These 8 COVID Nursing Tips could save your life

These 8 COVID Nursing Tips could save your life

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Whether we want to admit it or not, the COVID19 pandemic is not ending anytime soon. Even with the vaccines coming soon, there is still be months of hard work ahead of us. Using these COVID nursing tips might be able to help!

As nurses, COVID can be exhausting and even somewhat demoralizing. I have felt plenty of burn-out since this all began, and nurses across the nation can relate.

In this article, I will list some COVID nursing tips for ER and inpatient nurses – to help you get through your shift safely!

Covid Nursing Tips Featured Image

1. Minimize Contact

This is easier said than done – but minimize your contact with patients who have symptoms consistent with COVID. If you need a refresher, common symptoms of COVID include:

  • Fevers
  • Cough
  • SOB
  • Body aches and Headache
  • Nausea and Vomiting
  • Loss of taste/smell

As an NP, this is actually fairly doable. I can conduct my history at 3-6 feet away, and perform a very limited physical assessment, often without even touching the patient. Sounds terrible, but the safety of healthcare workers is essential.

Bedside nurses are much more hands-on. What I’m going to say might be controversial, but you do not need to listen to every patient with lung sounds. We are going to get a chest X-ray anyway. Minimize contact, minimize exposure, and minimize your risk as best possible.

Patients with COVID often have normal or somewhat diminished lung sounds. Knowing this does not change management. When I do listen to lung sounds, they are patients with asthma, COPD, or CHF, because I’m specifically looking for wheezes or rales.

Make sure you get everything you need before garbing up and entering the room. Bring with your IV equipment and blood tubes, vital sign hookups if not already in the room, any medications already ordered, a COVID nasopharyngeal swab, etc.

If the patient may be discharged and an ambulatory pulse ox might be ordered – might as well get them up and walk them around the room while recording their SPO2. This is using your nursing judgment to anticipate orders. Let’s face it – not all Providers are great about putting in every order at the same time (guilty!).

2. Reduce, Reuse, Recycle (Your N95)

Don’t take your N95 for granted, because they’re running out! At least, that was the worry when this pandemic started and is definitely a possibility if infections and hospitalizations continue as they have been in the US.

However, we can’t afford to be wasteful. Before COVID, we would use an N95 like a surgical mask – apply it when taking airborne precautions, and removing it upon leaving the room. This life of luxury is no more.

Many hospitals have decontamination protocols for N95s – where they decontaminate them in some capacity. However, not every hospital will do this. If needed, there are multiple ways that you can decontaminate your N95 yourself using the following COVID nursing tips.

Bake It

Covid Nursing Tips bake itNo, really – throw that N95 in the oven! Baking with dry heat at 75° C (167° F) for 30 minutes effectively kills Sars-COV-2. Researchers at Stanford found that this can be done for 20 cycles without significantly reducing the filtration efficiency. Other studies indicated that only 2 cycles proved safe.

Hang the N95 from the oven rack with a wooden paperclip, or place an oven-safe fabric on a metal sheet. Do not place the N95 directly on the metal as this can overheat the mask.

Rotation Schedule

COVID has been found to survive on hard surfaces for 48 hours, plastic for 72 hours, and cardboard for 24 hours. While scientists aren’t 100% sure on the specifics of covid spread via surfaces, they do know that COVID doesn’t spread much through touch.

An alternative method to decontaminating your N95 is to leave it in a safe, warm, dry area and allow it to “air-dry” for 3-4 days. Placing it in a paper bag may be useful for this. This will kill the coronavirus without degrading the filter.

If you have three or four N95s, you can start a rotation cycle and effectively never run out of N95s.

Please note this does not appear to be a well-studied decontamination procedure and is solely based on theory.

Covid Nursing Tips recycle n95

Other methods

There are other methods to decontaminate your N95, including moist heat, UV radiation exposure, boiling, and even steaming. These all kill COVID but degrade the N95 at varying rates, and are likely more difficult to perform while at home.

If the idea of having to decontaminate and then reuse your N95 does not fit your desires – you can always skip this COVID nursing tip and buy a reusable N95 Device.

3. Buy a Reusable N95 device

They do make reusable N95 devices which are somewhat affordable and probably worth it.

Using a reusable N95 is more comfortable, less of a hassle, and can leave you feeling more protected.

Envo Mask is all the rage in my ER, and for good reason. This reusable N95 is comfortable and won’t fog your goggles. There are replaceable filters that you use, making this usable forever (but hopefully COVID won’t last forever too).

You can also buy a respirator, which can be cheaper depending on which one you get. If you do, you need to make sure you buy the appropriate filter though, as many of these respirators were intended to be used for occupational exposure. The 2091 filter is recommended by the CDC.

Please be aware it can be somewhat difficult to speak to people with a respirator on, as they can have a hard time hearing. This can be especially difficult over the phone.

Covid Nursing Tips Different Masks

4. Protego Skin!

Covid Nursing Tips skin breakdown exampleWe’ve all seen those horrid photos of nurses who worked 12+ hours in an n95 mask, with deep facial markings to prove it. Many of us have experienced this firsthand.

You shouldn’t only worry about your patient’s skin breakdown. Wearing an N95 for 12 hours straight can cause your own skin-breakdown, and it can be very irritating, painful, and eventually lead to open wounds. There are a few different COVID nursing tips regarding your skin protection that can help!

Take Breaks

To minimize skin breakdown, frequent removal of the N95 is recommended. However, with the COVID pandemic among us – that is not always feasible.

If able to safely remove your N95, the recommendation is to take a 15-minute break every 2 hours. For the vast majority of us, this just won’t work.

Skin Protectant

Probably one of the safest options, you can apply a liquid skin protectant onto your skin. Once applied and allowed to dry, this creates a protective barrier that minimizes moisture and friction.

Any skin protectant should work, and skin repair creams with dimethicone can also be effective. Apply it over the areas where the N95 will cause the most skin breakdown (nasal bridge, cheeks, behind ears). Avoid getting the product in your eyes or mouth.Covid Nursing Tips Skin Prep locations

Good skin protectants to use:

Make sure to always allow the product to fully dry before applying your N95.

Protective Dressing

If skin protectant doesn’t do the trick – you can try a protective dressing.

The issue with protective dressings is they can alter the fit of the N95. Unfortunately, that could mean catching COVID. This is why skin protectant is a safer option. Still – if your skin really needs it – you can likely put a protective dressing in a safe manner.

