Monday, June 6, 2005 3:25 PM CDT
Hello folks, Today I turned "mad" into "action." I met today with the director of nursing and with the director of radiology.
As for using the port for CT scans, they said that their protocol is to try an arm IV first, and only use the port if that fails. (The tech was not accurate in what he told me.) It is true that the port can handle the contrast for the CT, but they said that the contrast medium is very viscous (thick and syrupy) and that they do have to put a higher volume in at a faster rate for a CT than they do for an MRI. This is why ports are not preferred, because there is a chance the contrast can "blow" the port and make it useless. So they try an arm IV first. They do have a procedure to call an RN to use the port if the IV stick fails. The whole point of the protocol is to protect the port if possible. This makes some sense to me, and it is reassuring to know that they will use the port if they have trouble with the IV.
So that led to my next question, which was: ok, now we have two sites accessed on a compromised patient with low blood counts. Twice the opportunity for infection. Why would they not remove one of them? The nursing director said that this was a mistake on the part of the nursing staff, that they should have left the arm IV in only long enough to make sure that they didn't have to repeat the CT scan and then should have taken it out. She will also address the issue at Urgent Care (an RN who refused to access his port and stuck him three times for a blood draw and then ended up calling an ER nurse to access his port anyway. I mean, there is the misery factor to consider in all this...hasn't the poor guy been through enough???) (The Urgent Care doc, btw was terrific!)
I also brought up the lack of proper procedure and hygiene that I had observed in some nurses. (Again, most of them are absolute gems, on the whole Dave is receiving excellent care, and the majority of nurses are top-notch and very caring.) I explained exactly what I had observed and told her that I had asked them to wash their hands, be more thorough in their sanitizing of the port cap, to wash their hands and re-glove after examining the weeping abcess on his arm before administering IV meds...the list goes on.
Bottom line, she is going to be retraining all nurses re: hygiene/procedure, in general and also specifically as it relates to ports, and will be reviewing with the nurses that refused to take out his arm IV what they should have done. They will also be doing a training in the proper use and care of ports, the director of radiology said he would also review with his staff the protocols and reasons for them, and when to call an RN to access a port.
Joycey brought to my attention that all staff that have been in contact with Dave should be tested to see if they have an active staph infection or if they are a carrier. I got that suggestion after the meetings, but I will definitely request that action be taken. Good idea, Joycey.
Dave has turned the corner. He is definitely feeling better today, and is so much more himself! It's very encouraging. Looks like we finally got the right antibiotic on board. The doc will be keeping him a while, he wants to make certain the infection is resolved before sending him home, and we still have a way to go on thinning the blood, his clotting times are still pretty fast. They're being extremely careful with the coumadin, because the avastin causes a risk of hemmorage, so they want to walk that particular tightrope very carefully.
I think that's all for now. Shelley
Hello folks, Today I turned "mad" into "action." I met today with the director of nursing and with the director of radiology.
As for using the port for CT scans, they said that their protocol is to try an arm IV first, and only use the port if that fails. (The tech was not accurate in what he told me.) It is true that the port can handle the contrast for the CT, but they said that the contrast medium is very viscous (thick and syrupy) and that they do have to put a higher volume in at a faster rate for a CT than they do for an MRI. This is why ports are not preferred, because there is a chance the contrast can "blow" the port and make it useless. So they try an arm IV first. They do have a procedure to call an RN to use the port if the IV stick fails. The whole point of the protocol is to protect the port if possible. This makes some sense to me, and it is reassuring to know that they will use the port if they have trouble with the IV.
So that led to my next question, which was: ok, now we have two sites accessed on a compromised patient with low blood counts. Twice the opportunity for infection. Why would they not remove one of them? The nursing director said that this was a mistake on the part of the nursing staff, that they should have left the arm IV in only long enough to make sure that they didn't have to repeat the CT scan and then should have taken it out. She will also address the issue at Urgent Care (an RN who refused to access his port and stuck him three times for a blood draw and then ended up calling an ER nurse to access his port anyway. I mean, there is the misery factor to consider in all this...hasn't the poor guy been through enough???) (The Urgent Care doc, btw was terrific!)
I also brought up the lack of proper procedure and hygiene that I had observed in some nurses. (Again, most of them are absolute gems, on the whole Dave is receiving excellent care, and the majority of nurses are top-notch and very caring.) I explained exactly what I had observed and told her that I had asked them to wash their hands, be more thorough in their sanitizing of the port cap, to wash their hands and re-glove after examining the weeping abcess on his arm before administering IV meds...the list goes on.
Bottom line, she is going to be retraining all nurses re: hygiene/procedure, in general and also specifically as it relates to ports, and will be reviewing with the nurses that refused to take out his arm IV what they should have done. They will also be doing a training in the proper use and care of ports, the director of radiology said he would also review with his staff the protocols and reasons for them, and when to call an RN to access a port.
Joycey brought to my attention that all staff that have been in contact with Dave should be tested to see if they have an active staph infection or if they are a carrier. I got that suggestion after the meetings, but I will definitely request that action be taken. Good idea, Joycey.
Dave has turned the corner. He is definitely feeling better today, and is so much more himself! It's very encouraging. Looks like we finally got the right antibiotic on board. The doc will be keeping him a while, he wants to make certain the infection is resolved before sending him home, and we still have a way to go on thinning the blood, his clotting times are still pretty fast. They're being extremely careful with the coumadin, because the avastin causes a risk of hemmorage, so they want to walk that particular tightrope very carefully.
I think that's all for now. Shelley
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