Phil Sones, RN

03/14/2022

Hi all - sorry I haven't posted in awhile. Today I thought I'd share a few tips on something just about every nurse needs to stay sharp on - starting an IV!
Tip #1 - Selecting a site. I always try to AVOID THE AC, if at all possible! If you place your IV in the AC, every time your patient bends their arm, it will kink the catheter and stop your IV flow. You'll have to deal with constantly silencing your pump and having to remind your patient to straighten out their arm.
Tip #2 - You will find veins with bigger lumens as you go more proximally (again, try to avoid the AC). You can always go for veins in the hand, but these tend to be smaller and more fragile.
Tip #3 - Use a warm pack or heated towel to apply to your patients arm for at least 5 minutes. This causes the veins to swell and give you a better target. Remember not to get your warm pack too warm, or you could burn your patient. If it's too hot on your own arm, don't put it on your patient!
Tip #4 - Anchor "roly poly" veins before you attempt a stick. This is common with elderly patients who have less collagen to anchor their veins under the skin. It works better if you apply traction perpendicularly across the vein vs. stretching the vein lengthwise.
Tip #5 - Apply your tourniquet NO MORE than 6" from your selected site to maximize vein distention.
Tip #6 - Watch out for valves in the veins and avoid them - a catheter tip up against a valve will not allow your infusion to flow properly, and you usually can't advance your catheter tip past the valve unless you "float" it in with saline - and this is super tricky to do.
Finally - practice, practice, practice!
If you have any tips you'd like to share - please feel free to post!
Happy hunting!

02/25/2022

Answer to the rhythm strip quiz: it's Second Degree Heart Block, Type I (also known as Wenckebach's). It's distinctive because the PR interval gets progressively longer until a beat (QRS) is dropped.

02/15/2022

02/04/2022

Has Omicron Peaked in Montana?

According to data published graphically in the Billings Gazette yesterday (2/3), it appears the numbers of new COVID-19 cases reached a peak of 2,408 on Jan. 28-30, and as of Feb 2 dropped down to 1,663. Does this mean we have put the worst behind us?

Not necessarily. We could still see some continued spikes in cases, but the numbers do look (somewhat) encouraging. One really encouraging set of statistics reveals Omicron to be a much milder variant of COVID-19 versus the Delta variant, i.e. it causes fewer deaths and ICU admissions.

On the other hand, Omicron is so contagious that hospital admissions have increased compared to figures from a year ago. One factor affecting the numbers is that people are getting vaccinated, and this is seen as a factor in preventing the disease from progressing to more serious complications.

Data from the Governor's office last week showed a correlation between the vaccine and improved outcomes: 82% of Montanans hospitalized with COVID recently are unvaccinated, as well as 78% of deaths.