Critical Innovation

[Old_School]

When I started thinking about this tread, I realized that my career has spanned a pretty exciting time in nursing. I remember when ICU was a converted 6-bed ward tucked back in the corner of some med-surg floor. All it had was some bulky oscilloscopes and extra oxygen and vacuum lines. It was all pretty rudimentary. The great innovations that I have seen over the years would comprise a list as long as both my arms. How would I be able to pick just one.My pick for all time best innovation without a doubt is the NIBP machine (automatic, programmable, self-inflating blood pressure measuring device). You may scoff, but that is because you all take them for granted. Do they still teach Krottkoff(sic) sounds in nursing school? Woe to the junior nurse at the code that had to stick his/her face down in the middle of the action to get the continuous blood pressure readings. Why do you think most of the older nurses buy the longest stethoscope they can find. This innovation was truly the beginning of push-button nursing.O_S

[Old_School]

Well, since nobody else had an opinion on this subject, I think I'll vote for #2. The triple-lumen central venous catheter, this device is a work horse. I don't know how anybody survived in the bad old days before this was invented. It's really a shame that it's so difficult to get surgeons or radiologist to put these things in; when they will obviously improve the outcomes of these critically ill patients.

I had a patient with a coagulopathy. PT 18, INR~2, PLTs 80s. Patient needed emergent surgery. Everybody's hitting the ball back and forth, nothing is getting accomplished. I have the RBCs, the FFP, the Pooled Platelets ready to go but nobody wants to touch this patient with a needle. No periperal IV access.

I called over to the OR and an Anesthesiologist with cajones walked right up to that patient...bam...one stick, clean as a whistle IJ. God bless him. This all happened at 1 o'clock in the afternoon. The patient was in surgery by 5pm. I had each port going with a blood product. The patient survived and left the ICU sitting up.

O_S

[WRRN]

Most of the TRIPLE LUMEN CATHS I've seen go into the Subclavin vein. I've seen internest's put them in. Though mostly the surgeon's do it. They actually love showing off.

Can't imagine why they wouldn't put one in this patient.

I had one for 14 days myself.

WR,,, three commas for Becca

[Old_School]

WR, I'll answer that question "why they wouldn't put one in" with a question. What would happen if you accidentally hit an arterial structure directly beneath the clavicle, with the coag profile given?

O_S

[WRRN]

I meant I couldn't believe no one would put one in. I meant it's sad that you had to fight for it.

And if I'm not mistaken there is a CAROTID ARTERY in the neck and I believe it's kinda close to the internal jugular.

I hate IJ's. A lazy doc's triple lumen site. IMHO. A skilled surgeon can get one in the subclavin vein. In 15 years I never saw them hit any arerial structures there.


WR,,, three commas for Becca

[Old_School]

I totally agree about the SCV site. Far superior to the IJ especially for long term.

In that situation it was a "worst case scenario" thing, no one wanted the liability. The IJ was chosen because if you did hit the artery at least you could hold direct pressure. In the case of the sub-clavian the actual cannulation takes place directly under the bone.

O_S