IV catheter

Acute GI Bleed ER Patient Admitted to ICU with One 22g IV Dangling in the Right AC

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CLEVELAND, OH – Initial news feeds are reporting that an acute GI bleed patient is being transferred up from the ER to the ICU within the next 10 minutes.  Report was called and mentioned that the patient has a 22g IV in the right AC with ½ NS trickling in at 50 ml/hr.  Vitals include a BP of 70/palpable and a HR of 129.

IV catheter
I think a 22g or even a 24g IV will work

“ER special again,” said ICU nurse Kim Williamson.  “If we are lucky the IV will be dangling in the AC, just one small tug away from coming out.  Oh, and I wonder if it will kink every time the patient bends his arm more than 10 degrees.  My money is on it kinking big time.”

No type and cross either!  Perfect!” exclaimed ICU attending Dr. Angela Phillips.  “Break out the MAC central line kit and some pink top tubes AGAIN.”

The ED paperwork, with a bunch of useless scribbles and circles, will likely be lost on the way up and it was just reported that the patient sticker machine is still broken at admissions.  All 3 copies of blood paperwork forms and consent forms, which weren’t filled out, will need to be hand printed.

The icing on the cake in regards to filling out the forms is that the patient’s name is Michael Klobstopilewskiviller-Deederviller, one of the longest last names in the community.  Admissions’ computer registry was not able to add the patient to the EHR yet, and have indicated that all orders will need to be written on paper as well.

Gastroenterology was notified by the ED, but the GI doctor on call decided that the patient wasn’t acute enough to scope today since it was after 4 p.m., despite the fact the patient was pale, diaphoretic, tachycardic, hypotensive, and had a hematocrit of 18.

“Just tank him with some blood and I’ll scope him in the morning,” was the response from the GI doc on call.  (GomerBlog inquires, how does GI always get away with this?)

“Yeah, I think a 22g IV should do the trick here,” Dr. Phillips sarcastically said to the charge nurse.  “Let’s hook up the Belmont and save a life!”

Meanwhile down in the ED, high fives were occurring and it is being reported that the movie Rudy was being played in the break room.

Veteran ED Nurse Bryan Meaters explained the difficulty in obtaining even a 22g IV.  “This vasculopath had nothing and was volume down coming in.  We were lucky to even get a 22g IV in, but the ICU nurses will of course never be happy with what we do.”

EM physician, Dr. Rubins, told GomerBlog the honest truth: “It’s all about placement.  No matter what you do or don’t do in the ED, every service is going to complain and moan.   If we DO something, than we get chastised for being too aggressive and acting like a cowboy.  If we DON’T do something than we get reprimanded for being idiots.  The ED is a big dumping ground for negative comments from patients, doctors, and nurses.  Seriously, when was the last time anyone every said, ‘Great job, ER’?  Never.”

“Knowing that, why bother.  Placement first and then move on to the next patient.  I’m going home at the end of my shift either way.  You guys sort it out, I’ve got 30 deep waiting in the lobby so I’ve already moved on by the time I call you.”

Well played, ED.  Well played.

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    Not about doing everything. Its about pt safety and dignity, I don’t mind getting lines but I don’t like shocky hypotensive, tachy pts with no or limited access, I don’t mind giving a bath but pt should not be laying in well dried feces, I will get a temp, but when you’ve been coding pt off and on for 4 hrs I should not be first one to discover a core temp of 92.1 . and if you have to intubate and sedate him his diprovan should not be running at 80 mg instead of 80 mc kg min when you send him up.

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    JesseSandi Adamson

    Nurses, that means all of us, need to be nicer to each other. Talk and stop bitching about everything! Please!

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    Aaaannd you’ll never hear anyone outside the ICU ( or in it, usually) saying, “Wow, the ICU did a great job!”
    Same issues everywhere.

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    John Forrant

    Gina, It is about patient saftey. NOT SAFE to transfer a patient like that. Do you not know the longer someone is shockythe more difficult ot becomes to find lines. Plus many of our meds are not compatable. And drop the attitude!!!

