Thursday, May 24, 2007

IV Therapy Escapades - Part IV

Dead is dead. I've read that on a couple of other blogs, and it's really true. If your heart stops and there's nobody around who knows how to resuscitate you -- and perhaps not even anyone around to call 911 for a while, your odds of ever having a heartbeat again are really low.

This doesn't stop the EMS folks from trying when they get on the scene - and it certainly doesn't stop the ER folks from trying some more when you get to the hospital. It just means they probably won't be successful. You might even be happier if they aren't.

I was a new IV therapy nurse. I knew I was supposed to show up for all stat pages and for all resuscitations. My job was to make sure the patient had some kind of IV access.

One evening, my pager went off for a resus in the ER. I hurried down to find the patient on the gurney, CPR in progress and an ER nurse on each side attempting to start an IV in the patient's arms. The EMS crew had been unsuccessful in the field and the ER nurses hadn't had any better luck by the time I arrived. (Note -- this was quite some time ago -- the patient would arrive with an intra-osseous needle in place these days)

Since the patient was very clean, down to the polished shoes and fresh socks, I asked the ER doc how he felt about accessing the saphenous vein (the large vein just above the ankle bone on the inside of the leg). There are a lot of good reasons not to start IVs in foot or leg veins in adults - but they don't apply when the patient doesn't have a heartbeat and you can't get any other access.

"Any place you can get me a line," was his response.

I quickly stripped off a shoe and sock, cleaned the site, and placed the catheter. Someone handed me a primed IV tubing. I connected it, gathered my supplies and headed toward the door to handle the rest of my pages.

As I was leaving, the ER doc said, "Thanks. Now we can push the drugs and call this code."

I didn't stick around to see if the medications had any effect. The team didn't expect that they would and I didn't want to know.

I don't know how long the patient had been without a pulse. I don't know how long he'd been without a pulse before the EMS people arrived on the scene. I know that there had been a great deal of effort - it was evident from the supplies, equipment, and personnel in the room. They knew the chances were very low, but didn't want to give up without doing every last thing possible

When I got back to the IV therapy office later that day, I told the nurse manager about my experience. That was when I learned that I wasn't expected to answer resus pages to the ER. Then she said, "I'm glad you got the line. The ER may appreciate us more."

Fourth in an occasional series - from my days as an IV therapy nurse several years ago.

Part 1
Part 2
Part 3

No comments: