Well, hopefully the troubles with the now only to be referred to as 'the clinic' are behind me as I have done what I could to ensure there is no reference to them. I did a lot of research and I was not in any way shape or form in conflict with anything that I have written regarding HIPAA, but I am not willing to fight about it when my livelihood is at stake. In the meantime, I have tried to keep up with some postings while the site was dark for maintenance. I hope you will take the opportunity to catch up with me and will be able to follow me forward into the many new and interesting predicaments that I find myself in.
In the meantime, I just finished watching the Wrestler, which was actually better than I had hoped it would be. I try not to expect much of critically acclaimed movies because, typically, that means they are slow and lack clear resolution. I don't mind complexity on occasion, but generally prefer my movies to be escapist in nature. That said, this one was solid fare and well done.
Watched Doubt as well. Really enjoyed the first 2/3, and kind of gradually lost interest as it played out. Again, critically acclaimed means not much happens and the resolution is lacking. Still, good acting.
Quantum of Solace - I am not, by and large, a huge fan of Bond films. I think they are entertaining, but I rarely get excited to see one. However, they have really pushed the stunts to a new level. Utterly unrealistic and insane............and fast paced and exhilarating. The story line, such as it is, just serves as a flimsy vehicle for explosions, shoot outs, and races across scenic locales. Pure popcorn and immediately forgettable. Escapism at its apex.
Off to bed. Tomorrow I get to hear the dentist bitch at me for my poor flossing (absent flossing?) habits.
Wednesday, April 29, 2009
Saturday, April 25, 2009
Piccing on me
This past week was entirely devoted to PICC (peripherally inserted central catheter) training. Quite terrifying since, ultimately, the goal is the thread the catheter from the basilic vein (ideally) just above the elbow on the inner arm to the superior vena cava just over the right atrium of the heart. This isn't exactly the complexity of a surgery, but it isn't as far off as I initially thought.
First, PICC placement involves complete and total sterility. What this means is a series of very VERY specific ways to do things to not contaminate your sterile field. You have to open sterile packages onto a sterile field without contaminating the field by actually touching anything within the field (including the things you are dropping onto the field). If things fall outside of the field, they go in the trash. If you touch inside the sterile field, you risk contaminating the whole thing and having to toss the whole lot and start again. Then, you yourself need to become sterile which involves a gown you cannot touch the exterior of and putting on sterile gloves through said gown (to mimic this at home, try putting winter gloves while your arms remain on the insideof a long sleeved shirt). You also have to be sure to drape the patient appropriately and not touch them or the bed shile sterile.
Once you are in your sterile gown with your surgical hat and mask on (including a plastic face shield) and you are gloved up, you can finally touch the things in your sterile field. There are too many things to really bother naming (and it wouldn't necessarily mean much), but suffice to say they have to be set up in a certain way and there is a specific order in which you progress through the procedure. It is a bit stressful trying to remember all that........especially with the patient awake and often alert waiting for you to begin.
Also, part of the procedure is using an ultrasound to locate the veins you are going to access. I fully appreciate the techs and other medical professionals that have to deal with them. It isn't always as clear a picture as one could hope for honestly. It is a lot of grey and black and exceedingly grainy. Like playing an old Caleco game on a black and white tv.
The actual procedure (don't read this if you are sqeemish............you've been warned) involves accessing the vein with a large needle that you place with the aid of the aforementioned ultrasound, then threading a wire into the vein and removing the access needle. After that, you place a larger holder in place over the wire and into the vein after making a small incision at the access point. You then de-access the guide wire and thread the catheter anywhere from 45-55cm in (depending on the person) and try to place it in the superior vena cava over the Right atrium of the heart. Then you wait for radiology to let you know if you hit the right spot, or if you need to pull it back/advance it. All in all, it can take anywhere from 45 minutes to 2 hours or more. I certainly NEVER expected that I would be doing something like this.
Another week begins soon enough. Now back to trying to figure out the clinical side of things.