Cut a thin dressing into small pieces, and apply a thin layer to the nasal bridge, the cheekbones, and behind the ears.

You should use a foam dressing that has a non-permeable outer layer, so any hydrocolloid dressing should work well. A good example is the Duoderm Hydrocolloid Dressing.

You should attempt to confirm the N95 fit by blowing out and seeing if there are any leaks. Definitive fit testing can also be done and is more accurate, although may not be feasible on the unit.

5. Surgical Mask Woes

Even with using our N95s, we are still recommended to be using a surgical mask on top of that. This prevents soiling of the N95 mask and adds that extra layer of protection for splashes.

Unfortunately, surgical masks wrap around your ears and they can lead to skin breakdown of your ears and just hurt.

There are scrub caps and headbands with buttons sowed on which you can loop the surgical mask onto, which takes the pressure off of your ears entirely.

They also make plastic devices that connect both sides and loop around the back of your neck. You can even MacGyver your own version with some rubber hands and/or paper clips.

Covid Nursing Tips paperclip hack

 

 

6. Bad Breath

No – wearing a mask won’t give you hypercarbia… But it can give you hyper-halitosis. If you have bad breath – you’ll definitely notice it now. Sure, bad breath won’t kill you, but it’s just not fun to be breathing in for 12 hours.

Working 12-hour shifts without time for water breaks will cause dry mouth and will increase the odor of your breath as well!

Covid Nursing Tips bad breathOne easy fix is to buy some gum. This leaves your breath smelling minty and fresh. If you’re someone who needs more help for your halitosis, you can try special toothpaste or special mouthwash.

Make sure you are able to stay hydrated. Drink plenty of water before your shift (not that you’ll have much time to pee). Try to take a few breaks throughout the shift just to drink some water and stay hydrated.

7. Wrap it Before you Tap It

No – I’m not talking sex-ed. I’m talking about your smartphone!

Let’s be real, we all bring our phones to work. No, we probably don’t have time to scroll Instagram (follow me!), but we occasionally check the time and maybe our messages.

I personally use multiple apps on my phone throughout my shift to help with antibiotic selection or to reference something related to patient care.

The problem is, we don’t want to contaminate our phones with COVID or who knows what else.

One simple COVID nursing tip is to bring a Ziplock baggie to work that your phone easily fits in. Ziplock it shut. Your touch screen actually works through the ziplock bag!

You could also just leave your phone at home – but if that doesn’t give you anxiety thinking about it, then something is wrong with you.

If you risk it and just use your phone while at risk, you should know how to decontaminate your phone. Pro Tip: Don’t put your phone in the oven like the N95!

Covid Nursing Tips ziplock bag phone

8. Decontamination Station

After a long shift working with COVID patients ALL day (or night), there is nothing you probably want more than to get home and crawl in bed. But you are also aware of all the NASTINESS on your body, scrubs, and everything else you’ve touched.

You need to have a procedure for how you clean yourself and your items. The last thing you want to do is infect members of your household!

Leave anything items you can at work, like your stethoscope, scissors, pens, penlights, etc. If you have a locker – use that!

Make sure you carry hand sanitizer in your car. Use it immediately once you get in before touching the steering wheel. Do not touch your face now that you are maskless.

Once you get home, find a way to strip quickly without touching anybody or anything. I put anything in my pockets (like my phone) on the island counter. I put my clothes directly in the washing machine. Take an immediate shower with hot water and plenty of soap.

After this, I personally go through and wipe down everything I touched including the doorknob, the bathroom door, etc with a disinfectant. I then wipe down all the items I had placed on the island counter. You can use clorox wipes, lysol wipes, but I personally use Original Pine-sol which kills COVID within 10 minutes (THAT’S the power of Pine-sol baby).

Other related content:

COVID Nursing Tip: Always Follow Hospital Policy

As always you should ALWAYS be following hospital policy and procedures whenever implementing any of these COVID nursing tips. This is an unconventional time, so there may not be much oversight regarding infection control practices, but make sure anything you do is safe for you and your patients.

Comment down below your COVID Nursing tips!

Covid Nursing Tips Pinterest Pin

9 Nursing Medication Errors that KILL

9 Nursing Medication Errors that KILL

William J. Kelly, MSN, FNP-C
William J. Kelly, MSN, FNP-C

Author | Nurse Practitioner

      

Did you know that Medication errors are the 3rd leading cause of death in the United States – right behind heart disease and cancer?

Med errors account for more than 250,000 US deaths every year. Medications save lives every day, but unfortunately, these same medications can also hurt our patients if given inappropriately.

Now, most nursing medication errors don’t actually kill our patients, but they do increase morbidity, increase hospital admissions and length of stay, as well as decrease the quality of life of our patients.

As nurses administer almost all of the medications within the hospital, this means that nurses are on the front lines and will be responsible for causing or preventing these nursing medication errors from occurring.

While nurses are not the ordering Provider, it takes a team of nurses, doctors, pharmacists, and patients to decrease these med errors from occurring.

1. Nitro Paste


There’s a reason that Nitropaste only seems to be good for one thing… causing headaches! One of the reasons that Nitropaste doesn’t work well sometimes is due to medication errors in administration!

If you’re anything like I was as a new grad – you may have been taught to squirt put a thin line of nitro-paste to the ½ inch or 1-inch mark (whichever was ordered by the Provider).

This leaves a good amount of paste leftover in the Nitrobid individual packet. What some nurses fail to realize is that this is incorrect dosing!

Each individual packet of nitrobid 2% is usually preloaded (pun intended) with 1 gram or about 1 square inch of ointment. So if the provider orders ½ inch, squirt out half the packet on the application paper, or squirt the whole thing out if 1 inch is ordered.

Now you might be saying “OK, but underdosing of Nitropaste isn’t exactly killing my patient”. But you see – it can! Nitroglycerin is a SUPER important medication when treating acute coronary syndrome (i.e. heart attacks!).

If the patient has a blocked coronary artery, nitro will dilate those arteries, improve blood flow around the obstruction, and can lead to saved cardiac tissue and potentially also saving a patient’s life!

It is also very helpful for decreasing preload and afterload in your CHF patients – so it is important to make sure the patient is receiving the correct dose!

2. Ceftriaxone and Lactated Ringer’s

Intravenous medication drips are very common within the hospital – especially IV fluids, antibiotics, and even critical drips within the ICU.

Oftentimes our patients will have IV fluids running as primary, and they may also have secondary IV pushes or IV antibiotics.

