards → with bevel up, and needle parallel to vein, insert with quick and smooth motion at 15-20 deg angle → hold in place and steady → push lab collection tube to the vacutainer needle while keeping needle in the vein → allow tube to fill to maximum capacity → remove tube → invert the tube mix gently 8-10 times → continue filling tubes and inverting until order is filled → as last tube begins filling, release tourniquet → remove last tube → place gauze over puncture site and remove needle → dispose of the needle assemply in sharps container. → complete lab requisiton form and send lab → document procedure

Supplies: medication, alcohol pads, correct size empty syringe, correct size needle, IV bag solution (based on order). Ensure med vial is compatible with IV solution

Remove cap from med vial and scrub with alcohol pad → Assemble needle to empty syringe → inject air (depending on dosage) into syringe, and then into vial → draw up right dose from med vial → remove air bubbles from syringe → locate med port on site of IV bag, scrub with alcohol pad → add drug into IV bag med port and dispose of needle into sharps container → gentle invert bag to mix med. Apply label w/name, dosage and med, date, time, initials

Hard Leather Restraints:

Mitten Restraints:

IF PT has had an OR debridement, central line, or a chest tube

Black telephone at nursing station = To comm. with Tele. You would call them here to let them know your patient is being sent to radiology or somewhere and will be taken off tele monitoring.

Learn tele-monitoring if tele pt. Do we need to print out tele strips? What sort of assessments and documentation are involved in tele monitoring?

Grey telephone at nurses station = To comm. with the remote sitter, but can also call them via vocera("Call Remote Observor"). E.g. You would ask them for privacy if the pt requests privacy for a procedure.

To message Dr.: Click Team (color): Type in name of Team color under "Providers" --> Click chat bubble --> Add pt to the chat. After messaging Dr. for request for an order to be put in, also fill out "provider notification" form as good practice to show proof of communication.

When getting something for a pt you will be using, such as a pill cutter: Always make sure to put their pt label on it after using it and storing it.

TOC Pharmacy: Sometimes pt's will have meds from pharmacy. You can try finding them in the grey bath bins in the big med room. If not found there, look in pt's room, or may have to call pharmacy to either have them sent up, or have to go down to pharmacy to pick them up.

Bomb enema

Req. Docs: Finished sepsis screening, head-to-toe, etc. within 2 hours of shift. Finish care plan doc. and education by 2200

Know to fill out Stroke Survery when discharging pt who came in for stroke.

What to do, admission documentation. How to set up a room for a new patient

Via Suction, Via