First, PICC placement involves complete and total sterility. What this means is a series of very VERY specific ways to do things to not contaminate your sterile field. You have to open sterile packages onto a sterile field without contaminating the field by actually touching anything within the field (including the things you are dropping onto the field). If things fall outside of the field, they go in the trash. If you touch inside the sterile field, you risk contaminating the whole thing and having to toss the whole lot and start again. Then, you yourself need to become sterile which involves a gown you cannot touch the exterior of and putting on sterile gloves through said gown (to mimic this at home, try putting winter gloves while your arms remain on the insideof a long sleeved shirt). You also have to be sure to drape the patient appropriately and not touch them or the bed shile sterile.
Once you are in your sterile gown with your surgical hat and mask on (including a plastic face shield) and you are gloved up, you can finally touch the things in your sterile field. There are too many things to really bother naming (and it wouldn't necessarily mean much), but suffice to say they have to be set up in a certain way and there is a specific order in which you progress through the procedure. It is a bit stressful trying to remember all that........especially with the patient awake and often alert waiting for you to begin.
Also, part of the procedure is using an ultrasound to locate the veins you are going to access. I fully appreciate the techs and other medical professionals that have to deal with them. It isn't always as clear a picture as one could hope for honestly. It is a lot of grey and black and exceedingly grainy. Like playing an old Caleco game on a black and white tv.
The actual procedure (don't read this if you are sqeemish............you've been warned) involves accessing the vein with a large needle that you place with the aid of the aforementioned ultrasound, then threading a wire into the vein and removing the access needle. After that, you place a larger holder in place over the wire and into the vein after making a small incision at the access point. You then de-access the guide wire and thread the catheter anywhere from 45-55cm in (depending on the person) and try to place it in the superior vena cava over the Right atrium of the heart. Then you wait for radiology to let you know if you hit the right spot, or if you need to pull it back/advance it. All in all, it can take anywhere from 45 minutes to 2 hours or more. I certainly NEVER expected that I would be doing something like this.
Another week begins soon enough. Now back to trying to figure out the clinical side of things.
Saturday, April 11, 2009
Week #2 & #3
Since I have been mostly lying around in bed today due to a crazy allergy flare that is sticking to me like Popsicle drippings, I thought I ought to blog and hope to post sometime in the nearish future. As a few are aware, I ran into some recent difficulties with a place I will heretofore refer to as 'the clinic' and I have to edit/remove some info that was evidently in question on my blog. In re-reading through it, I am honestly not finding said info, but I am not going to try to root it all out so I can make my blog fully public again. I am a scofflaw evidently.
Week 2 was nearly as busy as week 1 but with the added bonus of knowing some of what to expect. I also have a greater grasp on the new terminology, albeit it a rather tenuous one. I managed to not kill anyone for the second week in a row. Kudos to me! I am still learning a lot about well, everything and the constant switching from clinic to floor work makes it more, not less, confusing. I prefer to focus on one thing until I understand it and then move on to the next skill. Instead, I feel like it is hard to master anything at all.
Week 3 was more comprehensible because someone amongst the powers that be decided that I should spend the entirety of the week learning the clinic instead of bouncing back and forth. There is a lot to learn, but the people are great and seem more than willing to teach (to their benefit once I learn obviously, but it is amazing how some people dislike teaching others). I was able to focus a few days on just blood transfusions which let me practice IV starts, play with copious amounts of tubing, learn the blood pump, practice on Echarting, and learn all the intricacies of transfusions. I even, sadly, saw a reaction (thankfully not on my patient). The woman recovered, but it was alarming just the same. Good thing about working in a hospital though, she was taken straight to the ER (where she recovered nicely).
I am definitely liking the job thus far. A good blend of the things I thoroughly enjoy (clinic type settings, in and out of patient rooms, no total care) in conjunction with some intricate skills that will be very portable. It is also quite amazing how many of the skills I learned in 'the clinic' are coming in handy both in patient interactions and in a variety of needle sticks that I had copious practice with. I have PICC training next. I wish I had a better chance to cement some other skills first, but they will evidently have to wait. I admit, I am more than a little nervous after watching some other PICC procedures.