This really isn’t an issue with Normal Saline, as just about every drug is compatible with NSS.

However, sometimes Lactated Ringer’s (LR) or another fluid is ordered instead. Don’t give ceftriaxone (Rocephin) with IV LR, as this can form precipitates that can harm the patient.

This is because there is calcium within the LR, and Ceftriaxone + Calcium = bad! These precipitates can cause damage to your kidneys, lungs, or gallbladder.

This can be missed in the ED where many nurses have to mix their own antibiotics and hang it secondary to whatever fluid is running. If this is LR – this can lead to issues as above.

This is just another example of how ER nurses need to be hypervigilant about preventing medication errors like this from occurring – while simultaneously managing life-threatening emergencies of their patients.

Also check out: Intravenous Fluids: Types of IV Fluids

3. Paralytic Before Sedation

Rapid Sequence Intubation (RSI) is the term used to define the methods taken to intubate a patient who is awake (for now).

Considering we’re about to stick a tube down their trachea and breathe for them – this requires sedation!

To prevent the body from fighting against the intubation, this requires medication to paralyze them – a paralytic.

During RSI, there is a specific sequence that must be followed.

You must ALWAYS GIVE SEDATION BEFORE THE PARALYTIC.

Why you ask? Well.. isn’t it obvious? If you paralyze someone before knocking them out – they are going to be TERRIFIED.

They won’t be able to breathe or move, and will be aware of the whole ordeal… So no – this won’t kill the patient, but this nursing medication error will make the whole process much more traumatic, and the patient can remember the whole thing when they wake up.

Common IV sedatives (Induction agents) include: etomidate, midazolam, ketamine, fentanyl, propofol, thiopental.

Common IV paralytics include: succinylcholine, rocuronium, vecuronium.

4. IV Insulin

It doesn’t take long working as a nurse to realize how COMMON diabetes is in hospitalized patients.

This is because uncontrolled diabetes eats away at basically every body system that you have. Your kidneys fail, your nerves are destroyed, your eyes go bad, and your arteries clog up!

Diabetics often come in for Diabetic Ketoacidosis (DKA), Hyperosmolar Hyperglycemic State (HHS), or a patient may just need IV insulin for hyperkalemia (to push the K+ back into the cells).

Insulin is usually given SubQ, so some nurses may not be used to giving it through the IV. Those SubQ insulin needles don’t hook up to a needleless IV system – so what do you do?

Some facilities have special adapters, but honestly, the EASIEST way to do this is to draw the insulin up in your normal Subcutaneous syringe anyway. This will usually be 5-10 units. VERIFY this dose with other nurses – most facilities will require this.

Then, take a sterile NS flush, squirt half out, pull back on the syringe to make room, and squirt the insulin into the syringe. Essentially you’ve just diluted the insulin with ~5mL of saline.

Don’t set down the syringe – label it per facility protocol and give it to the patient the same way as any other IV push medication.

This may seem simple to some, but many nurses draw up the insulin in a regular 3mL syringe. I’ve seen nursing medication errors occur, and sometimes the patients are given up to 10x the ordered dose.

This obviously leads to hypoglycemia and a need for close monitoring. Worst case – this med error can lead to death, and there have been accidental deaths due to insulin overdoses.

  CLINICAL TIP

As a side note, when verifying ANY high-risk medication, make sure you look at the syringe AND the vial. I once had a nurse ask me to verify their 1mL (5,000u) subQ heparin dose. Turns out she had actually drawn up 1mL of INSULIN LISPRO! That’s 100 units! MUCH higher than most can tolerate. This med error was avoided by being diligent about verifying both the syringe amount and the vial.

5. Sound Alike – Look Alike

You may have heard about this , but a nurse in Tennessee had accidentally killed a patient when she administered VECURONIUM instead of VERSED.

This was apparently ordered to calm the patient down at MRI, so the nurse grabbed it out of the accu-dose, had overridden the medication, and administered the paralytic to the patient at CT.

Now – there are MANY nursing errors in this scenario, so let’s talk about them.

Overriding the Accudose System

This is usually a major no-no on the floors, but in the ED this is common for Pain meds, Zofran, Ativan, etc.

In the ED, they don’t always have the luxury of waiting for the pharmacy to verify medications, and some systems won’t even have the pharmacist verify ED physician orders.

If you absolutely HAVE to override, make sure you are hypervigilant about which medication you are pulling out, reconstituting, etc.

If you are unsure of a medication – ASK for help! You shouldn’t be giving a medication that you don’t know about anyway.

Always know the intended use, appropriate dosing, and potential side effects to monitor for! There are many sound-alike-look-alike drugs, and it can be common to make these nursing med errors if you aren’t careful!

Appropriate Monitoring

Monitoring the patient is an essential aspect of appropriate nursing management. As nurses, you are at the bedside and will be the first ones to notice a change in a patient’s status.

Monitoring is especially important after the administration of ANY IV medication, but especially high-risk meds like IV narcotics or sedatives.

This nurse was going to give IV versed to a patient at MRI. This patient was NOT hooked up to the monitor, the nurse had injected the medication and reportedly left back to the ER.

If you are giving IV versed, you should always have your patient on a monitor – at the least a pulse ox machine. Because she had given VECURONIUM instead of versed, her patient was paralyzed and couldn’t breathe – causing her suffocation in the MRI machine.

Appropriate monitoring of the patient, even after administering the wrong medication, would have saved the patient’s life.

6. IV Haldol

Speaking of monitoring, it is also necessary to have cardiac monitor during and after administration of certain medications.

This is because some medications can cause arrhythmias, and you want to be able to immediately identify them and recognize the need for rapid action.

Haldol can be given IV due to agitation or dementia, and sometimes for nausea. Unfortunately, this medication is high-risk for cardiac arrhythmias by increasing QT, predisposing the patient to PVCs, VTACH, Torsades, and even VFIB.

It also is worth noting that Haldol is technically to be avoided in cases of dementia-related agitation due to an increased risk of sudden death.

While our options are limited and Haldol may still need to be given, appropriate measures including cardiac monitoring should be used, at least when given IV.

Also check out:

7. IV Push Not IV Slam

Giving IV push medications is very common in the hospital: Zofran, IV narcotics, Toradol, and Lasix (among many others).

Nurses can be busy, so this can tempt us to quickly give the medication and immediately move on to the next task.

However, sometimes medications that are given too fast can cause unpleasant side effects for the patient, some even disastrous.