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    Debbie Edmondson

    I have worked both i.c.u. and work e.d and sometimes you are lucky to get a 22 in a patient . PERSONALLY INSTEAD OF WHINING JUST PUT IN THE I.V YOU NEED

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    Valerie Doyle

    Bedbath first, then finding another IV site. They can’t work backwards…

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    Sierra Romeo Bravo

    LOLOLOLOL Bawwwwhaaaaaaaa

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    Ron Hamilton

    I’m sure the E.D is always looking for good nurses; feel free to transfer. Of course it will mean leaving your tight little clique (who will now bad-mouth YOU) AND you will have to take care of WAY more than two patients all day AND do it FAST…

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    Sue Sill Latoni

    You are SO right Lauren DeMember!! She obviously walks on water and she can ASSume ICU nurses don’t start IVs but let her continue to ASS…ume!!!

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    Lauren DeMember

    ^^^gina cotton simpson you sound ridiculous.. Do you know what team work is? You totally diss every floor nurse as lazy people who only complain that the holier-than-thou ER didn’t do enough… How about just doing the right paperwork, following protocols and stabilizing a patient before transferring them? It’s all about the safety of the patient. Maybe you need a vacation.

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    You’re upsetting The Happy Hospitalist’s clientele on it’s Facebook Page!

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    Gina Cotton Simpson

    As an ER nurse I’d like to apologize to everybody else in the hospital. We are sorry to send you patients! I mean the nerve of us! We really need to do better– you know,like keep all those bothersome patients and cure them and stuff gosh darn it! And heck, if we really, really HAVE to interrupt those nurses upstairs, well by golly we should make sure we make things as easy and convenient for them as possible by doing EVERYTHING right down to the bedbath so those poor, poor nurses upstairs don’t have to do anything for the patient! We know we solely exist for the convenience of the rest of the hospital as that is made evident every time we call report! So sorry guys.. We will try and do better especially with IVs because we know ICU nurses can’t start an IV to save their lives. :)))

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    Jinger Birkholz

    and it wouldnt even flush once. ‘But it worked downstairs’ riiight.

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    Annette Adams

    As a nurse that has worked in both ICU & ED this entire thing saddens me. I do not feel that ,unless you have worked in the other area , you have no right to criticize the other departments job. We as health care professionals need to behave more professionally and focus on why we are there ….. For the patient.

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    Sadly you will never hear anybody outside of the ER say, “Wow, the ER did a great job”

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    Tammie McNally

    I’m sorry but it’s protocol to put 2 large bore iv’s in gi bleeds. A 22 is not sufficient for anyone but a pedi patient. I put 18’s in pretty much every patient for practice, so it’s easier to get them into the more difficult patients.

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    Todd Schultz

    Soon, bro. I really want to visit and see how you’re saving lives at the ‘hurst.

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    Jessica Granger

    It’s funny bc it’s so true! Lol

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    Manpreet Singh

    Lol funny!! Not!!! Anyways i thought u were gonna stay by and get lunch

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    Todd Schultz

    Manpreet maybe you confused the green and blue angiocaths again ;)

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    Manpreet Singh

    That is bullshit! GI bleeder are your worst nightmare as ER nurses! I put 18g in as many places i can because they will get Gi medication drips and pressors. Also, blood transfusion. We get cordis and central line in severe gi bleeder who is crashing! Like always er nurse will get blamed!

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    i see you, nurse

    I heard that guy was about to withdraw from alcohol too, wasn’t he?

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    Kristen Cline

    As an ER and flight nurse, it’s true- you will get bitched at no matter WHAT you do- everyone thinks we suck. But did your patient die??? ;)

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    Nancy Beach Toensing

    So true…never know what you are going to get

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    Connie Mundell

    Better than what I sent them last night. Sorry, guys…

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    Michele Adamec Scott

    Well, a 22 in the vein is better than a 16 in the sharps box–if the 22 is actually IN the vein!

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    Joann Larkins


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    Charlene Birdsall Basile

    Sooooo true!

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    Elaine Hannah

    Ha ha ha!!! So freaking true.

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