Patient Care Tips & Tricks

[steve]

Use this subject heading to share your special way of doing things that make a difference.  Click on "Reply" and let people know.  Thanks.

[Yvonne]

Hard to Start IV's- When I have trouble finding a vein, I press firmly with the pad of my thumb for about 30-45 seconds, over the skin where I think it is.  This does two things, 1- it squeezes out the interstitial fluid (like you're checking for pitting edema in a foot) so you can see and feel the vein much better, and 2) the pain receptors in the patients skin begin to habituate to the pressure and decrease their sensitivity to the impending needle (they hardly feel it if you don't wait too long).  If you press with your finger tips, they will become numb and you won't be able to feel the vein with them.  It works great. 

[Yvonne]

When removing tape on an IV or dressing or electrodes be nice to your patient.  Pull in the same direction that the hair grows.  When you pull in the opposite direction, it bends the hair back against the root and breaks it off.  Do this test on yourself- put two pieces of tape on your arm, push it down nice and hard.  Now remove one piece by pulling the tape off in the opposite direction of the hair growth, and then remove the other by pulling in the same direction that the hair grows.  You will never forget after doing this.

[epstaff]

When doing Pacer and ICD interrogations we put the head of the probe in a glove so it does not have direct contact with the patient. 

[manuel]

We're lucky to have a blanket warmer in the lab, and I put two warm blankets on the table right before having the patient lay down to warm it up, then put the blankets on top of them after they lay down.  They love us for doing this, and really feel cared for.

[roger57]

When patients first arrive in the department, as I review their chart I verbally include the patient in the review.  I start from their admission, include past history, and explain what tests have been done to them along the way, the reasons for them, the results, and why they are now here for their EP procedure.  Overwhelmingly, patients voice their appreciation at finally knowing what has been going on.  These 5 minutes demonstrate my concern for them and creates a huge amount of trust, and gives them confidence in us for the procedure.   

[epstaff]

When marking distal pulses before the procedure, rather than drawing a small line or X where you feel the pulse, write the number that you have graded it at the location on the foot where you feel it.  Continue you usual documentation. That way each person after you knows what it was earlier, and doesn't have to search through paperwork/computer to find it.  We use a 0 > 3 grade and a pen or sharpie works great.  If what you feel is different then before, wipe off the number with an alcohol pad and rewrite it. 

[epstaff]

We try to create allies out of the family members and significant others to the benefit of our patients.  When appropriate, we involve them in pre-procedure reviews of the patients history and medications and instruct all of them on the importance of compliance along with other helpful home care measures. Post procedure, we enlist them in observing for possible complications, and helping with at home recovery and follow up care.  They can make a big difference in the wellbeing of the patients.

[epstaff]

Venous sheath removal is the norm for EP.  Every so often an arterial sheath is places for left heart access, and the sheath removal can be tricky in terms of how much pressure to apply to the groin to stop the bleeding yet not occlude the blood flow.  We found that placing a pulse oximeter probe on the toe of the involved leg, and compressing the artery until you see just a faint waveform is very helpful.  Especially in big people where it is hard to feel the pulse.

[roger57]

After a procedure when using the sheet to pull the patient off of the table onto a stretcher, the patients feet have a tendency to drop down into the gap between the two and slam against the table rail.  This is if a slide board isn't used.  Rather than have two people pull from across the stretcher, have one at the foot of the stretcher lifting on both ends of the sheet under the legs to make a hammock for the legs and feet, then lift the feet up and over the gap when the upper staff pull the torso over.   

[epstaff]

If you are a lab using the Hospira Pumps, please let us know how you are using them for your air-less lines for the transeptals?  We have not been able to use them because they create a lot of air!!!!!!  Thanks!!!

[epstaff]

Question for other labs....What are other labs hanging for maintenance fluids for peripheral lines and any central lines via the groin for EP studies or ablations and also for device cases?

[epstaff]

We use NS with an EF over 35% and 1/2 NS with an EF less than 35%.

[epstaff]

When scrubbing left heart and complex procedures that require a variety of sheaths and catheters, it is more efficient not to go back and forth from the prep table to procedure table.  One way to organize transseptal supplies and catheters is to layer them on the foot of the table like a club sandwich with sterile towels as the bread.  Start with the earliest items to be used on top, then layer chronologically to the bottom.
For example all of the venous access needles, wires and sheaths are at the groin, The first catheter and US catheter are on top of the stack, then under the first sterile towel the first wire/transseptal sheath/transseptal needle, then the next item, etc. to the last catheter that is placed.  Have heparin on the table as well so you don't have to turn around to get it. 
It is much quicker and you never have to take your eyes off the action.