Dilaudid

Dilaudid (hydromorphone) is a common IV narcotic given for pain.

This is the “heavy hitter”, and is approximately 7 times stronger than morphine.

Dilaudid should be given slowly over 2-3 minutes.

Administering Dilaudid more rapidly has been associated with increased side effects, specifically respiratory depression and hypotension.

This is true for other IV narcotics as well like morphine and fentanyl.

As a quick tip, you can dilute the dilaudid in 50-100ml of NS and then administer it slowly over 10-15 minutes.

Reglan

IV Reglan (metoclopramide) can be given IVP in doses ≤ 10mg undiluted over 1-2 minutes.

If pushed too fast, this can cause an intense but short-lived feeling of anxiety and restlessness, followed by a period of drowsiness.

This is very common with Reglan, especially in younger females!

A small dose of Benadryl is often ordered to treat the restlessness, but note this will increase the drowsiness experienced afterward.

Be on the lookout for true dystonic reactions, characterized by involuntary contractions of the muscle of the body.

Cardiac Medicationss

Cardiac medications like Lopressor (metoprolol) and Cardizem (diltiazem) should be pushed slowly in order to prevent adverse events from occurring.

Side effects include bradycardia and/or hypotension.

Lopressor should be pushed over 2-5 minutes and Cardizem over 2 minutes.

Dexamethasone

Doses of IV dexamethasone 4-10mg are often given undiluted over <1 minute.

However, rapid administration is associated with perineal irritation.

Patients will tell you “my crotch is on fire!”.

This can even happen with slow administration, so warn the patient that this is a possible side effect, is short-lived, and will go away on its own.

Its recommended to dilute it in a 50ml bag and run it over 5-15 minutes to minimize this occurrence.

Also Check out: Adverse Drug Reactions Nurses Need to Know

8. Proper IM Location

When I was a nurse I was taught to inject most IM medications >1mL in the butt. However, where I was injecting in the butt wasn’t really specified.

Many nurses just shoot for the middle of the buttock (dorsogluteal), but this can actually cause all sorts of injury to the patient.

While not super common, injecting in the dorsogluteal region can lead to skin and tissue trauma, muscle fibrosis and contracture, hematoma, nerve palsy, paralysis, and infection. 

Instead, these medications should be given in the ventrogluteal site.

IM injections should be given in the ventrogluteal site to avoid complications

The Deltoid muscle is an easy location for all injections 1-2mL in most adults. However, even 1 mL can be very painful in the deltoid depending on the patient.

This is also not a recommended site if giving repeat injections, as the surface area of the muscle is not very high.

An important fact to know about intramuscular injections is that the vastus lateralis (the side of the thigh) actually offers the quickest absorption.

This means that if you have a patient come in for a severe anaphylactic reaction – your best bet is to inject the epinephrine in the thigh as opposed to the arm.

9. Broad Before Narrow

Antibiotics are given ALL the time within the hospital.

Patients may be septic and need immediate treatment including multiple IV antibiotics.

Some antibiotics have a very broad spectrum – eaning they kill all sorts of bacteria. Others have a narrow spectrum, meaning they kill fewer bugs.

You always want to make sure to hang the broad-spectrum antibiotic first. This ensures that the antibiotic most-likely to help will be given first.

One common mistake is nurses think Vancomycin is broad-spectrum because it is a “heavy hitter”, but Vancomycin is actually narrow!

Vancomycin mainly only covers gram-positive organisms!

This means unless the bacteria is actually MRSA or another Gram-positive infection, Vancomycin is less likely to help. PLUS it takes a while to infuse anyway (like 1.5-2 hours).

The best decision in sepsis is to hang the broad-spectrum antibiotic first. Common examples of broad-spectrum antibiotics include:

  • Ceftriaxone (Rocephin)
  • Cefepime
  • Pipericillin-Tazobactam (Zosyn)
  • Imipenem
  • Ampicillin

And there you have it! With great power comes great responsibility. Nurses are responsible for administering life-saving medications, but these medications can also hurt if given inappropriately.

We must be vigilant in avoiding nursing medication errors and improve our patient-outcomes.

Do you know of any other common nursing medicaiton errors? Let us know in the comments below!

5 Questions to Ask Before Calling the Doctor

5 Questions to Ask Before Calling the Doctor

Communication is an essential element in coordinating patient care in every clinical setting. Communication within the hospital is especially important due to the fact that there are often critical patients, and a patient’s status can change at any second. In order to convey this change of status accurately and provide the patient with the best care possible, it is imperative for the nurse and the provider to have great communication.

As a nurse, sometimes it can be difficult to know just what your patient needs. When you don’t know – it can be nerve-wracking trying to decide your next action. Do you call the doctor immediately, do you just ignore it and hope for the best, or do you have to call an RRT?

When you’re unsure – it’s common to call the doctor or provider because that is a frequent solution as they often know what to do. However, not every patient issue needs to be called to the provider. Decreasing these unnecessary calls can increase your efficiency and problem-solving skills, but additionally will allow the providers to be more efficient as well. To help you with the decision-making process – these are 5 questions to ask yourself before you call the doctor.

1. Is the Patient Stable?

Learning to be a great nurse involves learning how to prioritize. Whenever there is a change in patient status or a reason to call the provider, always ask yourself – “Is the patient stable?”. This will oftentimes seem obvious but calling a Rapid Response can be nerve-wracking. What if you call one and everyone thinks you’re dumb because it wasn’t necessary? This is a common worry as a new graduate RN. As you gain experience in nursing – you will be able to more easily be able to identify the need for an RRT when it presents itself. However, in order to assess your patient’s stability – you really must do two things first (in this order!):

Physical Assessment

You must lay eyes on your patient. Let me repeat that – YOU MUST LAY EYES ON YOUR PATIENT. You may not even need to touch the patient and already acknowledge the need for immediate emergent intervention. If they are unresponsive and not breathing and/or don’t have a pulse – you can immediately activate an emergency response (CODE BLUE). However, it won’t always be so black and white – so the next step is to assess their vital signs.

Vital Signs

Obtaining a new set of vital signs is imperative in order to assess the stability of a patient. “Is the patient stable” really just means “are their vital signs stable”. A patient who doesn’t have a pulse has a HR of 0 – so you don’t need to grab the Dynamap and grab a full set of vitals (spoiler – they won’t have any!). But it’s usually less clear. The patient may have increased lethargy, increased SOB (but not in acute respiratory failure), new chest pain, or any other changes of status. Getting these patient’s vital signs will determine whether or not they are stable. A patient who is SOB, in the tripod position, has an SPO2 of 80% on 4L NC, and RR of 48 – this patient needs an RRT or whatever emergency response team activated immediately. A patient with COPD who is moderately SOB, is 88% on 2L NC, and RR of 28 and mildly labored – this patient can likely be handled over the phone with changes in respiratory treatments and oxygen therapy.