Week 2 was nearly as busy as week 1 but with the added bonus of knowing some of what to expect. I also have a greater grasp on the new terminology, albeit it a rather tenuous one. I managed to not kill anyone for the second week in a row. Kudos to me! I am still learning a lot about well, everything and the constant switching from clinic to floor work makes it more, not less, confusing. I prefer to focus on one thing until I understand it and then move on to the next skill. Instead, I feel like it is hard to master anything at all.
Week 3 was more comprehensible because someone amongst the powers that be decided that I should spend the entirety of the week learning the clinic instead of bouncing back and forth. There is a lot to learn, but the people are great and seem more than willing to teach (to their benefit once I learn obviously, but it is amazing how some people dislike teaching others). I was able to focus a few days on just blood transfusions which let me practice IV starts, play with copious amounts of tubing, learn the blood pump, practice on Echarting, and learn all the intricacies of transfusions. I even, sadly, saw a reaction (thankfully not on my patient). The woman recovered, but it was alarming just the same. Good thing about working in a hospital though, she was taken straight to the ER (where she recovered nicely).
I am definitely liking the job thus far. A good blend of the things I thoroughly enjoy (clinic type settings, in and out of patient rooms, no total care) in conjunction with some intricate skills that will be very portable. It is also quite amazing how many of the skills I learned in 'the clinic' are coming in handy both in patient interactions and in a variety of needle sticks that I had copious practice with. I have PICC training next. I wish I had a better chance to cement some other skills first, but they will evidently have to wait. I admit, I am more than a little nervous after watching some other PICC procedures.
Friday, April 03, 2009
4 days
I had the idea initially to try and post daily following my shift over the course of my first week of orientation at least. But, by the time I got home after more than 10 hours at the hospital, the last thing I could manage was sustained focus and I lacked any ambition to do more than shovel in some food and curl up to relax and hope to fall asleep so that I wouldn't be in abysmal spirits at 5:45 when I had to get up. So this journal will be a little more retrospective than I had intended.
Day 1: This day wasn't particularly vexing in any way, but left me drained nonetheless. A LOT of computer learning related to charting. They chart everything at the hospital. I would say that a fair chunk of the day is actually spent on the computer writing about what what you did, how long it took, and what equipment you used. I am a little surprised that you don't chart your charting time as well. I found this noteworthy considering just how many patients you see in a day when you are doing rounds. Other than that, I got to explore all areas of one of the hospitals. It is a nice sized hospital, manageable but large enough to accomodate some extremely varied patient acuities. Just the same, I think I will be much happier in the smaller and more sedate confines of Meridian Park. Beyond the computer stuff the day was most akin to my first day in nursing school: a blur of information spoken in terminology so foreign that I couldn't attest whether or not it was actually in English. I just smiled and nodded..........a lot.
Day 2: Returned with my brain still hurting from day 1. Spent the early part of the day learning how to start IVs and change bandages on a rubber arm and then accessed a power port and changed dressing on a rubber chest. If only real people had the delightful combination of bulging stationary veins and the ability to stoically sit motionless as I poked and prodded with my needle. Also, it is nice to have absolutely NO pressure. We spent the second half of the day on rounds looking in on a few patients. I went home exhausted again.
Day 3: Woke up feeling weird. My allergies were in their not uncommon hyperactive state and they were unwilling to leave me physically unscathed. I looked at the mirror to see blood red eyes staring back. Knowing that taking an antihistamine is not my best bet in the AM hours, but having no real recourse other than trying to explain to everyone I met that day that I was not in fact contagious, I opted to take something. Mistake.
We started the day taking one of the phones and two floors. This meant that we would be responsible for the patients on our units and any calls that came into our phone. Thankfully the phone was mercifully silent because, not long after 10, I observed my first IV start. It was evidently not a clear one as my preceptor was having a hard time getting a blood return. I started to feel very loopy and, shortly thereafter, plopped myself down on the chair so as not to pass out. I immediately felt shivers and broke out in a sweat as I willed myself to take slow deep breaths and not pass out in a patient room. I have passed out before, but only in high school for unknown reasons and after giving blood, so I know the feeling just before. However, this time I was able to staunch the wave that had heretofore always managed to overtake me. Would have made for an interesting day. The remainder of the day was uneventful and I learned even more seemingly foreign terminology and went home both confused and a bit concerned about whether or not this job would be a good fit if I couldn't maintain consciousness and all.