If the patient has been deemed stable – you can move onto the next question.

Related content:

2. Is there more information I need to know first?

This will obviously depend on the situation and will require some investigation. If the patient is SOB – what is their history? Do they have any related diseases such as Asthma, COPD, or CHF? If they have back pain – have they had this before? What do they usually take for it? It’s possible the same complaint or situation may have happened earlier in their hospital stay – what was done about it and how did the patient respond?

Investigating trends in their labs or vital signs is also important. If a patient’s blood pressure is 180/90 – what has their BP been running? The same holds true for hypotension. A patient whose BP is 90/40 but who’s baseline is 90s/40s is important to know. If you get a call for an elevated troponin or lactic acid level – what were their previous levels? Note all of this information for when you have to call the provider – so you can anticipate what they will ask and assist them in making the appropriate clinical decision.

The next important step is to check the orders that already exist.

3. Are there any PRN orders?

Many times patient’s will have “PRNs” or medications “as needed” that are already ordered by the provider. This means they have a medication or order which can be used for pre-established reasons that the provider must list. Look at their MAR and see if they have any PRN medications.

Some frequent PRN medications are as follows:

  • Melatonin 3-9mg PRN for sleeping difficulty
  • Acetaminophen 650mg Q4H PRN for Fever > 101.4 F
  • Ondansetron 4mg IV PRN for nausea or vomiting
  • Morphine 2mg IV Q4H PRN for severe pain
  • Hydromorphone 0.5mg IV Q4H PRN for severe pain
  • Ketorolac 15mg IV Q6H PRN for moderate pain
  • Hydralazine 10mg IV Q6H PRN for SBP >160
  • Ipratropium-Albuterol Inhl Q4H PRN for SOB or wheezing

Other Frequent PRN orders include:

  • Oxygen via NC PRN – titrate SPO2 > 94%
  • Heating pad PRN for back pain
  • The patient may shower PRN

No matter the PRN order – it is your job as the nurse to look for which PRNs are available to you, and if you can utilize them accordingly. If your patient above who is mildly SOB and wheezing with a history of COPD – give them one of their Duonebs if it is appropriate. If they just received a treatment and still have not improved – then calling the provider is likely necessary.

Also check out my Nursing Medical Abbreviations graphic!

4. Can I phone a friend?

Sometimes we may not know what to do with our patients, but we may also be unsure if we need to call the doctor for it. Asking a fellow nurse’s opinion on what needs to be done for your patient can improve your problem-solving and clinical judgment. Your nursing colleagues, especially those with more experience or even just more skill in a particular area – may be the perfect person to ask of their nursing opinion. Do they feel like its necessary to call the doctor – or is there a nursing intervention that can be tried first instead? Are you unsure of what EKG rhythm you are reading and think you might see a run of VTACH but aren’t sure – ask a nurse who is good at rhythm interpretation.

Now I am NOT saying that asking a fellow nurse is a replacement for calling the provider. However, sometimes bouncing ideas off of our colleagues can save us from having to make an unnecessary call. Even calling the nursing supervisor may be a resource which you can utilize if appropriate. However – for a new significant change in patient status or vital signs – the provider will need to be called regardless.

5. Am I calling the right person?

OK – so you know that you’ve exhausted your other options, you have the background information you need… now you just need to actually call the provider. But make sure you are calling the right provider. First – check to see who the attending physician is on record. Is there an in-house medical team such as a hospitalist group, house coverage, or medical resident team that covers that attending? If not – you may need to reach out directly to the attending physician’s service to speak with whoever is on call. This will be facility-specific, so you may not always know if you are new. This is where asking your colleagues for assistance can benefit you.

Reaching out to the medical team (listed above) is common and usually, they can help! However, sometimes they are not the right person to be notified in certain instances. Are there any specialists on board? If Infectious Disease is seeing a patient and there is a positive blood culture – it would be better to put a call out to them instead. If a patient who is on dialysis has uncontrolled high BP, placing a call to nephrology would be a better choice as well. You can reach out to the general medical team – but don’t be surprised if they ask you to place another call to the specialists instead.

Now you are fully prepared to make the phone call and accurately communicate what is going on with your patient, you will have investigated the background information, you will have obtained vital signs and done a quick assessment, and you will have recommendations for medications or orders at the ready (thanks to the other nurses you’ve asked!). As you can see – this perfectly sets you up to provide a great phone report to the provider! To learn more about giving a great phone report to a provider and steps to calling the doctor – you can read all about it here!

Calling the doctor doesn’t have to be scary. If you critically think your way through these important steps, and utilize my IMSBAR communication style – you WILL succeed and you will be amazed at how far a little preparation can go.

You may also want to read:

Calling the Doctor – Giving Nurse to Provider report

Calling the Doctor – Giving Nurse to Provider report

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When I first started working as a bedside RN, one of the aspects of the job that gave me a deep sense of anxiety was having to call the doctor on a patient. Sure – some of them were super nice – but many of them were impatient and rude. Not giving the correct phone report in a format that the physician or Advanced Practice Provider (APP) is looking for can create tension and miscommunication. If you utilize my technique for giving phone report to the physician – the patient’s situation will be more effectively communicated and the encounter will go much smoother.

In this article, I am going to share with you all an effective method for giving a quick report to the physician or APP when you call them in the inpatient setting! I am uniquely positioned to help with this because I work as a Nurse Practitioner in the hospital and receive 20-30 calls per night from floor nurses. I have noticed many improvements that can be made to improve communication – so keep reading!

Step 1: Introduce yourself and the patient

“Hi, My name is Michelle and I’m calling from 1G. I’m the nurse taking care of Anita Lopez in 230-2. Are you familiar with her?”

First you need to introduce who you are, where you’re calling from, and who you’re calling about. I can’t tell you how many times the nurse has called me and launched into a full explanation about the patient and then I have to ask “Who is the patient!?” Oftentimes the inpatient Provider is at the computer and can look up the patient’s chart while the nurse is talking.

Sometimes over the phone it is difficult to understand last names – especially if accents are involved. When you say the patient’s name, it helps if you say “Anita Lopez, that’s L-O-P-E-Z”. Spell out the last name because oftentimes we have censuses pulled up from each floor or hospital which are ordered alphabetically. We usually do not need the spelling of the first name.

It also can be helpfult to include where they are located – their unit and room number. Additionally – the Provider you are calling may only cover certain attending physicians (as is the case at my job). If this is so – give the attending physician as well.

The next step is to ask if they are familiar with the patient. If I just admitted the patient – I don’t need a full explanation of why they’re here and what their medical history is. However, many specialists or Providers who are on call may not be very familiar with the patient yet. It always helps to ask and most Providers won’t give you an issue by asking.

Step 2: Brief Medical History

“She’s a 78 year old female who came in on 11/28 for a COPD exacerbation. She has a PMHx of COPD, Smoking, Hypertension, Hyperlipidemia, and afib which she’s on Coumadin for”

In the inpatient setting – I always want to know why the patient was admitted. This gives some context to the patient’s situation. If a patient who came in for COPD exacerbation is complaining of a headache – that typically deems less investigation than a patient who came in for a TIA or a mechanical fall and is now having a headache.

Additionally, a brief overview of their medical history should be given with emphasis on important/related diseases. Hit the following:

  • Cardiac: HTN, CAD (any stents or CABG?), Afib (anticoagulants?), CHF
  • Pulmonary: COPD, asthma, Lung cancer
  • Renal: AKI, CKD, ESRD (on dialysis?)
  • Vascular: DVT/PE, PAD/PVD

You usually don’t need to go into any details regarding surgical history unless it is directly relevant to this admission in some way.

Step 3: Why You’re Calling (SITUATION)

“The patient is complaining of increased SOB”

This is pretty simple. Why are you calling the Provider in the first place? Usually this is due to :

  • A new complaint: Chest pain, SOB, Headache
  • A medication need: sleeping medication, breathing tx, pain medicine
  • A change in the patient’s status: Respiratory distress, Unresponsive, confusion
  • A critical lab value : elevated troponin, elevated lactic, positive blood cultures

No matter why you’re calling – simply state it and then jump into the following step – the background of the situation.

Step 4: Situation Background

“They are ordered duonebs q6h but has nothing ordered PRN”

By this point you already given the important information such as who you are, who the patient is, where they are, why they were admitted, and why you’re calling. Now you can get to the heart of the call and give context to the situation at hand.

In this instance, the patient is SOB and has COPD. Are they ordered breathing treatments and how often? No matter why you’re calling, it helps to ask these questions:

  • Has this happened before and what was done? Did it help?
  • Are they currently on any medication for the situation?
  • What trends have been occurring (i.e. if you’re calling for high BP, how have their BPs been?)

Investigating the background of the situation can really help communicate the correct need to the Provider.

Step 5: Assessment

“The patient’s RR is 24 rpm and SPO2 is 90% on 2L NC. They’re breathing is non-labored, lung sounds show expiratory wheezes throughout”

As the nurse, you are responsible for assessing the patient first when there is a change in their status. This doesn’t mean you need to do an entire nursing assessment and report that, but get their vital signs and a do a quick physical assessment of the systems involved (I.e. If you’re calling for SOB – tell me how they are breathing and what their lungs sound like).

Please make sure you get an UPDATED set of vital signs whenever there is a change in patient status. Their vital signs from the 3-4 hours ago are not helpful to the current situation (depending on why you’re calling). That’s just good practice.

Step 6: Recommendations

“Can you please add albuterol PRN for inbetween scheduled duonebs”

Nurses are the eyes, ears, and hands of health care. They are on the front lines, are well-educated, and usually have great recommendations to help their patient. Maybe you know just what the patient needs to feel better.

Another important recommendation is asking if the Provider can evaluate the patient in-person. Sometimes it is difficult to convey your uneasiness about how a patient looks – even if their “numbers” look fine. Asking the Provider to personally evaluate the patient (if needed and indicated) is a great way to ensure the patient is in good hands.

Related Content: Tips for New Nurse Practitioners

– – – – – –

So Yes, it is SBAR, but with some important introductory steps beforehand. But what if you’re a Provider and need to know how to call consults to other Providers? I’m going to let you in on a secret – these steps are exactly what I do when I call a Provider for a consult as an NP. There really is no difference between a good nurse-to-provider report or a provider-to-provider SBAR.

As long as all the relevant information is conveyed in a concise and organized manner, you will be sure to impress the Providers you are calling, and ensure that proper communication is maintained – giving your patient the best possible care.

Tips for New Nurse Practitioners

Tips for New Nurse Practitioners

This post may contain affiliate links, which means I get a commission if you decide to purchase through my links, at no cost to you. Please read affiliate disclosure for more information

While I’m no expert NP, I do know what its like to be a new one! After all – that was just a little over a year ago! Being so fresh in my mind – I have some valuable tips to share with new NPs or NPs to be. No matter what setting you start in, utilize the resources you have available to you, work your butt off, and constantly be open to learning – and you will succeed! But to help you on your journey – here are 6 of my best tips for clinical practice!

1. Use UpToDate Religiously

If you haven’t heard of UpToDate – I don’t know how you made it through NP school! This medical reference database is the GOLD STANDARD of medical information for Providers. While I’m working, I often use this to quickly reference drug dosing information and renal dosing considerations. On the spot, the algorithms are SUPER useful. You can just scroll down to the bottom, check out the algorithm section, and viola – suddenly you know just what to do for your patient with hyponatremia of unknown etiology. No but really – there is SO much useful information. If you have a bit more time on your hands – you can read through articles more in-depth related to literally whatever medical topic that is relevant to your clinical practice. Keep a list throughout the day of symptoms and diagnosis that you don’t feel 100% comfortable with, and make a habit of reading up on those topics on UpToDate at the end of the day.

Unfortunately, UpToDate is expensive, but most hospitals provide free access for it’s providers. If you create an account, you just have to login once every 3 months on the hospital’s network to maintain access – and you can download the easy-to-use app for your smartphone.

There are other reference apps out there – but UpToDate is by far my favorite and the gold standard. Check out my top 5 medical reference apps for more information!