Day 4: Looks like it was the meds. We did 9 IV starts (I even managed my first successful one on a patient that was well medicated) and I didn't even feel a twinge of lightheadedness. No more AM antihistamines for me. I will just have to sport sunglasses when my eyes well up and tell people that I am in witness protection or something. The phone was ringing all day long and I got to see quite a bit. Left feeling quite successful and ready to tackle week 2............which will be a whole new orientation to a different hospital. Maybe I should just crawl in bed now so I will be ready for Monday.
1/4 update btw: I had a goal for new year to run 400 miles with aspirations to do 500 if at all possible. Well, 25% through, and I am above pace for 500 (close to 55o actually). I am pretty excited because most resolutions dont last me even this long. Will update again at the half way point. Wish my knees luck.
Day 1: This day wasn't particularly vexing in any way, but left me drained nonetheless. A LOT of computer learning related to charting. They chart everything at the hospital. I would say that a fair chunk of the day is actually spent on the computer writing about what what you did, how long it took, and what equipment you used. I am a little surprised that you don't chart your charting time as well. I found this noteworthy considering just how many patients you see in a day when you are doing rounds. Other than that, I got to explore all areas of one of the hospitals. It is a nice sized hospital, manageable but large enough to accomodate some extremely varied patient acuities. Just the same, I think I will be much happier in the smaller and more sedate confines of Meridian Park. Beyond the computer stuff the day was most akin to my first day in nursing school: a blur of information spoken in terminology so foreign that I couldn't attest whether or not it was actually in English. I just smiled and nodded..........a lot.
Day 2: Returned with my brain still hurting from day 1. Spent the early part of the day learning how to start IVs and change bandages on a rubber arm and then accessed a power port and changed dressing on a rubber chest. If only real people had the delightful combination of bulging stationary veins and the ability to stoically sit motionless as I poked and prodded with my needle. Also, it is nice to have absolutely NO pressure. We spent the second half of the day on rounds looking in on a few patients. I went home exhausted again.
Day 3: Woke up feeling weird. My allergies were in their not uncommon hyperactive state and they were unwilling to leave me physically unscathed. I looked at the mirror to see blood red eyes staring back. Knowing that taking an antihistamine is not my best bet in the AM hours, but having no real recourse other than trying to explain to everyone I met that day that I was not in fact contagious, I opted to take something. Mistake.
We started the day taking one of the phones and two floors. This meant that we would be responsible for the patients on our units and any calls that came into our phone. Thankfully the phone was mercifully silent because, not long after 10, I observed my first IV start. It was evidently not a clear one as my preceptor was having a hard time getting a blood return. I started to feel very loopy and, shortly thereafter, plopped myself down on the chair so as not to pass out. I immediately felt shivers and broke out in a sweat as I willed myself to take slow deep breaths and not pass out in a patient room. I have passed out before, but only in high school for unknown reasons and after giving blood, so I know the feeling just before. However, this time I was able to staunch the wave that had heretofore always managed to overtake me. Would have made for an interesting day. The remainder of the day was uneventful and I learned even more seemingly foreign terminology and went home both confused and a bit concerned about whether or not this job would be a good fit if I couldn't maintain consciousness and all.
Day 4: Looks like it was the meds. We did 9 IV starts (I even managed my first successful one on a patient that was well medicated) and I didn't even feel a twinge of lightheadedness. No more AM antihistamines for me. I will just have to sport sunglasses when my eyes well up and tell people that I am in witness protection or something. The phone was ringing all day long and I got to see quite a bit. Left feeling quite successful and ready to tackle week 2............which will be a whole new orientation to a different hospital. Maybe I should just crawl in bed now so I will be ready for Monday.
1/4 update btw: I had a goal for new year to run 400 miles with aspirations to do 500 if at all possible. Well, 25% through, and I am above pace for 500 (close to 55o actually). I am pretty excited because most resolutions dont last me even this long. Will update again at the half way point. Wish my knees luck.
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