2. Templates, Templates, Templates

When you’re a new NP – you are going to be overwhelmed – especially in a new hospital or office environment. You are going to forget to ask basic questions to the patients, and you are going to feel dumb plenty of times. You likely won’t have the most confidence when conducting you’re history and physical. That’s why templates are SUPER important in being your back-up. Find templates such as History/Physical or SOAP note templates, and use them with every patient. This will ensure that you don’t forget to ask about surgical history, family history, smoking status, even something as easy as allergies. If you can’t find a template that works for you – make one yourself! Get a system down, write down information in the same place when you’re doing your chart reviews, and this will help you know where to always find the information you need on your patient – especially in high-stress situations.

Since working as an inpatient hospitalist NP, I’ve been using the same H&P template since I started. I’ve made some small tweaks along the way, but this ensures I don’t forget to ask about anything important, and I always know where to look for the information on my patient. (You can get access to my templates here)

3. Master Verbal Report

As an NP – you will be communicating with physicians and other colleagues much more frequently, and mastering verbal report is essential. Sure – you might have been a nurse for years and know how to give a good NURSING report, but NP-to-Physician report is much different. Physicians are trained specifically to give and get report in a certain way, and unfortunately they can get a bit… testy if we take too long to get to the point or leave out crucial information. The idea it to be concise, but also include the relevant clinical information.

In general – start with their Age, Sex, relevant PMHx, Admission diagnosis, relevant findings, physical assessment, and any recommendations.

Since I work in the hospital, an example of this would be the following:

“86yo Female with a PMHx of HTN, HLD, T2DM, and COPD presenting with cellulitis of right lower extremity calcaneal wound. Initial XR does not indicate Osteomyelitis, MRI is pending, WBC  13, Lactic normal, Blood cultures pending. Patient was started on Zosyn and and vancomycin in the ED.”

After you present the initial basic information, you can specify exactly why you are calling and tailor it to their specific specialty – so obviously if you are calling a nephrologist you would focus on their renal function, blood pressure, electrolytes – etc.

I’m planning on doing a more detailed blog about presenting a patient to another provider whether or as NP or as an RN, so be on the lookout next week!

4. When in Doubt – Cheat!

When I began as a new NP in the hospital setting, I brainstormed the top 20 common diagnosis in my specific specialty. I sat down and made cheat sheets for each diagnosis including information on the etiology, pathophysiology, clinical manifestations, diagnostic findings, and clinical management. You can use textbooks and online resources to find uptodate information – as I said before I recommend UpToDate!

Making these cheat sheets can really help you narrow down specific need-to-know information for your exact clinical role. Making them yourself can help you retain the information. However, if you can’t find the time, the following books have some pretty solid cheat sheets:

These cheat sheets are going to help you look up relevant need-to-know information on the spot while you are at work. Personally, my sheets that I made on Acute kidney injury and hyponatremia have been especially handy in the inpatient setting.

5. Follow the Paper Trail

Whether you work inpatient or outpatient, there will be specialist consultation notes for you to read. You can learn a TON from these notes. These guys are literally specialists, and if you’re a generalist –  you’re kind of the jack of all trades and the master of none. Simply following the paper trail and reading up on your patient’s after you have seen them can help expand your knowledge tremendously.

But don’t only read specialist notes. Working inpatient, theres often medical students and medical resident notes which are very detailed and provide rationale – which Attending physician’s notes often do not have. Don’t write them off simply because they are not attendings. They learn so much in school that unfortunately, we as NPs do not. Reading these notes can be invaluable!

6. Have the Right Attitude

As a new NP, you are the new kid on the block. You need to be humble, ready to learn, confident in yourself but willingly admit when you don’t know. Trust your insticts, but check your ego at the door. We are dealing with patient’s lives here and nothing is more important than hard work, communication, and collaboration with our patients and our knowledgeable colleagues.

There are so many more tips to help new NPs, but I wanted to keep this list short and practical – things that will help you succeed in the clinical setting.

Something that I know will help you guys out as new NPs is signing up for my email list and getting access to my free NP resource library! You’ll be sent a folder with my templates for History and physicals (both inpatient and outpatient), Soap notes, and pronouncement notes. I plan on adding more useful information as time passes, so be sure to check back often!

10 IV Insertion Tips for Nurses

10 IV Insertion Tips for Nurses

IV Insertion is a skill that most nurses will need to become familiar with.

Nurses in the hospital use IVs every day to infuse fluids and medications, as well as to draw blood. While IVs are very useful, sometimes IV insertion can be difficult, – especially for the new or inexperienced nurse.

With time and experience, your IV skills will improve. In the meantime, use these 10 IV insertion tips to help you start an IV and sink those IVs like a pro.

1. IV Insertion: Location Location Location

AC

IV insertion - vein anatomyThe best location of your IV insertion really depends on which setting you are in, as well as the specific patient’s chief complaint.

It is common for inpatient nurses to be upset with AC lines, but the fact of the matter is an AC line is likely an ER nurse’s best friend.

If a patient presents with anything that can even possibly get a CTA – You’re better off choosing the AC. The LAST thing anybody wants to do is have to unnecessarily poke someone again.

So – if the patient has a neurological complaint (stroke s/s), cardiac complaint, or pulmonary complaint – a CTA may possibly be ordered and most hospital facilities/radiology staff won’t inject the high-pressured dye unless there is at least an 18g or 20g in a large vein (aka AC and above).

Additionally, patients who are hemodynamically unstable should receive a 16g – 18g in an AC for large fluid resuscitation.

If the patient is getting continuous infusions and the patient occlusion alarm keeps going off, ask the patient if you can place another IV preferably in the forearm or hand.

Forearm

Forearms are the perfect location for continuous fluids because they don’t kink with arm bending.

However, not everyone has great forearm options.

Additionally, forearm veins do not always reliably give great blood return for bloodwork, although this may mainly be a consideration in the ED where they typically draw blood work during IV insertions.

Hand

Hand IVs are sometimes the easiest veins to see. However, they are usually relatively small veins, and placing an 18g here may be somewhat difficult.

They are great for short periods of time, but can easily become irritated.

Additionally, they limit the use of the hand and are more likely to start hurting the patient – especially with vasocaustic infusions such as vancomycin or potassium.

2. Small veins? Make them Larger

Heat

Heat is great because it causes vasodilation. When veins dilate, they become bigger.

Applying a warm compress or hot pack can help you visualize the vein, palpate the vein, and can even make threading the IV easier when starting an IV.

Just ensure the compress is not too hot to cause thermal burns.

Gravity

Putting the arm in a dependent position forces blood pooling in the distal veins, which will make them bigger and easier to see and palpate.

This should make IV insertion easier with a higher chance of success.

Also Read: “10 ER Nursing Hacks you Need to Know”

Nitroglycerin Ointment 2%

A small amount of 2% Nitroglycerin can be topically applied to a small area in order to dilate the peripheral veins.

In a small study, those with 2% Nitro ointment applied to the dorsum of their hands required fewer needle sticks than the controlled group.

Please note that this is a medication, so you need an order!

3. IV Insertion with Fragile Veins

Change your Selection

Sometimes, elderly patients tend to have crappy veins.

Sure, you can see them alright, but once you stick them – they blow immediately (even with a 22g).

This is definitely a good time to look for larger more proximal veins, as IV insertion in these veins tends to be more stable and not blow immediately.

Forget the Tourniquet

If you can visualize or palpate the vein without a tourniquet – try the IV insertion without the tourniquet.

Tourniquets are great for engorging the vein and causing it to dilate, but they also add pressure to the vein.

Already fragile veins will have an increased tendency to blow with the added pressure from the tourniquet. Never forget to remove the tourniquet before flushing the IV!

4. Don’t Give Up during IV Insertion

OK – some people HATE digging when starting an IV – and this is understandable. However, sometimes it is minimally painful and you can thread the catheter within a few seconds of “digging”.

The trick is to not “dig” blindly – but instead use your fingers to palpate the accurate direction of the vein.

After inserting the needle with the catheter, if you do not get a flash of blood, pull the needle and catheter back out to almost out of the skin, re-palpate the vein, and aim again in the direction of the vein.

I can’t even count how many times I missed on the first pass, but immediately threaded the IV on the 2nd or 3rd advancement.

The patient also experiences some desensitization of their pain receptors and it is usually less painful than being poked again.

However, some patients really do NOT tolerate this, and they will let you know not to “dig”.

Quick Note: It is not recommended to retract only the needle while leaving the catheter in place, and then re-advancing the needle. This leads to a risk of fracturing the catheter and can possibly lead to a foreign body in the patient’s body!

Related content: “How to Start an IV”

    5. Go Big or Go Home

    Smaller is not always easier. Sometimes 22g and below are too flimsy.

    When the veins are sclerosed, hardened, or there is scar tissue – choosing a 20G might be a better bet in order to thread the catheter without any issues.

    Besides – 20g IVs are better in an emergency and are more durable.

    Related content: “5 Vital Signs Error to Avoid”

    6. Arterial Stick

    When inserting an IV, you can accidentally hit an artery instead of a vein.

    First, if the IV is pulsating – take it out immediately. It’s possible the vein is just right next to the artery, but it is likely you are actually in the artery.

    This is usually accompanied by blood filling up the catheter VERY quickly – depending on the patient’s mean arterial pressure.

    Arterial blood tends to be a bright red, versus the darker red of venous blood.

    So what’s the harm? Access is access, right?

    Well, sure that makes sense on the surface. But peripheral IVs inserted in arterial lines tend to have much higher complications – the worst of which being thrombophlebitis.

    You can literally cause a blood clot in the patient’s arm. This is even more of a risk if medications are infused through it.

    Remove the catheter and try again in an actual vein.

    7. Inserting the IV Outside the Box

    Or rather – think outside the lower arm.

    If you can, look at the upper arm as sometimes there are large veins close to the surface.

    Most facilities prefer you to stick an IV in an arm, but there are exceptions. If the patient is an extremely hard stick and needs access, you can look at lower extremities, but caution against it as these are high risk for infection.

    No – don’t go for these strange areas initially, but in an emergency, any access is better than none.

    However, in a code situation – temporary placement of an Intraosseous (IO) catheter is preferred.

    If a better IV site still cannot be obtained, someone skilled with ultrasound-guided IV placement should try, or a PICC/Central line should be considered.

    8. Angle Danger

    I have watched MANY nurses and nursing students miss when inserting an IV purely because of their technique.

    They hold the skin taut, stabilize the vein, and insert – but they go right through the vein and can’t thread the catheter.

    I have seen that this is often from approaching the vein with too much of an angle.

    You should really aim to be near parallel with the skin (10-30 degrees). Gliding the needle into the vein with this angle means once you get a flash, the needle is likely still within the vein and the catheter can be advanced.

    The exception is if you are aiming for a deeper vein – you may need to increase the angle accordingly.

    If you find that you insert the needle and cannot float the catheter in, despite having a “good” flash of blood – try pulling the needle and catheter out just a millimeter or two, and try advancing just the plastic catheter again.

    Related content: “How to Start an IV”

    9. Rollie Pollie Ollie

    Sometimes patient’s veins just like to roll – and the patient will likely forewarn you about this. There are a few things you can do to minimize this.

    First, pick a larger more proximal vein. These veins tend to be more stable.

    Second, make sure you stabilize the vein by holding the skin taut with your non-dominant hand.

    Lastly, make sure the patient does not tense up their muscles during the insertion. Tensing of muscles will cause movement of the veins. To minimize muscular contractions – use the tip below!

    10. Patient Comfort

    This IV insertion tip is really more for patient comfort than anything else. After you clean the IV site, place the needle flush with the skin right where you are going to poke.

    Press the needle with the bevel up into the cleansed skin for 3-5 seconds before you poke. The longer you wait – the more desensitized their skin receptors will become – this theoretically should decrease pain.

    With less perceived pain, the patient is less likely to tense up and should lead to a smoother successful IV placement. When I was an ER nurse, I used this technique every time and seemed to have good results.

    Well, there you have it – 10 IV insertion tips to improve your IV game! If you have any additional tips that I didn’t mention – leave a comment below letting everyone know!

    You might want to also read:

    Want to learn more?

    Hopefully this gave you a good grasp on the basics of how to start an IV.

    But if you want to learn more and become an IV King or Queen, I HIGHLY recommend The IV Video Course by @TheIVGuy.

    The IV Video course is EXACTLy what you need to take your IV skills to the next level

    This course includes:

    • 57 Video modules from the IV basics to more advanced techniques, tips, and tricks
    • In-depth notes with each video module
    • Specific video lectures on how to successfully place IVs in challenging patients including geriatric, bariatric, combative, obese, and IV drug users
    • 21 video demos of basically every type of IV insertion possible
    • 2 hours of CEUs by an accredited ANCC provider

    I also include some great free bonuses with the course, including:

    • IV Complications: Prevention, Detection, and Management 8-page pdf
    • IV PUSH GUIDE 15-page pdf
    • Nursing Procedure Manual: Chest Tube Insertion 13-page pdf

    Check out more about the course here.

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